Cigarette smoking, health status, socio-economic status and access to health care in diabetes mellitus: a cross-sectional survey.
BACKGROUND
In diabetes mellitus, cigarette smoking is associated with increased risk of cardiovascular mortality and microvascular complications. We evaluated cigarette smoking in people with diabetes mellitus in a socio-economically deprived area.


METHODS
We carried out a cross-sectional survey of people registered with diabetes mellitus at 29 general practices in inner London. Responses were analysed for 1,899 (64%) respondents out of 2,983 eligible.


RESULTS
There were 1,899 respondents of whom 968 (51%) had never smoked, 296 (16%) were current smokers and 582 (31%) were ex-smokers. Smoking was more frequent in white Europeans (men 22%, women 20%), than in African Caribbeans (men 15%, women 10%) or Africans (men 8%, women 2%). Smoking prevalence decreased with age. Smokers were more likely to be living in rented accommodation (odds ratio, OR 2.02, 95% confidence interval 1.48 to 2.74). After adjusting for confounding, current smokers had lower SF-36 scores than subjects who had never smoked (mean difference in physical functioning score -5.6, 95% confidence interval -10.0 to -1.2; general health -6.1, -9.7 to -2.5). Current smokers were less likely to have attended a hospital diabetic clinic in the last year (OR 0.59, 0.44 to 0.79), and their hypertension was less likely to be treated (OR 0.47, 0.30 to 0.74).


CONCLUSIONS
Compared with non-smokers, smokers had lower socio-economic status and worse health status, but were less likely to be referred to hospital or treated for their hypertension. People with diabetes who smoke can be regarded as a vulnerable group who need more intensive support and treatment.
Gulliford
M C
MC
Department of Public Health Sciences, King's College London, Capital House, 42 Weston St, London SE1 3QD, UK. martin.gulliford@kcl.ac.uk
Sedgwick
J E C
JE
Pearce
A J
AJ
D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000208:ethnology; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D011204:Poverty Areas; D015995:Prevalence; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000208:ethnology*; D000074606:Smoking Prevention; D012923:Social Class; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires