The association between smoking cessation and medical expenditure in china: a stratified analysis by gender and socioeconomic status

Smoking cessation is widely recommended to reduce long-term morbidity; however, healthcare expenditure may temporarily increase around the time of cessation. This may partly reflect health-related quitting, whereby deteriorating health prompts cessation while also increasing healthcare use. Whether this short-term economic burden differs across intersections of socioeconomic status and gender remains underexplored. This study aimed to examine the association between smoking cessation and medical expenditure in China, with further stratified analyses by gender and socioeconomic status. Utilizing longitudinal data from the China Family Panel Studies (CFPS) from 2018 to 2022, we analyzed 48,086 adult observations aged 18 to 60 years, including 470 individuals who transitioned from current to former smoker status. An event-study design using a heterogeneity robust difference-in-differences estimator assessed expenditure trajectories around cessation. Poisson pseudo-maximum likelihood and two-part models were used to examine subgroup-specific patterns, accounting for skewness and zero expenditures. The event study showed a statistically significant increase in medical expenditure with the cessation wave, which tended to decline in the post-cessation period. Stratified marginal estimates suggested differing patterns across gender and socioeconomic status. Males in the high socioeconomic stratum exhibited a 95.0% increase in medical expenditure following smoking cessation ( p < 0.01). Males in the low socioeconomic group exhibited a smaller estimated increase of 36.8% ( p < 0.05). Estimated expenditure changes for females were not statistically distinguishable from zero in either socioeconomic stratu m . Sensitivity analyses using a balanced panel and an ever-smoker subsample yielded similar patterns. Smoking cessation was associated with a short-term increase in medical expenditure around the quitting period. Subgroup-specific estimates suggested that the magnitude may vary by gender and socioeconomic status. The attenuated expenditure response among economically vulnerable groups may be consistent with the possibility of financial constraints and unmet healthcare needs. These findings highlight the importance of considering potential financial barriers and healthcare access disparities when designing smoking cessation and health protection policies.