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Mestre LM, Zoh RS, Perry C, Fukuyama J, Parker MA. Determining whether weight status mediates the association between number of cigarettes smoked per day and all-cause mortality among US adults who smoke cigarettes. PLoS One 2025; 20:e0319560. [PMID: 40305568 PMCID: PMC12043237 DOI: 10.1371/journal.pone.0319560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 02/04/2025] [Indexed: 05/02/2025] Open
Abstract
INTRODUCTION While there is evidence demonstrating the association between cigarette smoking and weight status, and mortality and weight status, it has not been examined whether weight status is a mediator between number of cigarettes smoked per day (CPD) and all-cause mortality, limiting our knowledge of this association and potential novel approaches to reduce all-cause mortality due to cigarette smoking. We aimed to evaluate whether weight status mediated the association between CPD and mortality. METHODS We harnessed the 2003-2018 NHANES and the Linkage Mortality Files, which included adults who smoked ≥ 100 lifetime cigarettes (unweighted n = 5,676). A generalized linear model estimated the association between cigarettes smoked per day (CPD) and weight status (e.g., Body Mass Index (BMI) or Waist Circumference (WC)). An Accelerated Failure Time model with a Weibull distribution estimated the association between CPD and all-cause mortality with weight status as a mediator, adjusting for age, SES, alcohol consumption, race/ethnicity, sex/gender, blood pressure, total cholesterol, and physical activity. RESULTS Between 2003-2018, the sample's mean BMI was 27.97 kg/m2, sample's mean WC was 97.58 cm and mean CPD was 13.21. The total effect in the mediation analysis of WC adjusted by BMI levels in the association between CPD and all-cause mortality was -0.44 (95% CI = -2.00, -0.20; p = 0.016), the average direct effect was -0.35 (95% CI = -1.86, -0.10; p = 0.036), and the average indirect effect was -0.10 (95% CI = -0.23, -0.05; p < 0.001). CONCLUSION WC, as a surrogate measure of weight status, when adjusted by BMI levels, was a partial mediator between CPD and all-cause mortality. Public health interventions aimed to reduce mortality due to cigarette smoking at the population level should consider weight management programs as a harm reduction strategy to reduce mortality.
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Affiliation(s)
- Luis Miguel Mestre
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health- Bloomington, Bloomington, Indiana, United States of America
| | - Roger S. Zoh
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health- Bloomington, Bloomington, Indiana, United States of America
| | - Cydne Perry
- Department of Applied Health Sciences, Indiana University School of Public Health- Bloomington, Bloomington, Indiana, United States of America
| | - Julia Fukuyama
- Computing and Engineering Department of Statistics, Indiana University School of Informatics, Bloomington, Indiana, United States of America
| | - Maria A. Parker
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health- Bloomington, Bloomington, Indiana, United States of America
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Aissani MS, Niskanen L, Tuomainen TP, Ould Setti M. Renal Hyperfiltration as a New Mechanism of Smoking-Related Mortality. Nicotine Tob Res 2025; 27:903-908. [PMID: 38894676 PMCID: PMC12012233 DOI: 10.1093/ntr/ntae136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 05/26/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024]
Abstract
INTRODUCTION Renal hyperfiltration (RHF), an established risk factor for mortality, is prevalent among tobacco smokers. The aim of this study was to assess the mediating role of RHF in the association between smoking and mortality. AIMS AND METHODS Data of this study were retrieved from the cohort of the Kuopio Ischemic Heart Disease Risk Factor Study (KIHD), including 2064 males from Finland. Study participants were followed over a 35-year period. Using classic and counterfactual mediation analysis approaches, we estimated the mediative effect of RHF in the association between smoking and each of the following outcomes: All-cause mortality, cardiovascular disease (CVD) mortality, and non-CVD mortality. RESULTS The risk of all-cause mortality in smokers was twice that in nonsmokers (hazard ratio [HR], 2.06; 95% confidence interval [CI]: 1.84 to 2.31). Under the counterfactual framework the direct effect of smoking on all-cause mortality, controlled for RHF, corresponded to an HR of 2.00 (95% CI: 1.78 to 2.30). Of the effect of smoking on mortality, 5% (p-value = .016) was mediated by RHF. This finding concerned particularly non-CVD mortality. CONCLUSIONS RHF mediated the effect of smoking on non-CVD and all-cause mortality, but not on CVD mortality. The generalizability of our study results is however limited by its focus on a Finnish male cohort, underscoring the need for further investigation into RHF's broader implications across diverse populations. IMPLICATIONS This study elucidates the complex interplay between smoking, renal hyperfiltration (RHF), and mortality, offering novel insights into the mediating role of RHF. Our findings demonstrate that RHF significantly mediates the relationship between smoking and non-cardiovascular disease (non-CVD), but not CVD mortality. This distinction underscores the multifaceted role of RHF beyond its established association with cardiovascular events. By highlighting the specific pathways through which RHF mediates some of the smoking-attributed mortality, this research contributes to our understanding of the mechanisms linking smoking to mortality.
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Affiliation(s)
| | - Leo Niskanen
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Mounir Ould Setti
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Epidemiology and Database Studies, Real World Solutions, IQVIA, Espoo, Finland
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Tilstra AM, Kapelle N. Breaking Bonds, Changing Habits: Understanding Health Behaviors during and after Marital Dissolution. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2025:221465251320079. [PMID: 40035089 DOI: 10.1177/00221465251320079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2025]
Abstract
Marital dissolution is a stressful transition that can lead to unhealthy coping strategies, including smoking and drinking. Using fixed effect linear probability models to assess health behavior changes, we analyzed 6,607 women and 6,689 men in the Household, Income, and Labour Dynamics in Australia data set who were either continuously married or experienced marital separation between 2002 and 2020. We observed 1,376 separations (744 women, 632 men). We found that drinking and smoking increases leading to and in the year of separation, with variability by gender, education, and parenthood status. From Cox proportional hazards models, we showed that among individuals who smoked (N = 337) or drank (N = 756) in the year of separation, cessation was most likely for the highly educated and/or women. Unhealthy coping mechanisms throughout marital dissolution suggests a need for targeted support to those separating, especially for men and those with children and lower education.
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Affiliation(s)
| | - Nicole Kapelle
- University of Oxford, Oxford, UK
- Trinity College Dublin, Dublin, Ireland
- Humboldt-Universität Zu Berlin, Dublin, Ireland
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Joshy G, Soga K, Thurber KA, Egger S, Weber MF, Sarich P, Welsh J, Korda RJ, Yazidjoglou A, Nguyen MTH, Paige E, Gourley M, Canfell K, Banks E. Relationship of tobacco smoking to cause-specific mortality: contemporary estimates from Australia. BMC Med 2025; 23:115. [PMID: 39994694 PMCID: PMC11854379 DOI: 10.1186/s12916-025-03883-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Accepted: 01/16/2025] [Indexed: 02/26/2025] Open
Abstract
BACKGROUND Tobacco industry activities and reduced smoking prevalence can foster under-appreciation of risks and under-investment in tobacco control. Reliable evidence on contemporary smoking impacts, including cause-specific mortality and attributable deaths, remains critical. METHODS Prospective study of 178,169 cancer- and cardiovascular-disease-free individuals aged ≥ 45 years joining the 45 and Up Study in 2005-2009, with linked questionnaire, hospitalisation, cancer registry and death data to November 2017. Cause-specific mortality hazard ratios (HR) by smoking status, intensity and recency were estimated, adjusted for potential confounding factors. Population attributable fractions were estimated. RESULTS There were 13,608 deaths during 9.3 years median follow-up (1.68 M person-years); at baseline, 7.9% of participants currently and 33.6% formerly smoked. Mortality was elevated with current versus never smoking for virtually all causes, including chronic lung disease (HR = 36.32, 95%CI = 26.18-50.40), lung cancer (17.85, 14.38-22.17) and oro-pharyngeal cancers (7.86, 4.11-15.02); lower respiratory infection, peripheral vascular disease, oesophageal cancer, liver cancer and cancer of unknown primary (risk 3-5 times as high); and coronary heart disease, cerebrovascular disease and cancers of urinary tract, pancreas, kidney, stomach and prostate (risk at least two-fold); former versus never-smoking demonstrated similar patterns with attenuated risks. Mortality increased with smoking intensity, remaining appreciable for 1-14 cigarettes/day (e.g. lung cancer HR = 13.00, 95%CI = 9.50-17.80). Excess smoking-related mortality was largely avoided with cessation aged < 45 years. In 2019, 24,285 deaths (one-in-every-six deaths, 15.3%), among Australians aged ≥ 45 years, were attributable to tobacco smoking. CONCLUSIONS Smoking continues to cause a substantial proportion of deaths in low-prevalence settings, including Australia, highlighting the importance of accelerated tobacco control.
