Self-Rated Health by Time Since Smoking Cessation

While the physiological benefits of quitting smoking are well established, less is known about how those who formerly smoked perceive these benefits over time. This study investigates the association between time since smoking cessation and self-rated health (SRH) in a nationally representative sample, and examines how predicted SRH varies by age, area-level deprivation, and education. Data were drawn from the 2017, 2018, 2019, and 2021 waves of the Scottish Health Survey, yielding a sample of 5,701 adults aged 16 and older who formerly smoked. The primary outcome was self-rated health, grouped as very good/good, fair, or bad/very bad. The main exposure was time since quitting smoking, categorised as <2 years, 2 to <5 years, 5 to <10 years, 10 to <20 years, and 20+ years. Generalized ordered logistic regression was used to estimate crude and adjusted odds ratios (ORs) for SRH. Predictive margins were calculated to assess variation across sociodemographic subgroups. All analyses were conducted in 2025. Longer cessation duration was associated with significantly lower odds of reporting poorer self-rated health. Compared to those who had quit within the past two years, adjusted ORs were 0.81 (95% CI: 0.62-1.06; p=0.125) for 2 to <5 years, 0.75 (95% CI: 0.58-0.97; p=0.027) for 5 to <10 years, 0.63 (95% CI: 0.49-0.80; p<0.001) for 10 to <20 years, and 0.45 (95% CI: 0.36-0.58; p<0.001) for 20+ years. When modelled as a continuous ordinal variable, each additional cessation category was associated with lower odds of poorer SRH (OR=0.82; 95% CI: 0.78-0.87; p<0.001). Predicted probabilities of reporting good or very good health increased with time since quitting across all subgroups (p<0.001). Among adults aged 45-64, probabilities rose from 59.7% (95% CI: 53.6%-65.9%) for <2 years to 72.2% (95% CI: 69.4%-74.9%) for 20+ years. Among those in the least deprived areas, the increase was from 64.4% (95% CI: 54.0%-74.8%) to 76.3% (95% CI: 73.2%-79.5%), and among individuals with higher education, from 65.7% (95% CI: 58.1%-73.4%) to 79.1% (95% CI: 76.6%-81.6%). Longer time since smoking cessation is associated with more favourable self-rated health, suggesting a graded, perceived benefit over time. However, these perceived subjective health gains are not evenly distributed, as individuals in disadvantaged groups continue to report lower probabilities of good health even after long-term cessation.