Disparities in health care utilization by smoking status in Canada

Int J Public Health. 2013 Dec;58(6):913-25. doi: 10.1007/s00038-013-0452-7. Epub 2013 Feb 24.


Objectives: To examine the association between smoking status and the utilization of health care services in Canada.

Methods: The study uses data from the 2007 Canadian Community Health Survey, which contains information on the number of visits to general practitioner (GP), specialists (SP) and the number of nights spent in a hospital. The finite mixture estimation method is used in order to account for heterogeneity among smokers.

Results: Multivariate regression results indicate differential effects of smoking on health care utilization for at least two different groups of health care users: low and high users. In particular, we find that among the low-use group, smokers use less GP and SP services than never smokers. However, for the low-use and high-use groups, smokers have more hospitalizations than never smokers. The incidence of hospitalization is higher for the low-use group after controlling for need, socio-demographic characteristics and province fixed effects. Former smokers who recently quit use more health care services.

Conclusions: Tobacco consumption elevates the use of health care services, especially among the high-use group.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Canada / epidemiology
  • Delivery of Health Care / statistics & numerical data*
  • Female
  • Health Care Surveys
  • Healthcare Disparities / statistics & numerical data*
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Poisson Distribution
  • Smoking / epidemiology*
  • Smoking Cessation / statistics & numerical data
  • Young Adult