International Journal of Public Health

, Volume 58, Issue 6, pp 913–925 | Cite as

Disparities in health care utilization by smoking status in Canada

  • Sunday Azagba
  • Mesbah Fathy Sharaf
  • Christina Xiao Liu
Original Article

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 

References

  1. Al-Windi A, Dag E, Kurt S (2002) The influence of perceived wellbeing and reported symptoms on health care utilization: a population-based study. J Clin Epidemiol 55:60–66CrossRefPubMedGoogle Scholar
  2. Bago d’Uva T (2006) Latent class models for utilization of health care. Health Econ 15:329–343CrossRefGoogle Scholar
  3. Baliunas D, Patra J, Rehm J, Popova S, Taylor B (2007) Smoking-attributable morbidity: acute care hospital diagnoses and days of treatment in Canada 2002. BMC Public Health 7:247CrossRefPubMedCentralPubMedGoogle Scholar
  4. Baumeister RF, Vohs KD, Tice DM (2007) The strength model of self-control. Curr Dir Psychol Sci 16:351–355CrossRefGoogle Scholar
  5. Cameron AC, Trivedi PK (1998) Regression analysis of count data. Econometric society monograph, No. 30. Cambridge University Press, Cambridge UKCrossRefGoogle Scholar
  6. Centers for Disease Control and Prevention (2008) Smoking-attributable mortality, years of potential life lost, and productivity losses-United States, 2000–2004. Morb Mortal Wkly Rep 57:1226–1228Google Scholar
  7. Chern JY, Wan TT, Begun JW (2002) A structural equation modeling approach to examining the predictive power of determinants of individuals’ health expenditures. J Med Syst 26:323–336CrossRefPubMedGoogle Scholar
  8. Collishaw NE, Myers G (1984) Dollar estimates of the consequences of tobacco use in Canada, 1979. Can J Public Health 75:192–199PubMedGoogle Scholar
  9. Deb P, Trivedi PK (1997) Demand for medical care by the elderly: a finite mixture approach. J Appl Econom 12:313–336CrossRefGoogle Scholar
  10. Deb P, Trivedi PK (2002) The structure of demand for health care: latent class versus two-part models. J Health Econ 21:601–625CrossRefPubMedGoogle Scholar
  11. Doll R, Peto R, Boreham J, Sutherland I (2004) Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ 328:1519CrossRefPubMedCentralPubMedGoogle Scholar
  12. Fishman PA, Khan ZM, Thompson EE, Curry SJ (2003) Health care costs among smokers, former smokers, and never smokers in an HMO. Health Serv Res 38:733–749CrossRefPubMedCentralPubMedGoogle Scholar
  13. Fishman PA, Thompson EE, Merikle E, Curry SJ (2006) Changes in health care costs before and after smoking cessation. Nicotine Tob Res 8:393–401CrossRefPubMedGoogle Scholar
  14. Gerdtham UG, Trivedi PK (2001) Equity in Swedish health care reconsidered: new results based on the finite mixture model. Health Econ 10:565–572CrossRefPubMedGoogle Scholar
  15. Gruber J, Koszegi B (2004) Tax incidence when individuals are time-inconsistent: the case of cigarette excise taxes. J Public Econ 88:1959–1987CrossRefGoogle Scholar
  16. Gupta ND, Greve J (2011) Overweight and obesity and the utilization of primary care physicians. Health Econ 20(Suppl. 1):53–67. doi:10.1002/hec.1711 CrossRefPubMedGoogle Scholar
  17. Haapanen-Niemi N, Miilunpalo S, Vuori I, Pasanen M, Oja P (1999) The impact of smoking, alcohol consumption, and physical activity on use of hospital services. Am J Public Health 89:691–698CrossRefPubMedCentralPubMedGoogle Scholar
  18. Harrison GW, Feehan JP, Edwards AC, Segovia J (2003) Cigarette smoking and the cost of hospital and physician care. Can Public Policy 29:1–19CrossRefGoogle Scholar
