Cigarette smoking, health status, socio-economic status and access to health care in diabetes mellitus: a cross-sectional survey

BMC Health Serv Res. 2003 Feb 11;3(1):4. doi: 10.1186/1472-6963-3-4. Epub 2003 Feb 11.


Background: In diabetes mellitus, cigarette smoking is associated with increased risk of cardiovascular mortality and microvascular complications. We evaluated cigarette smoking in people with diabetes mellitus in a socio-economically deprived area.

Methods: We carried out a cross-sectional survey of people registered with diabetes mellitus at 29 general practices in inner London. Responses were analysed for 1,899 (64%) respondents out of 2,983 eligible.

Results: There were 1,899 respondents of whom 968 (51%) had never smoked, 296 (16%) were current smokers and 582 (31%) were ex-smokers. Smoking was more frequent in white Europeans (men 22%, women 20%), than in African Caribbeans (men 15%, women 10%) or Africans (men 8%, women 2%). Smoking prevalence decreased with age. Smokers were more likely to be living in rented accommodation (odds ratio, OR 2.02, 95% confidence interval 1.48 to 2.74). After adjusting for confounding, current smokers had lower SF-36 scores than subjects who had never smoked (mean difference in physical functioning score -5.6, 95% confidence interval -10.0 to -1.2; general health -6.1, -9.7 to -2.5). Current smokers were less likely to have attended a hospital diabetic clinic in the last year (OR 0.59, 0.44 to 0.79), and their hypertension was less likely to be treated (OR 0.47, 0.30 to 0.74).

Conclusions: Compared with non-smokers, smokers had lower socio-economic status and worse health status, but were less likely to be referred to hospital or treated for their hypertension. People with diabetes who smoke can be regarded as a vulnerable group who need more intensive support and treatment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cross-Sectional Studies
  • Diabetes Complications*
  • Diabetes Mellitus / ethnology
  • Family Practice / statistics & numerical data
  • Female
  • Health Status*
  • Health Surveys
  • Humans
  • London / epidemiology
  • Male
  • Middle Aged
  • Minority Groups*
  • Poverty Areas*
  • Prevalence
  • Risk Factors
  • Smoking / adverse effects
  • Smoking / ethnology*
  • Smoking Prevention
  • Social Class*
  • Socioeconomic Factors
  • Surveys and Questionnaires