Smoking cessation attempts in relation to prior health care charges: the effect of antecedent smoking-related symptoms?
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PURPOSE: We hypothesize that elevated charges among former smokers reflect differential cessation of sicker individuals. We ascertained the relationship between prior health care charges and time to smoking cessation. DESIGN: Prospective, observational study using panel survey data and administrative health plan records. SETTING: A large managed care organization in Minnesota. SUBJECTS: A stratified random sample of 8000 health plan members 40 years and older, yielding 611 current smokers at baseline. MEASURES: Smoking cessation measured via self-report survey. Health care charges, mortality, and disenrollment data derived from automated health plan databases. RESULTS: Among smoking adults without chronic disease diagnoses at baseline, a first attempt at quitting smoking was positively associated with the presence of any inpatient charges (relative risk [RR], 1.9; p < .05) or any emergency department or urgent care charges (RR, 1.4; p < .10). We also observed positive associations between total charges and ambulatory charges in the top textile (RR, 1.5 and 1.6, respectively; p < .05) with a first attempt at quitting smoking, further suggesting graded relationships. Among smoking adults with one or more of four chronic disease diagnoses at baseline, being in the top two tertiles of total charges or ambulatory care charges was predictive of a subsequent attempt at quitting smoking. CONCLUSIONS: Higher health care charges, particularly from ambulatory (primary care clinic) settings, predicted smoking cessation among both individuals with and without chronic diseases. These charges may be proxies for other factors, such as smoking-related symptoms or physician advice or messaging regarding smoking cessation.
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