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



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


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.


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.


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


Smoking Health care utilization Unobserved heterogeneity Finite mixture model Canada 



We are grateful to an associate editor and three anonymous reviewers of this journal for their valuable comments and suggestions which substantially improved the paper. We are thankful to Nikolay Gospodinov, Ian Irvine and Gordon Fisher for useful comments and suggestions.


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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

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