title: Effects of smoking cessation on health care use: is elevated risk of hospitalization among former smokers attributable to smoking-related morbidity?
abstract: BACKGROUND
  Although the association between smoking status and health services use is well established, this relation is not well-studied for the comparison of current and former smokers. Some studies showed higher utilization of health services among former smokers compared to continuing smokers. This study investigates the relation between smoking status, time since smoking cessation and hospitalization in a general population sample. We hypothesized that elevated risk of hospitalization among former smokers compared with continuing smokers is related to higher smoking-related morbidity among former smokers.
  
  
  METHODS
  Data from a cross-sectional sample of 4310 adults aged 20-79 in Pomerania, Germany was used (response proportion 68.8%). Smoking status, time since smoking cessation (in years), and date of diagnosis of smoking-related diseases were determined from self-reports. We used fractional polynomials to determine the dose-response relation of time since cessation and risk of hospitalization. Confounding was investigated allowing for different sets of confounding variables.
  
  
  RESULTS
  We found that the probability of hospitalization was highest among those who quit 1-3 years ago and decreased thereafter. Adjustment for health status and socio-economic variables revealed that this association is attenuated by current diagnosis of smoking-related diseases.
  
  
  CONCLUSIONS
  Short-term excess health care utilization among former smokers might result from smoking-related conditions that may have led to smoking cessation. Findings suggest that smoking cessation has long-term health benefits resulting in lower health care needs.
authors.affiliation: Institute of Epidemiology and Social Medicine, Medical School, University of Greifswald, Walther-Rathenau-Str. 48, 17487 Greifswald, Germany. sebastian.baumeister@uni-greifswald.de
authors.forename: Sebastian E
authors.initials: SE
authors.lastname: Baumeister
authors.forename: Anja
authors.initials: A
authors.lastname: Schumann
authors.forename: Christian
authors.initials: C
authors.lastname: Meyer
authors.forename: Ulrich
authors.initials: U
authors.lastname: John
authors.forename: Henry
authors.initials: H
authors.lastname: Völzke
authors.forename: Dietrich
authors.initials: D
authors.lastname: Alte
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005858:Germany / Q000453:epidemiology; D006301:Health Services Needs and Demand; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D012907:Smoking / Q000009:adverse effects*; D016540:Smoking Cessation / Q000706:statistics & numerical data*; D013997:Time Factors