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Affiliation(s)
- Grace Joshy
- National Centre for Epidemiology and Population Health (NCEPH), The Australian National University, Acton, Canberra, ACT, 2601, Australia.
| | - Kay Soga
- National Centre for Epidemiology and Population Health (NCEPH), The Australian National University, Acton, Canberra, ACT, 2601, Australia
| | - Katherine A Thurber
- National Centre for Epidemiology and Population Health (NCEPH), The Australian National University, Acton, Canberra, ACT, 2601, Australia
| | - Sam Egger
- The Daffodil Centre, The University of Sydney, A Joint Venture With Cancer Council NSW, Sydney, NSW, Australia
| | - Marianne F Weber
- The Daffodil Centre, The University of Sydney, A Joint Venture With Cancer Council NSW, Sydney, NSW, Australia
| | - Peter Sarich
- The Daffodil Centre, The University of Sydney, A Joint Venture With Cancer Council NSW, Sydney, NSW, Australia
| | - Jennifer Welsh
- National Centre for Epidemiology and Population Health (NCEPH), The Australian National University, Acton, Canberra, ACT, 2601, Australia
| | - Rosemary J Korda
- National Centre for Epidemiology and Population Health (NCEPH), The Australian National University, Acton, Canberra, ACT, 2601, Australia
| | - Amelia Yazidjoglou
- National Centre for Epidemiology and Population Health (NCEPH), The Australian National University, Acton, Canberra, ACT, 2601, Australia
| | - Mai T H Nguyen
- National Centre for Epidemiology and Population Health (NCEPH), The Australian National University, Acton, Canberra, ACT, 2601, Australia
| | - Ellie Paige
- National Centre for Epidemiology and Population Health (NCEPH), The Australian National University, Acton, Canberra, ACT, 2601, Australia
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Michelle Gourley
- Burden of Disease and Mortality Unit, Australian Institute of Health and Welfare, Canberra, Australia
| | - Karen Canfell
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health (NCEPH), The Australian National University, Acton, Canberra, ACT, 2601, Australia
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Myran DT, Pugliese M, McDonald AJ, Xiao J, Fischer B, Finkelstein Y, Tanuseputro P, Firth J, Pakpour A, Hsu CW, Chang WC, Solmi M. Cannabis Use Disorder Emergency Department Visits and Hospitalizations and 5-Year Mortality. JAMA Netw Open 2025; 8:e2457852. [PMID: 39913138 PMCID: PMC11803479 DOI: 10.1001/jamanetworkopen.2024.57852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Accepted: 11/26/2024] [Indexed: 02/07/2025] Open
Abstract
Importance Cannabis use disorders (CUD) are associated with adverse health effects, including mental disorders and motor vehicle collision-related injuries. However, little is known about whether CUDs are associated with increased mortality risk. Objective To examine whether individuals receiving incident hospital-based care (an emergency department visit or hospitalization) for a CUD is associated with increased risk of death. Design, Setting, and Participants This population-based retrospective cohort study included all individuals aged 15 to 105 years living in Ontario, Canada, between 2006 and 2021 (n = 11 622 571 individuals). Overall and cause-specific mortality were compared between individuals with incident hospital-based CUD care and age- and sex-matched members of the general population or individuals with hospital-based care for other substance use disorders using cause-specific hazard models adjusted for comorbid mental health, substance use, and chronic health conditions. Statistical analysis was performed from September to December 2024. Exposure Incident hospital-based CUD care. Main Outcomes and Measures Overall and cause-specific mortality identified using vital statistics. Results The matched analysis included 527 972 individuals (mean [SD] age, 29.9 [13.6] years; 330 034 [62.5%] female) with a median (IQR) follow-up of 5 (3-9) years; 106 994 had incident CUD. Within 5 years of incident hospital-based CUD care, 3770 individuals (3.5%) died compared with 3770 (0.6%) of matched general population members. After adjusting for comorbid conditions, individuals with incident hospital-based CUD care were at increased risk of death relative to the general population (adjusted hazard ratio [aHR], 2.79 [95% CI, 2.62-2.97]). Individuals with hospital-based CUD care were at increased risk of all investigated types of death and particularly elevated risk of death by suicide (aHR, 9.70 [95% CI, 6.04-15.57]), trauma (aHR, 4.55 [95% CI, 3.55-5.82]), opioid poisoning (aHR, 5.03 [95% CI, 2.86-8.84]), other drug poisonings (aHR, 4.56 [95% CI, 3.11-6.68]), and lung cancer (aHR, 3.81 [95% CI, 2.39-6.07]) relative to the general population. Compared with an individual with hospital-based care for CUD, individuals with hospital-based care for alcohol (aHR, 1.30 [95% CI, 1.26-1.34]), stimulants (aHR, 1.69 [95% CI, 1.62-1.75]), and opioids (aHR, 2.19 [95% CI, 2.10-2.27]) were at relatively increased risk of death within 5 years. Conclusions and Relevance In this cohort study of all residents of Ontario, Canada, individuals with incident hospital-based CUD care were at markedly increased risk of death compared with the general population. These findings suggest important clinical and policy implications, given global trends toward cannabis legalization and market commercialization accompanied by increasing cannabis use and CUDs.
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Affiliation(s)
- Daniel T. Myran
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Michael Pugliese
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - André J. McDonald
- Peter Boris Centre for Addictions Research, St Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
- Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, Ontario, Canada
| | - Jennifer Xiao
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Benedikt Fischer
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
- Research & Graduate Studies, University of the Fraser Valley, Abbotsford, British Columbia, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Federal University of Sao Paulo, São Paulo, Brazil
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Yaron Finkelstein
- Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Peter Tanuseputro
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Amir Pakpour
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wing-Chung Chang
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Brain & Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Marco Solmi
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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Kang H, Cheon E, Hwang J, Jo S, Na K, Park SY, Cho SI. Risk of all-cause mortality by various cigarette smoking indices: A longitudinal study using the Korea National Health Examination Baseline Cohort in South Korea. Tob Induc Dis 2025; 23:TID-23-05. [PMID: 39877382 PMCID: PMC11773640 DOI: 10.18332/tid/199670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 12/30/2024] [Accepted: 01/03/2025] [Indexed: 01/31/2025] Open
Abstract
INTRODUCTION Smoking behaviors can be quantified using various indices. Previous studies have shown that these indices measure and predict health risks differently. Additionally, the choice of measure differs depending on the health outcome of interest. We compared how each smoking index predicted all-cause mortality and assessed the goodness-of-fit of each model. METHODS A population-based retrospective cohort, the Korea National Health Examination Baseline Cohort, was used (N=6001607). Data from 2009 were utilized, and the participants were followed until 2021. Cox proportional hazards regression analyses were performed among all participants and ever smokers, respectively, to estimate all-cause mortality. Model fit was assessed by the Akaike Information Criterion. RESULTS For men, smoking intensity showed the strongest effect size (hazard ratio HR=1.16; 95% CI: 1.14-1.18), while pack-years provided the best model fit for all-cause mortality. Among women, smoking intensity showed both the strongest effect size (HR=1.49; 95% CI: 1.28-1.74) and the best model fit. Smoking status (never/former/current) also showed comparable effect sizes (men, HR=1.14; 95% CI: 1.13-1.15; women, HR=1.14; 95% CI: 1.11- 1.18) with fair model fit. Analyses of people who ever smoked indicated that a model incorporating smoking status, duration, and intensity best described the mortality data. CONCLUSIONS The smoking indices showed varying effect sizes and model fits by sex, making it challenging to recommend a single optimal measure. Smoking intensity may be preferred for capturing cumulative exposure, whereas smoking status is notable for its simplicity, comparable effect size, and model fit. Further research that includes biochemical measurements, additional health outcomes, and longer follow-up periods is needed to refine these findings.
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Affiliation(s)
- Heewon Kang
- Institute of Health and Environment, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Eunsil Cheon
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Jieun Hwang
- Department of Health Administration, College of Health Science, Dankook University, Cheonan, Republic of Korea
| | - Suyoung Jo
- Institute of Health and Environment, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Kyoungin Na
- Division of Climate Change and Health Hazard, Korea Disease Control and Prevention Agency, Osong, Republic of Korea
| | - Seong Yong Park
- Department of Big Data Service, National Health Insurance Service, Wonju, Republic of Korea
| | - Sung-il Cho
- Institute of Health and Environment, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
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John U, Rumpf HJ, Hanke M, Meyer C. Estimating mortality attributable to alcohol or tobacco - a cohort study from Germany. Subst Abuse Treat Prev Policy 2025; 20:5. [PMID: 39844184 PMCID: PMC11755885 DOI: 10.1186/s13011-025-00633-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Accepted: 01/02/2025] [Indexed: 01/24/2025] Open
Abstract
BACKGROUND Little is known about mortality from four disorder combinations: fully attributable to alcohol or tobacco, partly attributable to both alcohol and tobacco, to tobacco only, to alcohol only. AIM To analyze whether residents who had disclosed risky alcohol drinking or daily tobacco smoking had a shorter time to death than non-risky drinkers and never daily smokers twenty years later according to the disorder combinations. METHODS A random adult general population sample (4,075 study participants) of a northern German area had been interviewed in the years 1996-1997. Vital status and death certificate data were gathered 2017-2018. The data analysis included estimates of alcohol- or tobacco-attributable mortality using all conditions given in the death certificate and alternatively the underlying cause of death only. RESULTS Among 573 deaths, 71.9-94.1% had any alcohol- or tobacco-attributable disorder depending on the estimate. Risky alcohol consumption and daily tobacco smoking at baseline were related to disorders in the death certificate according to the combinations. Deaths with an alcohol- and tobacco-attributable disorder were related to risky alcohol consumption (subhazard ratio 1.57; 95% confidence interval 1.25-1.98) and to daily tobacco smoking at baseline (subhazard ratio 1.85; 95% confidence interval 1.42-2.41). CONCLUSION First, more than 70% of the deceased persons had one or more alcohol- or tobacco-attributable disorders. This finding suggests that total mortality seems to be the suitable outcome if potential effects of alcohol or tobacco consumption in a general population are to be estimated. Second, the relations of risky alcohol consumption and tobacco smoking with time to death speak in favor of the validity of alcohol- and of tobacco-attributable disorders in death certificates and of considering both alcohol consumption and tobacco smoking if attributable deaths are to be estimated.
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Affiliation(s)
- Ulrich John
- Dep Prevention Research and Social Medicine, University Medicine Greifswald, Institute of Community Medicine, W.-Rathenau-Str. 48, 17475, Greifswald, Germany.
| | - Hans-Jürgen Rumpf
- Department of Psychiatry and Psychotherapy, Research Group S:TEP, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Monika Hanke
- Dep Prevention Research and Social Medicine, University Medicine Greifswald, Institute of Community Medicine, W.-Rathenau-Str. 48, 17475, Greifswald, Germany
| | - Christian Meyer
- Dep Prevention Research and Social Medicine, University Medicine Greifswald, Institute of Community Medicine, W.-Rathenau-Str. 48, 17475, Greifswald, Germany
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Coyle D. Implementing a smoke-free generation policy for Canada: estimates of the long-term impacts. Health Promot Chronic Dis Prev Can 2025; 45:39-53. [PMID: 39817710 PMCID: PMC11785163 DOI: 10.24095/hpcdp.45.1.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2025]
Abstract
INTRODUCTION The aim of this study was to assess the potential impacts of the introduction of a smoke-free generation (SFG) policy in Canada with a perpetual ban on cigarette sales to anyone born after 2009 instigated on 1 January 2025. METHODS An existing Canadian model relating to smoking cessation was adapted and augmented to assess the impact of an SFG policy on quality-adjusted life years (QALYs), life expectancy, health care costs, smoking-related taxes, and Canadian tobacco industry gross domestic product (GDP). The cumulative impact of the policy for the entire Canadian population was assessed for time horizons up to 90 years with an annual discount rate of 1.5%. RESULTS After 50 years, this SFG policy would lead to 476 814 more QALYs, $2.3 billion less in health care costs, $7.4 billion less in smoking-related taxes and a $3.1 billion reduction in tobacco industry GDP. The combined value of health benefits gained and health care costs averted would exceed the sum of tax revenues foregone and reduced GDP, if the value of a QALY was at least $17 147. Use of higher discount rates and inclusion of unrelated health care costs had little impact on the interpretation of the results. CONCLUSION The implementation of an SFG policy will bring substantive health benefits to the population in Canada. Although health care cost savings are lower than the combination of lost tax revenues and the decline in the GDP from the Canadian tobacco industry, the value of the health benefits realized outweigh the negative offsets.
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Affiliation(s)
- Doug Coyle
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Spangler J, Skidmore E, Dressler EV, Weaver KE, Lesser GJ, Burton G, Esparaz B, Gillett B, Shaw EG. Randomized Placebo-Controlled Trial of Memantine for Smoking Cessation (CCCWFU 99311). Cancer Control 2025; 32:10732748251336416. [PMID: 40340434 PMCID: PMC12062594 DOI: 10.1177/10732748251336416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 03/14/2025] [Accepted: 04/02/2025] [Indexed: 05/10/2025] Open
Abstract
IntroductionQuitting smoking is challenging even with existing pharmacotherapy. Thus, discovery of new cessation medications is imperative. Memantine, a well-tolerated Alzheimer's disease drug, partially antagonizes glutamate at the N-methyl-D-Aspartate receptor (NMDAR), modulating dopamine release in addiction pathways. Memantine may interrupt nicotine reward and promote smoking cessation.Materials and MethodsAt 23 community oncology practices nationwide, we recruited 130 breast, prostate, lung, or colorectal cancer survivors ≥ six months beyond definitive treatment who currently smoked at least 10 cigarettes daily and wanted to quit. In a double-blind fashion, participants were randomized to take either memantine (10 mg) or a matching placebo twice daily for 12 weeks (65 per arm). Toxicity, nicotine dependence, and past-week abstinence were recorded at 2, 4-, 6-, 9-, and 12-weeks post-randomization. The primary endpoint was feasibility and preliminary estimation of 12-week self-reported past-week smoking abstinence.ResultsThere were no significant differences in abstinence rates or nicotine dependence between the two groups at 12 weeks. Twelve-week completion of therapy was low, but lower in memantine than control participants (42% vs 63%, respectively; P = .01). Memantine participants reported trends of less anxiety, craving, and hunger. No significant differences in toxicity were observed between groups. Serious adverse events (3 in memantine arm, 1 in control arm) occurred; none considered possibly or probably related to study medication.ConclusionMemantine did not improve 12-week smoking abstinence rates in cancer survivors. While other NMDAR antagonists might deserve evaluation, this study suggests memantine is not efficacious for smoking cessation in a cancer survivor subpopulation.Trial registration numberNCT01535040 - February 17, 2012.
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Affiliation(s)
- John Spangler
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Elizabeth Skidmore
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Emily V. Dressler
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Kathryn E. Weaver
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Glenn J. Lesser
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Gary Burton
- Division of Hematology and Oncology, Louisiana State University Feist-Weiller Cancer Center, Shreveport, LA, USA
| | - Benjamin Esparaz
- Central Illinois Community Clinical Oncology Program, Cancer Care Specialists of Central Illinois, Decatur, IL, USA
| | - Brooke Gillett
- Central Illinois Community Clinical Oncology Program, Cancer Care Specialists of Central Illinois, Decatur, IL, USA
- Cancer Research for the Ozarks NCORP, Oncology Hematology Associates, Springfield, MO, USA
| | - Edward G. Shaw
- Department of Internal Medicine, Section of Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Li Y, Lai W, Zhao H, Zhong X, Guo L. Time from waking to the first cigarette and mortality and incident cardiovascular disease. J Public Health (Oxf) 2024; 46:487-497. [PMID: 39237361 DOI: 10.1093/pubmed/fdae242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 08/15/2024] [Accepted: 08/21/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND This study aimed to investigate the associations of time from waking to the first cigarette (TWFC) with all-cause mortality, cardiovascular disease (CVD) mortality and incident CVD among people smoking. METHODS Data were from the UK Biobank, including 32 519 people smoking aged 40-70 years. TWFC was investigated using a touch-screen questionnaire. Outcomes included all-cause mortality and mortality from and incidence of CVD, ischemic heart disease (IHD) and stroke. RESULTS Compared with participants reporting TWFC >120 min, those reporting TWFC between 61 and 120 min (HR, 1.30; 95% CI, 1.10-1.53), TWFC between 5 and 60 min (1.48, 1.30-1.70) and TWFC <5 min (1.65, 1.42-1.93) had a higher risk of all-cause mortality. Compared with participants reporting TWFC >120 min, those reporting TWFC between 5 and 60 min and TWFC <5 min had higher risks of CVD and IHD mortality and incident CVD and IHD, but those reporting TWFC between 61 and 120 min did not. The associations of TWFC with stroke mortality and incident stroke were not observed. CONCLUSION In this cohort study, a shorter TWFC was associated with higher risks of all-cause mortality, mortality from CVD and IHD, as well as incident CVD and IHD.
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Affiliation(s)
- Yanzhi Li
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou 510080, China
| | - Wenjian Lai
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou 510080, China
| | - Hao Zhao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou 510080, China
| | - Xiali Zhong
- Department of Toxicology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou 510080, China
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11
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Klopack ET, Crimmins EM. Epigenetic Aging Helps Explain Differential Resilience in Older Adults. Demography 2024; 61:1023-1041. [PMID: 39012228 PMCID: PMC11485224 DOI: 10.1215/00703370-11466635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
Past research suggests that resilience to health hazards increases with age, potentially because less resilient individuals die at earlier ages, leaving behind their more resilient peers. Using lifetime cigarette smoking as a model health hazard, we examined whether accelerated epigenetic aging (indicating differences in the speed of individuals' underlying aging process) helps explain age-related resilience in a nationally representative sample of 3,783 older U.S. adults from the Health and Retirement Study. Results of mediation moderation analyses indicated that participants aged 86 or older showed a weaker association between lifetime cigarette smoking and mortality relative to participants aged 76-85 and a weaker association between smoking and multimorbidity relative to all younger cohorts. This moderation effect was mediated by a reduced association between smoking pack-years and epigenetic aging. This research helps identify subpopulations of particularly resilient individuals and identifies epigenetic aging as a potential mechanism explaining this process. Interventions in younger adults could utilize epigenetic aging estimates to identify the most vulnerable individuals and intervene before adverse health outcomes, such as chronic disease morbidity or mortality, manifest.
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Affiliation(s)
- Eric T Klopack
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Eileen M Crimmins
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
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12
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Odeny L, Gathecha G, Mwenda V, Kendagor A, Cheburet S, Mugi B, Mithi C, Jaguga F, Okinda K, Devotsu RK, Mohamed SF, Ong’ang’o JR. Tobacco smoking-attributable mortality in Kenya, 2012-2021. Tob Induc Dis 2024; 22:TID-22-134. [PMID: 39050115 PMCID: PMC11267916 DOI: 10.18332/tid/186170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 04/10/2023] [Accepted: 03/16/2024] [Indexed: 07/27/2024] Open
Abstract
INTRODUCTION Tobacco smoking poses a significant risk for various diseases, including cardiovascular diseases, chronic respiratory diseases, and cancers. In Kenya, tobacco-related deaths contribute substantially to non-communicable disease mortality. This study aims to quantify the mortality attributed to tobacco smoking in Kenya from 2012 to 2021. METHODS Employing a prevalence-based analysis model, the study utilized population attributable fraction (PAF) to estimate age-specific smoke attributable mortality (SAM) rates for individuals aged ≥35 years. Causes of death associated with tobacco use, including cancers, cardiovascular diseases, respiratory diseases, tuberculosis, and diabetes, were analyzed based on age, sex, and death records between 2012 and 2021. RESULTS Over the study period, 60228 deaths were attributed to tobacco-related diseases, with an annual increase observed until 2016 and subsequent fluctuations. Respiratory diseases, diabetes mellitus, malignant cancers, tuberculosis, and cardiovascular diseases collectively accounted for 16.5% of deaths among individuals aged ≥35 years. Notable contributors were pneumonia and influenza (respiratory diseases), esophageal cancer (cancers), and cerebrovascular diseases (cardiovascular diseases). Of the observed deaths, 16.5% were attributed to smoking, with respiratory diseases (40.5%), malignant cancers (31.4%), tuberculosis (13%), cardiovascular diseases (8.9%), and diabetes mellitus (6.1%) contributing. Pneumonia and influenza, esophageal cancer, chronic airway obstruction, and tuberculosis were primary causes, comprising 70% of all SAM. CONCLUSIONS Tobacco-related mortality is a significant public health concern in Kenya. Efforts should focus on preventing tobacco use and managing associated disease burdens. Smoking cessation initiatives and comprehensive tobacco control measures are imperative to mitigate the impact on population health.
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Affiliation(s)
- Lazarus Odeny
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Gladwell Gathecha
- Division of Non-communicable Diseases, Kenya Ministry of Health, Nairobi, Kenya
| | - Valerian Mwenda
- Division of Non-communicable Diseases, Kenya Ministry of Health, Nairobi, Kenya
| | - Anne Kendagor
- Division of Non-communicable Diseases, Kenya Ministry of Health, Nairobi, Kenya
| | - Samuel Cheburet
- Division of Non-communicable Diseases, Kenya Ministry of Health, Nairobi, Kenya
| | - Beatrice Mugi
- Radiology Department, Kenyatta National Hospital, Nairobi, Kenya
| | - Caroline Mithi
- Internal Medicine Department, Kenyatta University Teaching, Referral and Research Hospital, Nairobi, Kenya
| | - Florence Jaguga
- Alcohol and Drug Abuse Rehabilitation Services Department, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Kennedy Okinda
- Research and Program Department, Kenyatta National Hospital, Othaya, Kenya
| | | | - Shukri F. Mohamed
- Chronic Disease Management Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Jane Rahedi Ong’ang’o
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Kisumu, Kenya
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13
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Hwang J, Jo S, Cheon E, Kang H, Cho SI. Dose-response risks of all-cause, cancer, and cardiovascular disease mortality according to sex-specific cigarette smoking pack-year quantiles. Tob Induc Dis 2024; 22:TID-22-127. [PMID: 38988742 PMCID: PMC11234345 DOI: 10.18332/tid/189952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 06/06/2024] [Accepted: 06/11/2024] [Indexed: 07/12/2024] Open
Abstract
INTRODUCTION This study investigated the risks for all-cause death and death from cancer or cardiovascular diseases due to smoking status and behavior, focusing on differences in smoking duration and amount stratified by sex. METHODS The integrated Korean Genome and Epidemiology Study provided data for 209770 individuals who were classified as never, former, or current smokers, based on their current smoking status. Pack-years were computed using daily average smoking amount and total smoking duration, and were categorized into quantiles separately for men and women. Based on the number of deaths in 2018, hazard ratios (HRs) were estimated for all-cause mortality, as well as for death caused by all cancers, lung cancer, and cardiovascular diseases according to pack-years adjusted for age, household income, marital status, body mass index, physical activity, and alcohol consumption. RESULTS A significant increase in the risk of all-cause mortality was observed for current smokers (men HR=1.90; 95% CI: 1.69-2.14; women HR=2.25; 95% CI: 1.68-2.99) and former smokers (men HR=1.31; 95% CI: 1.17-1.47; women HR=2.35; 95% CI: 1.63-3.39) compared with that for those who had never smoked. Among men, HR for death from lung cancer was 3.13 (95% CI: 2.06-4.75) in former smokers and tended to increase with each pack-year quantile (range HR: 5.72-17.11). Among women, the HR was estimated to be 17.20 (95% CI: 6.22-47.57) only for >3rd quantile. CONCLUSIONS Smoking increases the risks of all-cause death. Considering the persistent risks post-smoking cessation, it is vital to focus on preventing smoking initiation and providing proactive support for successful smoking cessation and maintenance of a smoke-free lifestyle.
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Affiliation(s)
- Jieun Hwang
- Department of Health Administration, College of Health Science, Dankook University, Cheonan, Republic of Korea
- Institute of Convergence Healthcare, Dankook University, Cheonan, Republic of Korea
| | - Suyoung Jo
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
| | - Eunsil Cheon
- Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Heewon Kang
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
| | - Sung-Il Cho
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
- Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
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14
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Kendzor DE, Businelle MS, Frank-Pearce SG, Waring JJC, Chen S, Hébert ET, Swartz MD, Alexander AC, Sifat MS, Boozary LK, Wetter DW. Financial Incentives for Smoking Cessation Among Socioeconomically Disadvantaged Adults: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2418821. [PMID: 38954415 PMCID: PMC11220567 DOI: 10.1001/jamanetworkopen.2024.18821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/23/2024] [Indexed: 07/04/2024] Open
Abstract
Importance Socioeconomically disadvantaged individuals (ie, those with low socioeconomic status [SES]) have difficulty quitting smoking and may benefit from incentive-based cessation interventions. Objectives To evaluate the impact of incentivizing smoking abstinence on smoking cessation among adults with low SES. Design, Setting, and Participants This study used a 2-group randomized clinical trial design. Data collection occurred between January 30, 2017, and February 7, 2022. Participants included adults with low SES who were willing to undergo smoking cessation treatment. Data were analyzed from April 18, 2023, to April 19, 2024. Interventions Participants were randomized to usual care (UC) for smoking cessation (counseling plus pharmacotherapy) or UC plus abstinence-contingent financial incentives (UC plus FI). Main Outcomes and Measures The primary outcome was biochemically verified 7-day point prevalence smoking abstinence (PPA) at 26 weeks after the quit date. Secondary outcomes included biochemically verified 7-day PPA at earlier follow-ups, 30-day PPA at 12 and 26 weeks, repeated 7-day PPA, and continuous abstinence. Multiple approaches were employed to handle missing outcomes at follow-up, including categorizing missing data as smoking (primary), complete case analysis, and multiple imputation. Results The 320 participants had a mean (SD) age of 48.9 (11.6) and were predominantly female (202 [63.1%]); 82 (25.6%) were Black, 15 (4.7%) were Hispanic, and 200 (62.5%) were White; and 146 (45.6%) participated during the COVID-19 pandemic. Overall, 161 were randomized to UC and 159 were randomized to UC plus FI. After covariate adjustment with missing data treated as smoking, assignment to UC plus FI was associated with a greater likelihood of 7-day PPA at the 4-week (adjusted odds ratio [AOR], 3.11 [95% CI, 1.81-5.34]), 8-week (AOR, 2.93 [95% CI, 1.62-5.31]), and 12-week (AOR, 3.18 [95% CI, 1.70-5.95]) follow-ups, but not at the 26-week follow-up (22 [13.8%] vs 14 [8.7%] abstinent; AOR, 1.79 [95% CI, 0.85-3.80]). However, the association of group assignment with smoking cessation reached statistical significance at all follow-ups, including 26 weeks, with multiple imputation (37.37 [23.5%] in the UC plus FI group vs 19.48 [12.1%] in the UC group were abstinent; AOR, 2.29 [95% CI, 1.14-4.63]). Repeated-measures analyses indicated that participants in the UC plus FI group were significantly more likely to achieve PPA across assessments through 26 weeks with all missing data estimation methods. Other secondary cessation outcomes also showed comparable patterns across estimation methods. Participants earned a mean (SD) of $72 ($90) (of $250 possible) in abstinence-contingent incentives. Participation during the COVID-19 pandemic reduced the likelihood of cessation across assessments. Conclusions and Relevance In this randomized clinical trial, incentivizing smoking cessation did not increase cessation at 26 weeks when missing data were treated as smoking; however, the UC plus FI group had greater odds of quitting at follow-ups through 12 weeks. Cessation rates were higher for the UC plus FI group at all follow-ups through 26 weeks when multiple imputation was used to estimate missing outcomes. Trial Registration ClinicalTrials.gov Identifier: NCT02737566.
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Affiliation(s)
- Darla E. Kendzor
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City
- TSET (Tobacco Settlement Endowment Trust) Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Michael S. Businelle
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City
- TSET (Tobacco Settlement Endowment Trust) Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Summer G. Frank-Pearce
- TSET (Tobacco Settlement Endowment Trust) Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Joseph J. C. Waring
- Department of Mental Health, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland
| | - Sixia Chen
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Emily T. Hébert
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Austin
| | - Michael D. Swartz
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston
| | - Adam C. Alexander
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City
- TSET (Tobacco Settlement Endowment Trust) Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Munjireen S. Sifat
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Laili Kharazi Boozary
- TSET (Tobacco Settlement Endowment Trust) Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City
| | - David W. Wetter
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City
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15
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Carbonneau M, Li Y, Prescott B, Liu C, Huan T, Joehanes R, Murabito JM, Heard‐Costa NL, Xanthakis V, Levy D, Ma J. Epigenetic Age Mediates the Association of Life's Essential 8 With Cardiovascular Disease and Mortality. J Am Heart Assoc 2024; 13:e032743. [PMID: 38808571 PMCID: PMC11255626 DOI: 10.1161/jaha.123.032743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/25/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Life's Essential 8 (LE8) is an enhanced metric for cardiovascular health. The interrelations among LE8, biomarkers of aging, and disease risks are unclear. METHODS AND RESULTS LE8 score was calculated for 5682 Framingham Heart Study participants. We implemented 4 DNA methylation-based epigenetic age biomarkers, with older epigenetic age hypothesized to represent faster biological aging, and examined whether these biomarkers mediated the associations between the LE8 score and cardiovascular disease (CVD), CVD-specific mortality, and all-cause mortality. We found that a 1 SD increase in the LE8 score was associated with a 35% (95% CI, 27-41; P=1.8E-15) lower risk of incident CVD, a 36% (95% CI, 24-47; P=7E-7) lower risk of CVD-specific mortality, and a 29% (95% CI, 22-35; P=7E-15) lower risk of all-cause mortality. These associations were partly mediated by epigenetic age biomarkers, particularly the GrimAge and the DunedinPACE scores. The potential mediation effects by epigenetic age biomarkers tended to be more profound in participants with higher genetic risk for older epigenetic age, compared with those with lower genetic risk. For example, in participants with higher GrimAge polygenic scores (greater than median), the mean proportion of mediation was 39%, 39%, and 78% for the association of the LE8 score with incident CVD, CVD-specific mortality, and all-cause mortality, respectively. No significant mediation was observed in participants with lower GrimAge polygenic score. CONCLUSIONS DNA methylation-based epigenetic age scores mediate the associations between the LE8 score and incident CVD, CVD-specific mortality, and all-cause mortality, particularly in individuals with higher genetic predisposition for older epigenetic age.
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Affiliation(s)
- Madeleine Carbonneau
- Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood InstituteNational Institutes of HealthBethesdaMD
- Framingham Heart StudyFraminghamMA
| | - Yi Li
- Department of BiostatisticsBoston University School of Public HealthBostonMA
| | - Brenton Prescott
- Section of Preventive Medicine and EpidemiologyBoston University School of MedicineBostonMA
| | - Chunyu Liu
- Department of BiostatisticsBoston University School of Public HealthBostonMA
| | - Tianxiao Huan
- Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood InstituteNational Institutes of HealthBethesdaMD
- Framingham Heart StudyFraminghamMA
| | - Roby Joehanes
- Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood InstituteNational Institutes of HealthBethesdaMD
- Framingham Heart StudyFraminghamMA
| | - Joanne M. Murabito
- Framingham Heart StudyFraminghamMA
- Department of MedicineSection of General Internal Medicine Boston University Chobanian & Avedisian School of Medicine, Boston, MA and Boston Medical CenterBostonMA
| | - Nancy L. Heard‐Costa
- Department of MedicineSection of General Internal Medicine Boston University Chobanian & Avedisian School of Medicine, Boston, MA and Boston Medical CenterBostonMA
| | - Vanessa Xanthakis
- Framingham Heart StudyFraminghamMA
- Department of BiostatisticsBoston University School of Public HealthBostonMA
- Section of Preventive Medicine and EpidemiologyBoston University School of MedicineBostonMA
| | - Daniel Levy
- Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood InstituteNational Institutes of HealthBethesdaMD
- Framingham Heart StudyFraminghamMA
| | - Jiantao Ma
- Nutrition Epidemiology and Data Science, Friedman School of Nutrition Science and PolicyTufts UniversityBostonMA
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16
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Borrell LN, Echeverria SE. The clustering effects of current smoking status, overweight/obesity, and physical inactivity with all-cause and cause-specific mortality risks in U.S. adults. Prev Med Rep 2024; 42:102742. [PMID: 38764759 PMCID: PMC11101885 DOI: 10.1016/j.pmedr.2024.102742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/20/2024] [Accepted: 04/22/2024] [Indexed: 05/21/2024] Open
Abstract
Objective To estimate the associations of smoking, weight status and physical inactivity with all-cause and cause-specific deaths, and the advanced rate period (RAP) to determine how early death was advanced among United States (U.S.) adults aged 18 years or older. Methods We used data from the third National Health and Nutrition Examination Survey (NHANES III) and the 2019 Linked Mortality File (LMF) with a follow-up period of 21.6 years (n = 16,612, including 7,278 deaths). Smoking, weight status, and physical inactivity were obtained from NHANES III and mortality outcomes from the 2019 LMF. Cox regression was used to estimate hazard ratios, RAPs and their corresponding confidence intervals. Results For adults who currently smoke, were obese and physically inactive, the rate of dying from all-cause, CVD, and cancer was at least 231 % greater than for those who never smoked, were normal weight and physically active. The RAPs associated with the clustering of these risk factors for all cause, CVD- and cancer-specific cause of deaths were 13.0, 12.1 and 18.9 years older, respectively. Conclusions Our findings underscore the need to focus on modifiable risk factors for illness prevention and health promotion and call attention to the increasing clustering of unhealthy risk factors in the U.S. population.
