title: Smoking and potentially preventable hospitalisation: the benefit of smoking cessation in older ages.
abstract: OBJECTIVE
  Reducing preventable hospitalisation is a priority for health systems worldwide. This study sought to quantify the contribution of smoking to preventable hospitalisation in older adults and the potential benefits of smoking cessation.
  
  
  METHODS
  Self-reported smoking data for 267,010 Australian men and women aged 45+ years linked with administrative hospital data were analysed using Cox's models to estimate the effects on risk of hospitalisation for congestive heart failure (CHF), diabetes complications, chronic obstructive pulmonary disease (COPD) and angina. The impacts of smoking and quitting smoking were also quantified using risk advancement periods (RAP).
  
  
  RESULTS
  The cohort included 7% current smokers, 36% former smokers and 57% never smokers. During an average follow-up of 2.7 years, 4% of participants had at least one hospitalisation for any of the study conditions (0.8% for CHF, 1.7% for diabetes complications, 0.8% for COPD and 1.4% for angina). Compared to never smokers, the adjusted hazard ratio for hospitalisation for any of the conditions for current smokers was 1.89 (95% CI 1.75-2.03), and the RAP was 3.8 years. There were strong dose-response relationships between smoking duration, smoking intensity and cumulative smoking dose on hospitalisation risk. The excess risk of hospitalisation and RAP for COPD was reduced within 5 years of smoking cessation across all age groups, but risk reduction for other conditions was only observed after 15 years.
  
  
  CONCLUSIONS
  Smoking is associated with increased risk of preventable hospitalisation for chronic conditions in older adults and smoking cessation, even at older ages, reduces this risk.
authors.affiliation: Centre for Big Data Research in Health, Faculty of Medicine, UNSW Australia, NSW 2052, Australia. Electronic address: bich.tran@unsw.edu.au.
authors.forename: Bich
authors.initials: B
authors.lastname: Tran
authors.affiliation: Centre for Big Data Research in Health, Faculty of Medicine, UNSW Australia, NSW 2052, Australia.
authors.forename: Michael O
authors.initials: MO
authors.lastname: Falster
authors.affiliation: Australian National University, Canberra ACT 0200, Australia.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Douglas
authors.affiliation: The Sax Institute, Haymarket, NSW 2000, Australia; Concord Clinical School, University of Sydney, NSW 2006, Australia.
authors.forename: Fiona
authors.initials: F
authors.lastname: Blyth
authors.affiliation: Centre for Big Data Research in Health, Faculty of Medicine, UNSW Australia, NSW 2052, Australia.
authors.forename: Louisa R
authors.initials: LR
authors.lastname: Jorm
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000209:etiology; D001315:Australia; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000209:etiology; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012907:Smoking / Q000009:adverse effects*; D016540:Smoking Cessation; D014029:Tobacco Use Disorder / Q000150:complications*
keywords: 45 and Up Study; Preventable hospitalisation; Rate advancement period; Smoking