Different Trends in US Tobacco Use: Inpatient Databases and Population-Based Surveys

There is considerable evidence to support the effectiveness of inpatient tobacco cessation interventions. However, national trends data in tobacco-use disorder among hospitalized patients in the United States is scarce. We compared temporal trends (2002-2017) in diagnoses of tobacco-use disorder among hospitalized patients with estimates of current and former smoking in the general population, based on 2 multiyear national databases.

We used data from the National Inpatient Sample (NIS) and the Behavioral Risk Factor Surveillance Survey (BRFSS) to establish annual estimates of current and former smoking. We assessed temporal trends (Joinpoint regression analysis) overall and within levels of several sociodemographic factors. To describe the burden and risk of tobacco-use disorder in inpatient settings, we used principal codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) that corresponded with the highest volume (burden) and rates (risk) of tobacco-use disorder.

There were contrasting trends in the prevalence of current tobacco-use disorder between the NIS population (significantly increasing) and BRFSS (significantly decreasing). Concordance (at 16%) was only recorded in 2017, with approximately 5,022,000 hospitalizations with a recorded diagnosis of tobacco-use disorder. Among all hospitalizations, the highest number of cases of tobaccouse disorder occurred for mood disorders (n = 2,415,985), chronic obstructive pulmonary disease and bronchiectasis (n = 2,406,551), and acute myocardial infarction (n = 1,873,326).

Despite the underestimation of current smoking by NIS, we believe the trends toward improved identification and documentation-which is likely leading to the increasing prevalence we observed among hospitalized patients of all ages-bodes well for future utilization of smoking data in the NIS for epidemiological and health services research.