Are smoking and alcohol misuse associated with subsequent hospitalizations for ambulatory care sensitive conditions?

J Behav Health Serv Res. 2011 Jan;38(1):3-15. doi: 10.1007/s11414-010-9215-x.


Hospitalizations for ambulatory care sensitive conditions (ACSCs) are used to assess quality of care, but studies rarely adjust for health behaviors. This study evaluated whether results of smoking or alcohol screening were associated with hospitalizations for ACSCs. Participants included 33,273 male Veterans Affairs general medicine outpatients who returned mailed surveys. The main outcome was hospitalization with a primary discharge diagnosis for an ACSC in the year following screening. Analyses were adjusted for demographics, comorbidity, and other health behaviors. Current and previous smoking and abstaining from alcohol were associated with significantly increased risk of hospitalization for ACSCs, but alcohol misuse was not. However, severe alcohol misuse was associated with increased risk of hospitalizations with a primary or secondary ACSC discharge diagnosis. When ACSCs are used to evaluate the quality of care, health systems caring for populations with higher rates of smoking or nondrinking could falsely appear to have poorer quality care if alcohol and tobacco use are not considered.

Publication types

  • Evaluation Study
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Alcohol Drinking / adverse effects*
  • Alcohol Drinking / epidemiology
  • Alcoholism / epidemiology
  • Ambulatory Care*
  • Comorbidity
  • Hospitalization / statistics & numerical data*
  • Humans
  • Male
  • Mass Screening
  • Middle Aged
  • Prevalence
  • Primary Health Care
  • Proportional Hazards Models
  • Quality of Health Care
  • Risk
  • Smoking / adverse effects*
  • Smoking / epidemiology
  • United States
  • United States Department of Veterans Affairs / statistics & numerical data
  • Veterans / statistics & numerical data*
  • Young Adult