Financial Costs of Tobacco-Attributable Temporary Sick Leave in Social Security Systems: The Case of Mexico, 2010-2022.

AIMS: To estimate the current costs of non-occupational temporary sick leave attributable to tobacco (SLAT) from the perspective of the Instituto Mexicano del Seguro Social (IMSS), a public social security institution and Latin America's largest insurer.

METHODS

Data were drawn from anonymized IMSS sick leave records (2010-2022) for workers in the formal sector. Selected tobacco-related non-communicable diseases (NCDs) included chronic obstructive pulmonary disease (COPD), lung cancer, acute myocardial infarction, cerebrovascular disease, diabetes, and mental illnesses. Smoking-attributable fractions were applied to estimate SLAT cases. To address uncertainty, 1,000 random samples without replacement were used. Financial costs were derived from IMSS subsidy records and converted to 2023 Mexican pesos (Mx2023$). Broader social costs were estimated using full salary amounts, as IMSS covers only 60% of wages from the fourth day of leave. Reporting follows STROBE recommendations.

RESULTS

On average, sick leave totaled 32,547 events per year, 29.5% of which were tobacco-attributable. COPD-related absences increased during the COVID-19 pandemic, while absences due to diabetes and cerebrovascular cases decreased. The median leave duration ranged 3-97 d, with AMI-related durations nearly halving over time. One in every three pesos spent by IMSS on sick leave payments for major NCDs is tobacco-attributable. In 2022, this amounted to Mx$118.1 million (Mx$113.1 direct and Mx$5.0 secondhand smoke). Including total wage losses, the costs reached Mx$205.7 million.

CONCLUSIONS

Tobacco significantly contributes to NCD-related sick leave costs, highlighting the need for workplace prevention and cessation strategies to reduce the health and financial burden. Sick leave data may constitute a valuable tool for epidemiological surveillance.