  19. Health Canada (2011) Canadian Tobacco Use Monitoring Survey (CTUMS). Summary of Annual Results for 2010. http://www.hc-sc.gc.ca/hc-ps/tobac-tabac/research-recherche/stat/_ctums-esutc_2010/ann_summary-sommaire-eng.php
  20. Heckman J, Singer B (1984) A method for minimizing the impact of distributional assumptions in econometric models for duration data. Econometrica 52:271–320CrossRefGoogle Scholar
  21. Hvidtfeldt UA, Rasmussen S, Gronbaek M, Becker U, Tolstrup JS (2010) Influence of smoking and alcohol consumption on admissions and duration of hospitalization. Eur J Public Health 20(4):376–382CrossRefPubMedGoogle Scholar
  22. Jones AM (2000) Health econometrics. Handbook of health economics, vol Vol. 1. Elsevier, North Holland, pp 265–344Google Scholar
  23. Kahende JW, Adhikari B, Maurice E, Rock V, Malarcher A (2009) Disparities in health care utilization by smoking status—NHANES 1999–2004. Int J Environ Res Public Health 6:1095–1106CrossRefPubMedCentralPubMedGoogle Scholar
  24. Kaiserman MJ (1997) The cost of smoking in Canada, 1991. Chronic Dis Can 18:13–19PubMedGoogle Scholar
  25. Lourenço ÓD, Ferreira PL (2005) Utilization of public health centres in Portugal: effect of time costs and other determinants. Finite mixture models applied to truncated samples. Health Econ 14:939–953CrossRefPubMedGoogle Scholar
  26. Martinson BC, Crain AL, Pronk NP, O’Connor PJ, Maciosek MV (2003) Changes in physical activity and short-term changes in health care charges: a prospective cohort study of older adults. Prev Med 37:319–326CrossRefPubMedGoogle Scholar
  27. Miller V, Ernst C, Collin F (1999) Smoking attributable medical care costs in the USA. Soc Sci Med 4:375–391CrossRefGoogle Scholar
  28. Oberg M, Jaakkola MS, Prüss-Ustün A, Schweizer C, Woodward A (2010) Second-hand smoke: assessing the environmental burden of disease at national and local levels. World Health Organization, Environmental Burden of Disease Series, No. 18, GenevaGoogle Scholar
  29. Rehm J, Baliunas D, Brochu S, Fischer B, Gnam W, Patra J, Popova S, Sarnocinska-Hart A, Taylor B (2006) The costs of substance abuse in Canada 2002. Canadian Centre on Substance Abuse, Ottawa, CanadaGoogle Scholar
  30. Sari N (2009) Physical inactivity and its impact on healthcare utilization. Health Econ 18:885–901CrossRefPubMedGoogle Scholar
  31. Single E, Robson L, Xie X, Rehm J (1996) The costs of substance abuse in Canada. Canadian Centre on Substance Abuse, TorontoGoogle Scholar
  32. Viscusi WK, Hersch J (2008) The mortality cost to smokers. J Health Econ 27:943–958CrossRefPubMedGoogle Scholar
  33. Winkelmann R (2008) Econometric analysis of count data, 5th edn. Springer-Verlag, BerlinGoogle Scholar
  34. World Bank (1999) Curbing the epidemic: governments and the economics of tobacco control. The World Bank, WashingtonCrossRefGoogle Scholar
  35. World Health Organization (2011) WHO report on the global tobacco epidemic, 2011, warning about the dangers of tobacco. WHO Press, Geneva, Switzerland. http://www.who.int/tobacco/global_report/2011/en/index.html

Copyright information

© Swiss School of Public Health 2013

Authors and Affiliations

  • Sunday Azagba
    • 1
  • Mesbah Fathy Sharaf
    • 2
  • Christina Xiao Liu
    • 2
  1. 1.Department of Community Health and Epidemiology, Centre for Clinical ResearchDalhousie UniversityHalifaxCanada
  2. 2.Department of EconomicsConcordia UniversityMontrealCanada

Personalised recommendations