title: The association of tobacco and alcohol consumption with the use of health care services in Spain.
abstract: BACKGROUND
  Information on the impact of tobacco and alcohol consumption on the use of health services is scant and partially inconsistent. This paper examines the relationship between tobacco and alcohol consumption and the use of health care services in Spain.
  
  
  METHODS
  Data were drawn from the 1993 Spanish National Health Survey, covering a random 21,120-person representative sample of Spain's noninstitutionalized population ages 16 years and older. Information was obtained through home-based interviews.
  
  
  RESULTS
  Compared with never smokers, male smokers of more than 20 cigarettes/day tend to be hospitalized more frequently (odds ratio (OR) 1.31; 95% confidence limits (CL) 0.89-1.93) and make greater use of hospital emergencies (OR 1.51; 95%CL 1.13-2.01; P < 0.01). Among female smokers of more than 20 cigarettes/day, hospitalizations (OR 1.62; 95%CL 0.80-3.26) and medical visits (OR 1. 35; 95%CL 0.79-2.30) are also higher than among never smokers, although the associations do not reach statistical significance. Compared with never smokers, ex-smokers of both sexes make greater use of health care services (P < 0.01 for most services). There is a negative dose-response relationship (P < 0.001) between alcohol consumption and utilization of hospital and ambulatory services, for both sexes. Results are reasonably consistent across all age groups and are observed after adjustment for the principal confounding factors. We have found no evidence of a tobacco-alcohol interaction with the use of health care services.
  
  
  CONCLUSIONS
  Smokers and ex-smokers make greater use of health care services. Control of smoking might reduce the use of such services and the ensuing human and economic costs. However, as alcohol consumption increases, the use of health care services decreases. This finding should not be used to promote even the moderate consumption of alcoholic drinks.
authors.affiliation: Department of Preventive Medicine and Public Health, Universidad del País Vasco, Vitoria-Gasteiz, Spain. fernando.artalejo@uam.es
authors.forename: F
authors.initials: F
authors.lastname: Rodríguez Artalejo
authors.forename: B
authors.initials: B
authors.lastname: de Andrés Manzano
authors.forename: P
authors.initials: P
authors.lastname: Guallar-Castillón
authors.forename: M T
authors.initials: MT
authors.lastname: Puente Mendizabal
authors.forename: J
authors.initials: J
authors.lastname: González Enríquez
authors.forename: J
authors.initials: J
authors.lastname: del Rey Calero
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking; D000553:Ambulatory Care / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006306:Health Surveys; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D016017:Odds Ratio; D012907:Smoking; D013030:Spain