Background:
Smoking is a leading cause of preventable death internationally, but it impacts some population groups more than others. While the highest smoking rates in California are for Korean, Vietnamese, and African American males, current estimates of the resulting smoking-attributable healthcare costs are not available.

Methods:
We developed econometric models of smoking-attributable healthcare costs using US national data and then applied the models to California-specific data from the California Health Interview Survey. Healthcare costs were estimated for hospitalizations, ambulatory care, prescriptions, and home health care, and for Whites, Blacks, Asians (Chinese, Korean, Vietnamese, Filipino, and Other Asians), Hispanics, and Other/MultiRacial. Costs were estimated using an excess cost approach that compares smokers with nonsmokers who have all the same characteristics as smokers except they don't smoke. The difference in costs between these groups is attributed to smoking.

Results:
Annual healthcare expenditures attributable to smoking in California totaled $10.7 billion for 2014, including $5.7 million for men and $5.0 million for women. Costs were greatest for Whites ($6.5 million) followed by Hispanics ($2.1 million) and Blacks ($1.0 million). Among Asians, the highest healthcare costs were for Filipinos ($191,000) and Chinese ($157,000). Healthcare costs were $276 per resident but were highest for Blacks ($443 per resident) and Whites ($438 per resident). Hospital care accounted for 53% of this total, followed by ambulatory care services (25%), prescription drugs (14%), and home health care (7%).

Conclusions:
Healthcare costs attributable to smoking differ substantially by racial/ethnic group, reflecting differences in population size, smoking prevalence, and smoking patterns (e.g. daily vs. nondaily smoking and menthol use). Tobacco control efforts to reduce the economic burden of smoking need to take into account these differences in developing effective programs targeted to specific groups.