More smokers receive smoking cessation service in low disposable income regions in Taiwan

Background: Cigarettes smoking is the leading cause to poverty and health inequality. To establish cessation service is urgent and must be prioritized. However, some arguments concern the inappropriate distribution of service may worsen the existing disparity of health. Taiwan has implemented nation-wide project – Taiwan Cessation Service (TCS) since Sep 2002. This research intends to understand whether the coverage of TCS is impartial without jeopardizing health equality. Methods: A total of 305,654 participants were retrieved from the TCS registration dataset between 2007 and 2009. The service coverage rates were calculated for each of 17 regions in Taiwan. The quartile levels of disposable income and physician capacity were produced for each region. GEE model was employed to compare the coverage rates of different income regions, adjusted by the levels of physician capacity, in 3 successive years. Results: TCS coverage rates of 17 regions ranged from 1.48% to 6.03%, 1.30% to 3.41%, 1.12% to 4.29% for 2007, 2008 and 2009 respectively. After adjustment of physician capacity, the increase of coverage rate was statistically significant (OR=1.51, 1.18-1.93, p=0.0009*) in the lowest income regions (fourth quartile) as compared to the highest income regions (first quartile). For the regions in the third and second quartiles, the OR (vs. first quartile regions) were 1.22 (0.98-1.52, p=0.08) and 1.30 (1.04-1.62, p=0.02*). Conclusion: After adjustment for physician capacity, our analysis clearly demonstrated that more smokers utilized TCS in the lower disposable income regions. Thus, the distribution of TCS seemed to curtail the health inequality.