Smoking, poverty, ill-health and health care utilization in China

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Smoking, poverty, ill-health and health care
utilization in China

• Juncheng Qian
• Center for Health Statistics and Information
• qianjc_at_moh.gov.cn
• 30 October 2007

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Main Contents

• Background and data source
• Smoking status and poverty
• Comparison between smoker and non smoker among
  urban and rural on ill health and health care
  utilization in 2003
• Comparison between poor smoking household and
  poor non smoking household on ill health and
  health care utilization in 2003
• Potential to inform policy formulation of
  tobacco control

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Background Leading producers of tobacco
leavesmetric tonnes, 2001 data
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Data Source

• The latest China National Health Services Survey
  (NHSS) in 2003, Large, representative,
  cross-sectional survey, taking place every 5
  years.
• Organized by the Centre for Health Statistics and
  Information, part of the Ministry of Health.
• Main emphasis is health service utilization. Also
  collects some information on lifestyle behaviours
  and socio-economic factors, household
  characteristics and household expenditures.
• Large sample size
• Approximate sample sizes were 200,000
  participants from 55,000 households

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NHSS sampling process
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Definitions used

• Based WHO definitions, modified as used in 1996
  National Prevalence Survey
• Current smoker smoking at time of survey
• Regular or daily smokers smoke at least one
  cigarette daily at time of survey for at least 6
  months (only 2003 survey)
• Heavy smokers at least 20 cigarettes daily
• Quitter had stopped smoking for at least two
  years
• Current quitter stopped smoking for at least 6
  months
• Intention to quit (in next two years)
• Quit attempts (yes, no and n) in past 12 months

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Smoking status and poverty
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Smoking and poverty conceptual framework
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Household expenditures for poorest 10 households
in rural areas, Yuan in RMB (crude data)
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Direct smoking Impoverishing rate

• RateHH falling below poverty line by direct cost
  of cigarette / Smoking HH above poverty line

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Impoverishing rate by direct cost of tobacco in
smoking household above the poverty lineBy
National line (R637,U1850)
Quin_1 is the poorest, quin_5 is the richest
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Smoking status and ill health among urban and
rural
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Smoking status and health self-assessmentbad
health rate
Age standardized rate () of respondent with self
assessing bad health
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Smoking status effect on health self-assessment
by logistic regression (odds ratio)
The control group is non smoker, the control
variables are gender, age, marriage, occupation,
education, insurance, income, HH size, distance
to the closest medical facility, drinking water
type, alcohol status,.
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Smoking status and two week morbidity
Age standardized rate of respondent with two week
morbidity
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Smoking status and acute illness of Respiratory
System
Age standardized rate () of respondent with
acute illness of Respiratory System
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Smoking status effect on two week morbidity by
logistic regression (odds ratio)
The control group is non smoker, the control
variables are gender, age, marriage, occupation,
education, insurance, income, HH size, drinking
water type, alcohol status.
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Smoking status and chronic illness of Respiratory
System
Age standardized rate () of respondent with
chronic illness of Respiratory System
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Smoking status effect on chronic morbidity by
logistic regression (odds ratio)
The control group is non smoker, the control
variables are age, marriage occupation,
education, insurance, income, HH size, drinking
water type, alcohol status.
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Smoking Status and Health Care Utilization among
Urban and Rural
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Smoking status and two week health care
utilization
Age standardized rate () of respondent with two
week health care utilization
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Smoking status and two week clinic utilization
for illness of Respiratory System
Age standardized rate () of respondent with two
week health care utilization for illness of
Respiratory system
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Smoking status effect on clinic utilization by
logistic regression (odds ratio)
The control group is non smoker, the control
variables are age, occupation, education,
insurance, income, self-assessed health, HH size,
drinking water type, type of two week morbidity,
main symptom.
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Smoking status and hospitalization
Age standardized rate () of respondent with
hospitalization last year
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Smoking status and hospitalization for diseases
of Respiratory System
Age standardized rate () of respondent with
hospitalization for dis. of Respiratory System
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Smoking status effect on hospitalization by
logistic regression (odds ratio)
The control group is non smoker, the control
variables are gender, age, marriage, occupation,
education, insurance, income, self-assessed
health, HH size, drinking water type.
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Smoking status and average medical expenditure
for two week morbidity
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Smoking status and average medical expenditure
for hospitalization
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Reasons for attempting to quit
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Reasons for failing to quit
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Comparison between poor smoker and poor non
smoker
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Two week morbidity between poor smoker and poor
non smoker
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Non utilization of health care for two week acute
heavy illness between poor smoking and poor non
smoking household
The sicker ratio of non visiting doctor for acute
heavy illness in the poorest 10 respondent in
2003
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Hospitalization between poor smoker and poor non
smoker
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Non-hospitalization between poor smoking and poor
non smoking household
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Medical expenditure between poor smoker and poor
non smoker in 2003
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Potential to inform policy formulation

• Starting of smoking behaviour was easier to
  happen in better health people
• Chronic diseases is mainly smoking harmfulness
  though acute illness is also resulted in.

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Potential to inform policy formulation of tobacco
control

• The quitters quitting reason suggest that the
  quitting behaviour were mainly passive in China
• The quitters health status suggest the quitting
  behaviour was too late.
• The quitter have to pay much for diseases burden
  by smoking.

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Potential to inform policy formulation of tobacco
control

• The poor smoking household is higher morbidity,
  lower health care utilization, and expensive
  average medical expenditure than the poor non
  smoking household. Reducing the poorest smoking
  prevalence may improve their health, health care
  utilization.

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Potential to inform policy formulation of tobacco
control

• Tobacco use resulted in impoverish especially in
  the poorer household
• Tobacco control in rural area should be given
  more attention

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Thanks!