Is the provision of a national opt-out tobacco dependence treatment service in acute hospitals in England equitable? A national cohort study.

Abstract

People who smoke are a third more likely to be admitted to hospital than non-smokers. A disparity in smoking prevalence between the most and least deprived populations persists. Hospital-initiated treatment could reduce smoking-related inequalities if people admitted to hospital from more deprived populations have greater access and uptake of treatment and successfully quit. The National Health Service (NHS) in England has introduced 'opt-out' tobacco dependency treatment and in this study, we examined how treatment of tobacco dependency differed in relation to deprivation. Data were available from 111 (84%) acute hospital trusts in England, describing 243 847 hospital admissions of people who smoked in 2024, a total of 185 147 individuals. We reviewed whether individuals had made a supported quit attempt and successful quits and used logistic regression to determine if these outcomes differed according to level of deprivation based on patient residence. Data adjusted for demographic characteristics and hospital clustering demonstrated that the proportion of those making quit attempts was higher in more deprived quintiles of deprivation, 24.8% in quintile 1 (most deprived) versus 18.3% in quintile 5 (least deprived); however, the proportion of people who quit smoking was highest in the least deprived quintile (25.3%) with a gradient to the most deprived quintile (16.0%). The NHS opt-out inpatient tobacco dependency service provides treatment on an equitable basis across deprivation quintiles, with the greatest proportion of patients making a supported quit attempt in the most deprived quintile. However, there are opportunities to reduce inequalities by improving quit success in this group.