title: Cigarette smoking in a Middle Eastern country and its association with hospitalisation use: a nationwide cross-sectional study.
abstract: OBJECTIVE
  Little is known about the distribution of cigarette smoking by place and persons at the national level or its burden on healthcare expenditure in countries of the Middle East. We examine in this study the pattern of cigarette smoking by age, gender and geography and assess its association with hospitalisation use in Lebanon, a small middle-income country in the Middle East.
  
  
  METHODS
  Population-based cross-sectional study.
  
  
  METHODS
  The study draws on data collected as part of the nationwide multistage cluster sample Nutrition and Non-Communicable Disease Risk Factor survey conducted in Lebanon in 2009.
  
  
  METHODS
  A total of 2836 Lebanese adults 18 years and over.
  
  
  METHODS
  Hospitalisation, the outcome variable, was measured using one item and recoded as a dichotomous variable. Cigarette smoking, the main exposure variable, was assessed by examining smoking status and pack-years, capturing intensity, frequency and duration of exposure.
  
  
  RESULTS
  The overall prevalence rate of current smoking in this study was 34.7%, with significantly higher rates in males than females (42.9% and 27.5%, respectively). Close to two-thirds of the study population reported ever being hospitalised (62.8%). Compared to non-smokers, past and current smokers were significantly more likely to be hospitalised, after controlling for sociodemographic and health-related characteristics (OR=2.9, 95% CI 1.26 to 3.34, and OR=1.35, 95% CI 1.12 to 1.63, respectively). Hospitalisation use increased significantly in a dose-response manner with increasing pack-years.
  
  
  CONCLUSIONS
  When compared to regional and international estimates, the prevalence rates of smoking in Lebanon are considerably high, with percentages among women being among the highest in the region. Our findings of increased odds of hospitalisation among ever smokers, net of the effect of comorbidity, underscore the additional burden of smoking on the healthcare bill cost. Continued monitoring of smoking rates and disease surveillance frameworks are warranted in developing countries for policy development and evaluation.
authors.affiliation: Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
authors.forename: Abla Mehio
authors.initials: AM
authors.lastname: Sibai
authors.affiliation: Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Iskandarani
authors.affiliation: Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
authors.forename: Andrea
authors.initials: A
authors.lastname: Darzi
authors.affiliation: Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
authors.forename: Rima
authors.initials: R
authors.lastname: Nakkash
authors.affiliation: Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
authors.forename: Shadi
authors.initials: S
authors.lastname: Saleh
authors.affiliation: Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
authors.forename: Souha
authors.initials: S
authors.lastname: Fares
authors.affiliation: Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon.
authors.forename: Nahla
authors.initials: N
authors.lastname: Hwalla
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D015897:Comorbidity; D003430:Cross-Sectional Studies; D059026:Diagnostic Self Evaluation; D005260:Female; D015438:Health Behavior; D005102:Health Expenditures; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007861:Lebanon / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: EPIDEMIOLOGY; HEALTH SERVICES ADMINISTRATION & MANAGEMENT; PUBLIC HEALTH