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People Who Quit Smoking Are Much Less Likely to Be Hospitalized Than Those Who Don't

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Media Advisory: March 5, 1998

A new study funded by the Agency for Health Care Policy and Research (AHCPR) shows that people who give up smoking are no more likely to be hospitalized than persons who never smoked. The finding is from the largest and most comprehensive study to date on how people's biomedical risk factors influence their likelihood of someday needing costly inpatient care.

"This study reaffirms the critical importance of smoking cessation," said AHCPR's administrator John M. Eisenberg, M.D. "Quitting smoking reaps tremendous economic as well as human rewards."

AHCPR-sponsored the development of a practice guideline for clinicians, released in 1996, that recommends proven treatments to help patients stop smoking. The agency later released data showing smoking cessation to be extremely cost-effective when compared with other routine interventions. For example, at an average cost of $2,600 per year of life saved, smoking cessation treatment costs nearly 40 times less than treatment to reduce cholesterol levels.

The Rutgers University-led study also found that men who smoke are a third more likely to be hospitalized than those who do not smoke. Middle-aged women smokers also have a greater probability of hospitalization than their nonsmoking counterparts, but to a lesser degree then that of male smokers.

Based on calculations of the maximum proportion of hospitalizations that could be attributed to a specific risk factor, the researchers estimate that if smoking were eliminated among middle-aged men, hospital admissions for all men in this 45 to 64 years of age group would decline by as much as 12.5 percent. According to AHCPR intramural researchers, a decline of this proportion in the 1995 hospital admissions of all men in this age group would have amounted to about $5.4 billion. AHCPR's estimate is based on data from its Healthcare Cost and Utilization Project.

The researchers used data collected over a 16-year period, from 1971 to 1987, on a nationally representative sample of nearly 6,500 men and women participating in the National Center for Health Statistics' National Health and Nutrition Examination Survey I. At the start of the survey, each subject underwent a physical examination, laboratory tests, and a medical interview to collect baseline data. Each was at least 45 years of age at the start of the survey. The participants' hospital admission and other health outcomes data were collected periodically thereafter.

The study also looked at the influence on hospital admission of other biomedical factors. Among the chronic diseases the researchers found to significantly increase the probability of inpatient care were arthritis, bronchitis and other lung conditions, diabetes, and ulcer. Actual risk rates varied according to age group and gender. The study also found that having elevated serum cholesterol did not increase the risk of hospitalization, and having higher levels of serum albumin—which has been shown to be associated with a lower risk of death—actually reduced the likelihood of hospital care.

According to the authors, the findings make it possible for researchers to not only examine the relation between risk factors and hospitalization, but also estimate the impact on hospital admission rates of risk-reduction interventions, such as smoking cessation.

The study is from a research project led by Rutgers University's Louise B. Russell, Ph.D. The other authors are with Rutgers, the Robert Wood Johnson Medical School of the University of Medicine and Dentistry of New Jersey, and Harvard Medical School. Details are in "Biomedical risk factors for hospital admission in older adults," by Jane E. Miller, Ph.D., Dr. Russell, Diane M. Davis, B.A., and others. The article was published in the March 1998 issue of Medical Care, a journal of the American Public Health Association.

Note to Editors: For further information, please call Dr. Louise B. Russell at Rutgers University, New Brunswick, N.J. (732) 932-6507.

For additional information, contact AHCPR Public Affairs: Harriett Bennett, (301) 427-1861 (; Salina Prasad, (301) 427-1864 (

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