*269. Health Status and Health Care Utilization of Veterans Who Smoke
SE Sherman, VA Center for the Study of Health Care Provider Behavior, Sepulveda, CA; EM Yano, VA Center for the Study of Health Care Provider Behavior, Sepulveda, CA; AB Lanto, VA Center for the Study of Health Care Provider Behavior, Sepulveda, CA; M Wang, VA Center for the Study of Health Care Provider Behavior, Sepulveda, CA; ML Lee, VA Center for the Study of Health Care Provider Behavior, Sepulveda, CA; BS Mittman, VA Center for the Study of Health Care Provider Behavior, Sepulveda, CA; LV Rubenstein, VA Center for the Study of Health Care Provider Behavior, Sepulveda, CA
Objectives: Smokers tend to be sicker and have more health care utilization than non-smokers. We assessed whether or not this same relationship holds among veterans, who themselves tend to be sicker and have more health care utilization than the general public.
Methods: As part of the baseline patient survey for a multi-site trial of evidence-based quality improvement for smoking cessation, we interviewed veterans at 18 sites in the Southwestern U.S. The survey, conducted by computer-assisted telephone interview among patients with at least 3 primary care visits in the prior 18 months, covered smoking history, health habits, health status and demographics. Questions were adapted from previously validated sources, including the California Tobacco Survey, Medical Outcomes Study, CES-D (depression), AUDIT (alcohol abuse), and others. Outpatient utilization data for FY 1999 were extracted from the VA Outpatient File at Austin and grouped by type of visit. Inpatient utilization data were obtained from the Patient Treatment File at Austin. Comparisons were done using chi-squared tests and ANOVA. For this preliminary analysis, we also analyzed the utilization data splitting subjects into those under 65 (n=3745) and those 65 or older (n=3961).
Results: Of the 7,706 subjects interviewed, current smokers were more likely than former smokers or those who never smoked to be younger, less active, and divorced (all p<0.001). Current smokers were more likely than the other two groups to have severe mental health impairment (21% vs. 12% vs. 14%, p<0.001) and severe physical health impairment (55% vs. 48% vs. 46%, p=0.026). Current smokers were less likely than former smokers or those who never smoked to report being in excellent or very good health (16% vs. 22% vs. 26%, p<0.001). Among current smokers, approximately half reported they never drink alcohol, but 18% met AUDIT criteria for alcohol abuse. Forty-three percent of current smokers met CES-D criteria for depression at the time of the interview.
Current smokers, former smokers, and those who never smoked did not differ in the total number of outpatient visits or for emergency room or general medicine visits. Current smokers did average more mental health and social work visits and fewer medical subspecialty visits than former smokers or those who never smoked (p<0.001). The rate and length of acute care hospitalizations did not differ among the three groups, but smokers had more nursing home admissions. When we analyzed the data separately for subjects over 65 and under 65, the utilization differences tended to occur predominantly in the half of the sample under age 65.
Conclusions: While smokers had higher outpatient mental health use, they did not have higher utilization for most other categories. They tended to have worse functional and health status than former smokers and those who never smoked.
Impact: These data help to assess the impact smoking has on VA health care utilization. They will be particularly helpful in assessing the economic effect of smoking on VA health care utilization and the cost-effectiveness of smoking cessation interventions.