Disparities in Healthcare Utilization by Smoking Status in the U.S 1999-2004

Objective:

To analyze disparities in healthcare utilization by smoking status among adults in the U.S.

Methods:

We used 1999-2004 National Health and Nutrition Examination Survey data from 15,332 adults. Self reported inpatient utilization was measured by the number of days hospitalized and outpatient utilization by number of visits to a medical facility in the past year. Multivariate logistic regressions were conducted for the relationship between smoking status (current, former and never smoker) and healthcare utilization controlling for age, gender, education, poverty level, country of birth and health insurance coverage.

Results:

After controlling for demographic characteristics current smokers (OR=1.18) and former smokers who had quit for less than two years (OR=2.46) were more likely to have had inpatient admission in the past year than never smokers. They were also more likely to have four or more outpatient visits (OR=1.16 for current smokers, OR=1.63 for former < 2years). Those who quit either less than two years (OR=1.73) or ten years or more (OR=1.73) were more likely to have had an outpatient visit than never smokers. Regardless of length of time one quit, having smoked resulted in more frequent outpatient visits compared to those who had never smoked.

Conclusions:

Our data shows that tobacco use translates into higher healthcare utilization for current and former smokers even after controlling for demographic characteristics and health insurance status. Frequent hospitalization and outpatient visits translate to high medical costs and therefore more efforts are needed to promote programs that discourage initiation and encourage cessation.