Disparities in health care utilization by smoking status--NHANES 1999-2004

Int J Environ Res Public Health. 2009 Mar;6(3):1095-106. doi: 10.3390/ijerph6031095. Epub 2009 Mar 13.


The objective of this study was to assess disparities in health care utilization, by smoking status, among adults in the United States. We used 1999-2004 National Health and Nutrition Examination Survey (NHANES) data from 15,332 adults. Multivariate logistic regressions were used to examine the relationship between smoking status (current, former, and never smoker), with health care utilization. After controlling for demographic characteristics, current smokers and former smokers who quit either <2 years or > or =10 years prior to the survey were more likely to have had inpatient admission in the past year than never smokers. Current smokers did not differ from never smokers on whether they had an outpatient visit in the past year. They were, however, more likely than never smokers to have > or =4 outpatient visits. Smokers who quit either <2 years ago or > or =10 years ago were more likely to have had an outpatient visit than never smokers. Former smokers were more likely than never smokers to have > or =4 outpatient visits regardless of when they quit. Our results show that cigarette smoking is associated with higher health care utilization for current and former smokers than for never smokers. Frequent hospitalization and outpatient visits translate into higher medical costs. Therefore, more efforts are needed to promote interventions that discourage smoking initiation and encourage cessation.

Keywords: Smoking; cessation; health care; tobacco use; utilization.

MeSH terms

  • Adult
  • Aged
  • Female
  • Health Services / statistics & numerical data*
  • Healthcare Disparities*
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Nutrition Surveys
  • Smoking*
  • United States
  • Young Adult