Disparities in health care utilization by smoking status in Canada
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ORIGINAL ARTICLE
Disparities in health care utilization by smoking status in Canada Sunday Azagba • Mesbah Fathy Sharaf Christina Xiao Liu
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Received: 25 August 2011 / Revised: 1 February 2013 / Accepted: 6 February 2013 Ó Swiss School of Public Health 2013
Abstract 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. Keywords Smoking Health care utilization Unobserved heterogeneity Finite mixture model Canada S. Azagba (&) Department of Community Health and Epidemiology, Centre for Clinical Research, Dalhousie University, 5790 University Avenue, Halifax, NS, Canada e-mail: [email protected] M. F. Sharaf C. Xiao Liu Department of Economics, Concordia University, Montreal, Quebec, Canada
Introduction It is well established that tobacco use leads to premature death, economic losses to society, and a significant burden on the health care system. Smoking is a major risk factor for many diseases such as heart attacks, strokes, chronic obstructive pulmonary disease and cancer (Centers for Disease Control and Prevention [CDC] 2008). The World Health Organization (WHO) (2011) links 6 million deaths each year to tobacco use and by 2030 tobacco-related deaths are expected to reach 8 million per year. The average life span of a smoker is reduced by 6–10 years (Doll et al. 2004). The cost per pack of cigarettes in terms of a shorter life span is estimated to be about $36 (Gruber and Koszegi 2004). Recently, Viscusi and Hersch (2008) suggest that the mortality costs of smoking could be as high as $222 for men and $94 for women. Viscussi and Herch project the mortality cost of smoking as the expected number of years of life lost due to smoking multiplied by the economic value of these years. Smoking imposes a substantial burden on society. For example, in developed countries, smoking-attributable health care costs account for up to 15 % of all annual health care costs (World Bank 1999). Tobacco accounts for 42.7 % of the total ($39.
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