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obstruction disease (COPD) to coronary artery disease, as opposed to only 40% for the 

 predominantly younger, Medicaid population. 



The Medicare population is at a much higher risk for getting smoking-related 

 diseases because people over 65 who have smoked tend to have done so more heavily and for 

 longer time periods. Nearly 3 out of 5 of current Medicare smokers (58%) and almost one 

 third of former smokers (32.7%) smoked an average of more than 10 cigarettes per day for 

 over 35 years (Graph 3). 



Substance Abuse as a Complicating Factor in the Treatment of other Diseases 



When substance abuse is recorded as a secondary diagnosis to an otherwise 

 unrelated condition, it tends to complicate and prolong the treatment for the underlying 

 problem. On average, a secondary diagnosis of alcohol and/or drug abuse increased the length 

 of time patients stay in the hospital. Compared to Medicare patients with the same primary 

 diagnoses, those with a secondary diagnosis of substance abuse stayed an average of more than 

 a half a day longer, 9.3 days compared with 8.6 days. While this is not insignificant, the 

 marginal effect of substance abuse as a secondary diagnosis in the Medicare population is 

 much smaller than what was found for Medicaid, where substance abusers stayed twice as long 

 as non-substance abusers. 



This small differential between length of stay for Medicare patients with and without 

 substance abuse problems is most likely a significant underestimate of the full effect of alcohol 

 and drugs as a complication. Many cases that actually involved alcohol or drug problems were 

 not recorded as having this secondary diagnosis. Since, in our analysis, these cases would be 

 counted in the non-substance abuse group, they may be artificially inflating the length of stay 

 for that group. If the secondary diagnosis of substance abuse had been correctly noted, the 



