title: Smoking and functional status among Medicare managed care enrollees.
abstract: BACKGROUND
  Smoking is a major determinant of health status and outcomes. Current smoking has been associated with lower scores on the Short Form-36 Health Survey (SF-36). Whether this occurs among the elderly and disabled Medicare populations is not known. This study assessed the relationships between smoking status and both physical and mental functioning in the Medicare managed-care population.
  
  
  METHODS
  During the spring of 1998, data were collected from 134309 elderly and 8640 disabled Medicare beneficiaries for Cohort 1, Round 1 of the Medicare Health Outcomes Survey. We subsequently used these data to calculate mean standardized SF-36 scores, self-reported health status, and prevalence of smoking-related illness, by smoking status, after adjusting for demographic factors.
  
  
  RESULTS
  Among the disabled, everyday and someday smokers had lower standardized physical component (PCS) and mental component (MCS) scores than never smokers (-2.4 to -4.5 points; p <0.01 for all). Among the elderly, the lowest PCS and MCS scores were seen among recent quitters (-5.1 and -3.7 points, respectively, below those for never smokers; p <0.01 for both), but current smokers also had significantly lower scores on both scales. For the elderly and disabled populations, MCS scores of long-term quitters were the same as nonsmokers. Similar patterns were seen across all eight SF-36 scales. Ever smokers had higher odds of reporting both less-than-good health and a history of smoking-related chronic disease.
  
  
  CONCLUSIONS
  In the elderly and disabled Medicare populations, smokers report worse physical and mental functional status than never smokers. Long-term quitters have better functional status than those who still smoke. More effort should be directed at helping elderly smokers to quit earlier. Smoking cessation has implications for improving both survival and functional status.
authors.affiliation: Division of Epidemiology and Disease Surveillance, US Army Center for Health Promotion and Preventive Medicine, Washington, DC, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Arday
authors.forename: Micah H
authors.initials: MH
authors.lastname: Milton
authors.forename: Corinne G
authors.initials: CG
authors.lastname: Husten
authors.forename: Samuel C
authors.initials: SC
authors.lastname: Haffer
authors.forename: Sara C
authors.initials: SC
authors.lastname: Wheeless
authors.forename: Shelton M
authors.initials: SM
authors.lastname: Jones
authors.forename: Ruby E
authors.initials: RE
authors.lastname: Johnson
mesh_terms: D000368:Aged; D006233:Persons with Disabilities; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000191:economics / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data*; D008875:Middle Aged; D016017:Odds Ratio; D012044:Regression Analysis; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D016540:Smoking Cessation; D014481:United States / Q000453:epidemiology