The impact of cigarette smoking on healthcare utilization among rural residents in China

The effects of smoking, regular drinking, and unhealthy weight on health care utilization in China

Background

Preventive risk factors such as smoking, drinking, and unhealthy weight have contributed to the accelerated rise in noncommunicable chronic diseases, which are dominant drivers of health care utilization and spending in China. However, few studies have been conducted using a large longitudinal dataset to explore the impact of such preventive risk factors on health care utilization. Therefore, this study aimed to ascertain the effects of smoking, regular drinking, and unhealthy weight on health care utilization in China.

Methods

This research was a longitudinal study using data from five waves of the China Family Panel Studies (CFPS) conducted between 2010 and 2018, and the final sample consisted of 63,260 observations (12,652 participants) across all five waves of data collection. Health care utilization was measured from two perspectives: outpatient utilization and inpatient utilization. Smoking status was categorized as never smoker, former smoker, or current smoker. Unhealthy weight was classified based on the participants’ body mass index. A fixed effects logistic regression model was used for the analysis.

Results

The results of fixed effects logistic regression showed that current and former smokers were approximately 1.9 times and 2.0 times more likely to use outpatient care than those who never smoked, respectively (odds ratio (OR) = 1.88, p < 0.05; OR = 2.03, p < 0.05). Obese people were approximately 1.3 times more likely to use outpatient care than healthy weight people (OR = 1.26, p < 0.05). Moreover, the results show that compared to those who never smoked, for current and former smokers, the odds of being hospitalized increased by 42.2 and 198.2%, respectively (OR = 1.42; p < 0.1, OR = 2.98; p < 0.05). Compared to healthy weight people, overweight and obese people were also more likely to be hospitalized (OR = 1.11; p < 0.1, OR = 1.18; p < 0.1, respectively).

Conclusion

Among Chinese adults, current and former smokers were more likely to use outpatient and inpatient care than those who had never smoked. Moreover, compared to healthy weight people, obese people were more likely to use outpatient and inpatient care, and overweight people were more likely to use inpatient care. These results may have important implications that support the government in making health care resource allocation decisions.

Does smoking impact trust in physicians and satisfaction with the health system in China?

INTRODUCTION

Trust and satisfaction play vital roles in how smokers react to smoking cessation treatment delivered by physicians. This paper aims to ascertain whether smoking status and pack-years of smoking affect trust in physicians and satisfaction with the health system in China.

METHODS

The current study used the ordered probit model to evaluate how smoking status affects trust in physicians and satisfaction with the health system in China. Data from the China Family Panel Studies (CFPS) 2018 were used for the analysis, and the final sample consisted of 29500 adults. The CFPS is a nationally representative, comprehensive, high-quality, biennial longitudinal survey of Chinese communities, families, and individuals. The survey was conducted in 25 provinces and their administrative equivalents. The population of 25 provinces represents 95% of the total population in Mainland China.

RESULTS

According to the ordered probit model, the results showed that current smokers were significantly negatively associated with trust in physicians, and more cigarette smoking was associated with decreased trust in physicians. Moreover, current smokers were also significantly negatively related to satisfaction with the health system.

CONCLUSIONS

The present study found that current smokers would be more likely to rate trust in physicians lower, and less likely to rate greater satisfaction with the health system, than never smokers. These results may have important implications for regaining trust in physicians from smokers and supporting health-system reform for tobacco treatment.

Health services utilization and its determinants in the context of recession: evidence from Greece

BACKGROUND

In 2009, Greece entered a prolonged economic recession and adopted austerity reforms, which have profoundly affected many aspects of health sector, including health services use. The objective of this study was to investigate healthcare utilization in the Greek population in the context of austerity and its determinants.

METHODS

Two National Health Surveys of the population aged 15 and over, conducted in 2009 and 2014-before and after the adoption of austerity measures-, were used to analyse possible changes in healthcare utilization and its determinants applying chi-square tests, Mann-Whitney U-tests and generalized linear models.

RESULTS

Between 2009 and 2014, the share of those who had visited a specialist decreased, whereas that of those who had visited a general practitioner or had been hospitalized did not change significantly. The number of outpatient consultations decreased and the number of nights spent in hospital did not change significantly. The strongest predictors were self-rated health, presence of chronic diseases and experiencing pain.

CONCLUSIONS

Identifying the procyclical or counter-cyclical nature of healthcare utilization and the association between utilization and its determinants in different settings is an important priority in order to improve access and promote health equity.