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Affiliation(s)
- Luisa N. Borrell
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, USA
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcala, Alcalá de Henares, Spain
| | - Sandra E. Echeverria
- Department of Public Health Education, The University of North Carolina at Greensboro, North Carolina, NC, USA
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Anders J, Carpenter CW, Willyard KA, DeSalvo B. A Research Note on Community Resilience Estimates: New U.S. Census Bureau Data With an Application to Excess Deaths From COVID-19. Demography 2024; 61:627-642. [PMID: 38779962 DOI: 10.1215/00703370-11374710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
In this research note, we describe the results of the first validation study of the U.S. Census Bureau's new Community Resilience Estimates (CRE), which uses Census microdata to develop a tract-level vulnerability index for the United States. By employing administrative microdata to link Social Security Administration mortality records to CRE, we show that CRE quartiles provide more stable predictions of COVID-19 excess deaths than single demographic categorizations such as race or age, as well as other vulnerability measures including the U.S. Centers for Disease Control and Prevention's Social Vulnerability Index (SVI) and the Federal Emergency Management Agency's National Risk Index (NRI). We also use machine learning techniques to show that CRE provides more predictive power of COVID-19 excess deaths than standard socioeconomic predictors of vulnerability such as poverty and unemployment, as well as SVI and NRI. We find that a 10-percentage-point increase in a key CRE risk measure is associated with one additional death per neighborhood during the initial outbreak of COVID-19 in the United States. We conclude that, compared with alternative measures, CRE provides a more accurate predictor of community vulnerability to a disaster such as a pandemic.
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Affiliation(s)
- John Anders
- Department of Economics, Trinity University, San Antonio, TX, USA
- Social, Economic, and Housing Statistics Division, U.S. Census Bureau, Washington, DC, USA
| | - Craig Wesley Carpenter
- Department of Agricultural, Food, and Resource Economics, Michigan State University, East Lansing, MI, USA
- Social, Economic, and Housing Statistics Division, U.S. Census Bureau, Washington, DC, USA
| | - Katherine Ann Willyard
- Social, Economic, and Housing Statistics Division, U.S. Census Bureau, Washington, DC, USA
| | - Bethany DeSalvo
- Social, Economic, and Housing Statistics Division, U.S. Census Bureau, Washington, DC, USA
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18
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Schöttl SE, Insam K, Frühauf A, Kopp-Wilfling P, Holzner B, Kopp M. Acute effects of outdoor and indoor walking on cigarette cravings, withdrawal symptoms and affective response during temporary smoking abstinence. Psychopharmacology (Berl) 2024; 241:739-752. [PMID: 38001265 PMCID: PMC10927848 DOI: 10.1007/s00213-023-06506-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023]
Abstract
RATIONALE Cigarette smoking is one of the leading preventable causes of premature death worldwide. There is evidence in the literature that brief exercise units indoors can improve well-being in temporarily abstinent smokers and reduce cigarette cravings and withdrawal symptoms. OBJECTIVE Because exercise in natural environments showed enhanced psychological effects, the aim of our study was to examine the acute effects of outdoor exercise compared with indoor exercise on craving, withdrawal symptoms and affective response in temporarily abstinent smokers. METHODS In a randomized controlled within-subject-design, temporarily abstinent smokers (N = 16) participated in three interventions lasting 10 min: outdoor walking (OUT-EX), indoor walking (IN-EX) and a sedentary control condition (CC). Self-reported cigarette craving, withdrawal symptoms and affective response were assessed pre-, mid-, post-interventions and at follow-up. RESULTS In contrast to CC, OUT-EX and IN-EX significantly reduced cigarette cravings during and at the end of the intervention compared to pre-intervention, but not at 20 min follow-up. Cigarette withdrawal symptoms decreased significantly over time in all three groups, but no significant group differences were found. OUT-EX and IN-EX, but not CC, showed significantly improved affective valence at the end of the intervention and at follow-ups. Outdoor walking resulted in significantly lower cigarette cravings than indoor walking at the end of the intervention. CONCLUSION The study adds to existing evidence that short bouts of indoor or outdoor exercise can help reduce cigarette cravings and increase well-being in abstinent smokers. Further studies are needed to address the potential additional effect of outdoor exercise on craving, affective states and smoking cessation.
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Affiliation(s)
- Stefanie E Schöttl
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria.
| | - Kathrin Insam
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria
| | - Anika Frühauf
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria
| | - Prisca Kopp-Wilfling
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatry I, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Bernhard Holzner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatry I, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Martin Kopp
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria
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Hill TD, Bostean G, Upenieks L, Bartkowski JP, Ellison CG, Burdette AM. (Un)holy Smokes? Religion and Traditional and E-Cigarette Use in the United States. JOURNAL OF RELIGION AND HEALTH 2024; 63:1334-1359. [PMID: 36520262 PMCID: PMC9753896 DOI: 10.1007/s10943-022-01721-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/08/2022] [Indexed: 06/17/2023]
Abstract
This study employed national cross-sectional survey data from the 2021 Crime, Health, and Politics Survey (n = 1578 to 1735) to model traditional cigarette and e-cigarette use as a function of religious affiliation, general religiosity, biblical literalism, religious struggles, and the sense of divine control. Although the odds of abstaining from cigarettes and e-cigarettes were comparable for conservative Protestants and non-affiliates, conservative Protestants were more likely to cut down on cigarettes and e-cigarettes during the pandemic. Religiosity increased the odds of abstaining from cigarettes (not e-cigarettes) and reduced pandemic consumption of cigarettes and e-cigarettes. Biblical literalism was unrelated to abstaining from cigarettes and pandemic changes in cigarette use; however, biblical literalists were more likely to cut e-cigarette use during the pandemic. While the sense of divine control was unrelated to abstaining from cigarettes and e-cigarettes, these beliefs increased the odds of cessation from traditional and e-cigarette use. Finally, our religious struggles index was unrelated to smoking behavior. Our study is among the first to report any association between religion and lower e-cigarette use.
