Opt-out tobacco dependency treatment for inpatients: confronting entrenched inequalities but under threat

The substantial burden of disease, poverty and early mortality executed by tobacco smoking falls heaviest on those in society already suffering some of the greatest disadvantage and represents the severest form of injustice and ‘structural violence’.1 2 People who smoke are 36% more likely to be admitted to hospital and 16–18% of all adult acute hospital admissions are in patients who currently smoke.3 4 Approximately 40% of patients admitted to hospital who currently smoke live in the highest levels of deprivation compared with 10% of patients who live in the least deprived communities.5 Hospital admissions in patients who smoke, therefore, represent a substantial opportunity to reduce the significant inequalities driven by tobacco, particularly in relation to deprivation, and to reduce the costs of emergency healthcare provision.