Effects of smoking cessation on health care use:: Is elevated risk of hospitalization among former smokers attributable to smoking-related morbidity?

Background: Although the association between smoking status and health services use is well established, this relation is not well-studied for the comparison of current and former smokers. Some studies showed higher utilization of health services among former smokers compared to continuing smokers. This study investigates the relation between smoking status, time since smoking cessation and hospitalization in a general population sample. We hypothesized that elevated risk of hospitalization among former smokers compared with continuing smokers is related to higher smoking-related morbidity among former smokers. Methods: Data from a cross-sectional sample of 43 10 adults aged 20-79 in Pomerania, Germany was used (response proportion 68.8%). Smoking status, time since smoking cessation (in years), and date of diagnosis of smoking-related diseases were determined from self-reports. We used fractional polynomials to determine the close-response relation of time since cessation and risk of hospitalization. Confounding was investigated allowing for different sets of confounding variables. Results: We found that the probability of hospitalization was highest among those who quit 1-3 years ago and decreased thereafter. Adjustment for health status and socio-economic variables revealed that this association is attenuated by current diagnosis of smoking-related diseases. Conclusion: Short-term excess health care utilization among former smokers might result from smoking-related conditions that may have led to smoking cessation. Findings suggest that smoking cessation has long-term health benefits resulting in lower health care needs. (c) 2006 Elsevier Ireland Ltd. All rights reserved.