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Affiliation(s)
- Terrence D. Hill
- Department of Sociology, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249-1644 USA
| | - Georgiana Bostean
- Department of Sociology and Environmental Science & Policy Program, Chapman University, Orange, USA
| | | | - John P. Bartkowski
- Department of Sociology, University of Texas at San Antonio, San Antonio, USA
| | | | - Amy M. Burdette
- Department of Sociology and Public Health Program, Florida State University, Tallahassee, USA
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Govori V, Budinčević H, Morović S, Đerke F, Demarin V. Updated Perspectives on Lifestyle Interventions as Secondary Stroke Prevention Measures: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:504. [PMID: 38541229 PMCID: PMC10972452 DOI: 10.3390/medicina60030504] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/13/2024] [Accepted: 03/16/2024] [Indexed: 01/03/2025]
Abstract
Despite being highly preventable, stroke is the second-most common cause of death and disability in the world. Secondary prevention is critical as the stroke recurrence risk is 6- to 15-fold higher than the risk of stroke in the general population. Stroke recurrence is associated with higher mortality rates and increased disability levels. Lifestyle modifications should address not single but multiple cardiovascular risk factors to effectively reduce the risk of stroke. Lifestyle modifications on a personal level should include adequate physical activity, a healthy diet, the cessation of smoking and alcohol consumption, and stress reduction. Physical activities should be performed in a healthy environment without air pollution. According to recent studies, up to 90% of strokes might be prevented by addressing and treating ten modifiable stroke risk factors, half of which are related to lifestyle modifications. These lifestyle modifications, which are behavioral interventions, could impact other modifiable risk factors such as arterial hypertension, hyperlipidemia, obesity, diabetes, and atrial fibrillation. The most common obstacles to effective secondary stroke prevention are motor impairment, post-stroke cognitive impairment, post-stroke depression, and stroke subtype. Long-term lifestyle modifications are difficult to sustain and require comprehensive, individualized interventions. This review underlines the benefits of adhering to lifestyle modifications as the most effective secondary stroke prevention measure.
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Affiliation(s)
- Valbona Govori
- Department of Neurology, University Clinical Center, 10000 Prishtina, Kosovo
| | - Hrvoje Budinčević
- Department of Neurology, Sveti Duh University Hospital, 10000 Zagreb, Croatia
- Department of Neurology and Neurosurgery, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
| | | | - Filip Đerke
- Department of Neurology, Dubrava University Hospital, 10000 Zagreb, Croatia
| | - Vida Demarin
- International Institute for Brain Health, 10000 Zagreb, Croatia
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21
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Dudukina E, Horváth-Puhó E, Sørensen HT, Ehrenstein V. Association between pregnancy affected by vaginal bleeding and women's mortality: A cohort study. BJOG 2024; 131:175-188. [PMID: 37519289 DOI: 10.1111/1471-0528.17623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE To investigate the association between vaginal bleeding (VB) in pregnancy and women's mortality, using VB-unaffected pregnancies, terminations and miscarriages as comparators. DESIGN Observational cohort study. SETTING Nationwide registries of Denmark linked at an individual level. POPULATION OR SAMPLE 1 354 181 women and their 3 162 317 pregnancies (1979-2017), including 70 835 VB-affected pregnancies and comparators: 2 236 359 VB-unaffected pregnancies ending in childbirth; 589 697 terminations; and 265 426 miscarriages. METHODS We followed pregnancies until the earliest date of woman's death, emigration or end of data. MAIN OUTCOME MEASURES All-cause and cause-specific mortality rates per 10 000 person-years (PY) and hazard ratios (HRs) with 95% confidence intervals (CIs) adjusted using Cox proportional hazards regression for age, calendar year, pre-existing chronic conditions and socio-economic factors. RESULTS There were 2320 deaths from any cause among women following VB-affected pregnancy (mortality rate 15.2, 95% CI 14.6-15.9 per 10 000 PY); 55 030 deaths following VB-unaffected pregnancy (mortality rate 12.7, 95% CI 12.6-12.8); 27 500 deaths following a termination (mortality rate 21.9, 95% CI 21.6-22.1), and 10 865 deaths following a miscarriage (mortality rate 19.2, 95% CI 18.8-19.6). For comparison of VB-affected versus VB-unaffected pregnancies, associations with all-cause (HR 1.14, 95% CI 1.09-1.19), natural causes (HR 1.15, 95% CI 1.09-1.22) and non-natural causes (HR 1.27, 95% CI 1.08-1.48) mortality were attenuated in a sensitivity analysis of pregnancies recorded in 1994-2017 (HR 1.00, 95% CI 0.90-1.12, HR 0.98, 95% CI 0.85-1.14 and HR 1.04, 95% CI 0.72-1.51, respectively). Contrasts with remaining comparators did not suggest increased risks of all-cause, natural or non-natural mortality causes. CONCLUSION We found no evidence of an increased risk of women's mortality following VB-affected versus VB-unaffected pregnancy, termination or miscarriage.
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Affiliation(s)
- Elena Dudukina
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Erzsébet Horváth-Puhó
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
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22
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Burton R, Fryers PT, Sharpe C, Clarke Z, Henn C, Hydes T, Marsden J, Pearce-Smith N, Sheron N. The independent and joint risks of alcohol consumption, smoking, and excess weight on morbidity and mortality: a systematic review and meta-analysis exploring synergistic associations. Public Health 2024; 226:39-52. [PMID: 38000113 DOI: 10.1016/j.puhe.2023.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVE Alcohol consumption, smoking, and excess weight independently increase the risk of morbidity/mortality. Less is known about how they interact. This research aims to quantify the independent and joint associations of these exposures across health outcomes and identify whether these associations are synergistic. STUDY DESIGN The protocol for this systematic review and meta-analysis was pre-registered (PROSPERO CRD42021231443). METHODS Medline and Embase were searched between 1 January 2010 and 9 February 2022. Eligible peer-reviewed observational studies had to include adult participants from Organisation for Co-Operation and Development countries and report independent and joint associations between at least two eligible exposures (alcohol, smoking, and excess weight) and an ICD-10 outcome (or equivalent). For all estimates, we calculated the synergy index (SI) to identify whether joint associations were synergistic. Meta-analyses were conducted for outcomes with sufficiently homogenous data. RESULTS The search returned 26,290 studies, of which 98 were included. Based on 138,130 participants, the combined effect (SI) of alcohol and smoking on head and neck cancer death/disease was 3.78 times greater than the additive effect of each exposure (95% confidence interval [CI] = 2.61, 5.48). Based on 2,603,939 participants, the combined effect of alcohol and excess weight on liver disease/death was 1.55 times greater than the additive effect of each exposure (95% CI = 1.33, 1.82). CONCLUSION Synergistic associations suggest the true population-level risk may be underestimated. In the absence of bias, individuals with multiple risks would experience a greater absolute risk reduction from an intervention that targets a single exposure than individuals with a single risk.
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Affiliation(s)
- R Burton
- Office for Health Improvement and Disparities (OHID), London, England, United Kingdom; Institute of Psychiatry, Psychology, and Neuroscience, Kings College London, London, England, United Kingdom.
| | - P T Fryers
- Office for Health Improvement and Disparities (OHID), London, England, United Kingdom
| | - C Sharpe
- Office for Health Improvement and Disparities (OHID), London, England, United Kingdom
| | - Z Clarke
- Office for Health Improvement and Disparities (OHID), London, England, United Kingdom
| | - C Henn
- Office for Health Improvement and Disparities (OHID), London, England, United Kingdom
| | - T Hydes
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University Hospital Aintree NHS Foundation Trust, University of Liverpool, Liverpool, England, United Kingdom
| | - J Marsden
- Institute of Psychiatry, Psychology, and Neuroscience, Kings College London, London, England, United Kingdom
| | - N Pearce-Smith
- Knowledge and Library Services, UK Health Security Agency, London, England, United Kingdom
| | - N Sheron
- Office for Health Improvement and Disparities (OHID), London, England, United Kingdom; Institute of Liver Studies, Kings College London School of Medicine at King's College Hospital, London, England, United Kingdom
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Syrnioti G, Eden CM, Johnson JA, Alston C, Syrnioti A, Newman LA. Social Determinants of Cancer Disparities. Ann Surg Oncol 2023; 30:8094-8104. [PMID: 37723358 DOI: 10.1245/s10434-023-14200-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/09/2023] [Indexed: 09/20/2023]
Abstract
Cancer is a major public health issue that is associated with significant morbidity and mortality across the globe. At its root, cancer represents a genetic aberration, but socioeconomic, environmental, and geographic factors contribute to different cancer outcomes for selected population subsets. The disparities in the delivery of healthcare affect all aspects of cancer management from early prevention to end-of-life care. In an effort to address the inequality in the delivery of healthcare among socioeconomically disadvantaged populations, the World Health Organization defined social determinants of health (SDOH) as conditions in which people are born, live, work, and age. These factors play a significant role in the disproportionate cancer burden among different population groups. SDOH are associated with disparities in risk factor burden, screening modalities, diagnostic testing, treatment options, and quality of life of patients with cancer. The purpose of this article is to describe a more holistic and integrated approach to patients with cancer and address the disparities that are derived from their socioeconomic background.
