The association of tobacco and alcohol consumption with the use of health care services in Spain

Background. Information on the impact of tobacco and alcohol consumption on the use of health services is scant and partially inconsistent, This paper examines the relationship between tobacco and alcohol consumption and the use of health care services in Spain. Methods. Data were drawn from the 1993 Spanish National Health Survey, cove ring a random 21,120-person representative sample of Spain's noninstitution alized population ages 16 years and older. Information was obtained through home-based interviews. Results. Compared with never smokers, male smokers of more than 20 cigarett es/day tend to be hospitalized more frequently (odds ratio (OR) 1.31; 95% c onfidence limits (CL) 0.89-1.93) and make greater use of hospital emergenci es (OR 1.51; 95%CL 1.13-2.01; P < 0.01), Among female smokers of more than 20 cigarettes/day, hospitalizations (OR 1.62; 95%CL 0.80-3.26) and medical visits (OR 1.35; 95%CL 0.79-2.30) are also higher than among never smokers, although the associations do not reach statistical significance. Compared with never smokers, ex-smokers of both sexes make greater use of health car e services (P < 0.01 for most services). There is a negative dose-response relationship (P < 0.001) between alcohol consumption and utilization of hos pital and ambulatory services, for both sexes. Results are reasonably consi stent across all age groups and are observed after adjustment for the princ ipal confounding factors. We have found no evidence of a tobacco-alcohol in teraction with the use of health care services, Conclusions. Smokers and ex-smokers make greater use of health care service s. Control of smoking might reduce the use of such services and the ensuing human and economic costs. However, as alcohol consumption increases, the u se of health care services decreases. This finding should not be used to pr omote even the moderate consumption of alcoholic drinks. (C) 2000 American Health Foundation and Academic Press.