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Affiliation(s)
- Georgia Syrnioti
- Department of Surgery, New York Presbyterian, Weill Cornell Medicine, New York, NY, USA.
- Department of Surgery, One Brooklyn Health-Brookdale University Hospital and Medical Center, Brooklyn, NY, USA.
| | - Claire M Eden
- Department of Surgery New York Presbyterian Queens, Weill Cornell Medicine, Flushing, NY, USA
| | - Josh A Johnson
- Department of Surgery, New York Presbyterian, Weill Cornell Medicine, New York, NY, USA
| | - Chase Alston
- Department of Surgery, New York Presbyterian, Weill Cornell Medicine, New York, NY, USA
| | - Antonia Syrnioti
- Department of Pathology, School of Medicine, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - Lisa A Newman
- Department of Surgery, New York Presbyterian, Weill Cornell Medicine, New York, NY, USA
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24
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Wang Y, Liu X, Xue T, Chen Y, Yang Q, Tang Z, Chen L, Zhang L. Body mass index and risk of all-cause mortality among elderly Chinese: An empirical cohort study based on CLHLS data. Prev Med Rep 2023; 35:102308. [PMID: 37455755 PMCID: PMC10339046 DOI: 10.1016/j.pmedr.2023.102308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023] Open
Abstract
The aim of our study was to evaluate the relationship between body mass index (BMI) and all-cause mortality among elderly Chinese. The subjects of our study were a cohort of 13 319 elderly Chinese enrolled between 2008 and 2018. Participants were classified in three groups: underweight (<18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight and obese (≥25 kg/m2) according to different BMI levels. Cox proportional-hazards regression model was used to analyze the association between BMI grouping and the risk of mortality among the three groups and each corresponding subgroup. The restricted cubic spline regression was performed to investigate the variation tendency of BMI and mortality in different groups and subgroups. We found that the hazard ratios (HRs) of mortality in the underweight and the normal-weight groups were 1.213 and 1.104, respectively, compared with those in the overweight and obesity groups. HR for mortality decreased as BMI increased, although this phenomenon was not observed as not a linear relationship in all participants. Nonetheless, this nonlinear relationship was significant in type 2 diabetes patients. Among subjects with non-type 2 diabetes, the shape of the negative curve, reflecting the HR for BMI and mortality, decreased when BMI increased. Our findings suggest that an obesity paradox exists in non-type 2 diabetes patients, in which BMI has a nonlinear negative relationship with mortality. Conversely, in type 2 diabetes patients there is a U-shaped association. Obesity may thus be protective for all-cause mortality among non-diabetic older populations.
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Affiliation(s)
- Yun Wang
- The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Xuekui Liu
- Department of Central Laboratory, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Tongneng Xue
- The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Yu Chen
- The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Qianqian Yang
- The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Zhengwen Tang
- The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Lianhua Chen
- The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Liqin Zhang
- The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China
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25
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Kzar WA, Abbas RF, Hussein HM. The Antimicrobial Peptide LL-37 as a Predictor Biomarker for Periodontitis with the Presence and Absence of Smoking: A Case-Control Study. BIOMED RESEARCH INTERNATIONAL 2023; 2023:5581267. [PMID: 37711877 PMCID: PMC10499532 DOI: 10.1155/2023/5581267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/18/2023] [Accepted: 08/23/2023] [Indexed: 09/16/2023]
Abstract
Background A major issue is finding a valid biomarker able to diagnose periodontal disease with the presence and absence of risk factors. Indeed, the association between smoking and periodontal diseases and its impact on the manifestation of antimicrobial peptides has been delineated in clinical and epidemiological investigations. The antimicrobial peptide cathelicidin (LL-37) is pivotal in preserving periodontal health. Objectives This investigation examines and contrasts the levels of cathelicidin in the saliva of smokers and nonsmokers of periodontitis. The study also seeks to establish this biomarker's diagnostic ability to differentiate between periodontal health and disease. Materials and Methods The study involved the collection of unstimulated saliva samples from 160 participants, comprising 80 patients diagnosed with periodontitis (40 of whom were smokers and 40 were nonsmokers) and 80 periodontitis-free individuals (40 smokers and 40 nonsmokers). The clinical periodontal parameters were assessed, including recording the probing pocket depth, the level of clinical attachment, and the percentage of bleeding on probing. Subsequently, enzyme-linked immunosorbent assays were conducted to quantify the protein levels of LL-37 in the saliva samples obtained from the subjects mentioned above. Results The highest level of salivary LL-37 was found in the nonsmoker periodontitis (NSP) patients, followed by the group of smoker periodontitis (SP) and then nonsmoker healthy (NSH) group, while the lowest level was found in the healthy smoker (HS) group. At the same time, the LL-37 seems to be a very good biomarker in differentiating periodontal health from disease with the presence and absence of smoking. Conclusion Periodontitis results in a significant elevation of salivary LL-37 levels in smoker and nonsmoker patients compared to healthy individuals. These levels are positively correlated with the periodontal parameter and can serve as a valuable diagnostic tool to predict periodontitis, whereas smoking significantly reduces these levels.
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Affiliation(s)
- Wael Abdulazeez Kzar
- Department of Periodontology, College of Dentistry, University of Baghdad, Baghdad, Iraq
| | - Raghad Fadhil Abbas
- Department of Periodontology, College of Dentistry, University of Baghdad, Baghdad, Iraq
| | - Hashim Mueen Hussein
- Department of Conservative Dentistry, College of Dentistry, Mustansiriyah University, Baghdad, Iraq
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Voutilainen A, Brester C, Kolehmainen M, Tuomainen TP. What is the most appropriate follow-up time for detecting the epidemiological relationship between coronary artery disease and its main risk factors: novel findings from a 35-year follow-up study. Coron Artery Dis 2023; 34:320-331. [PMID: 37139560 PMCID: PMC10836792 DOI: 10.1097/mca.0000000000001245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND The aim was to investigate the most appropriate follow-up time to detect the associations of coronary artery disease (CAD) with its traditional risk factors in a long-term prospective cohort study. METHODS The Kuopio Ischaemic Heart Disease Risk Factors Study provided the study material of 1958 middle-aged men free from CAD at baseline and followed up for 35 years. We performed Cox models adjusted for age, family history, diabetes, obesity, hypercholesterolemia, hypertension, smoking, and physical activity, investigated covariate interactions, and tested Schoenfeld residuals to detect time-dependent covariates. Moreover, we applied a sliding window procedure with a subarray of 5 years to better differentiate between risk factors manifested within years and those manifested within decades. The investigated manifestations were CAD and fatal acute myocardial infarction (AMI). RESULTS Seven hundred seventeen (36.6%) men had CAD, and 109 (5.6%) men died from AMI. After 10 years of follow-up, diabetes became the strongest predictor of CAD with a fully adjusted hazard ratio (HR) of 2.5-2.8. During the first 5 years, smoking was the strongest predictor (HR 3.0-3.8). When the follow-up time was 8-19 years, hypercholesterolemia predicted CAD with a HR of >2. The associations of CAD with age and diabetes depended on time. Age hypertension was the only statistically significant covariate interaction. The sliding window procedure highlighted the significance of diabetes over the first 20 years and hypertension after that. Regarding AMI, smoking was associated with the highest fully adjusted HR (2.9-10.1) during the first 13 years. The associations of extreme and low physical activity with AMI peaked when the follow-up time was 3-8 years. Diabetes showed its highest HR (2.7-3.7) when the follow-up time was 10-20 years. During the last 16 years, hypertension was the strongest predictor of AMI (HR 3.1-6.4). CONCLUSION The most appropriate follow-up time for most CAD risk factors was 10-20 years. Concerning smoking and hypertension shorter and longer follow-up times could be considered, respectively, particularly when studying fatal AMI. In general, prospective cohort studies of CAD would provide more comprehensive results by reporting point estimates in relation to more than one timepoint and concerning sliding windows.
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Affiliation(s)
- Ari Voutilainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland
| | - Christina Brester
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland
| | - Mikko Kolehmainen
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland
| | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland
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27
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Oh TK, Song IA. Lifestyle factors and long-term survival in patients with chronic non-cancer pain: a nationwide cohort study in South Korea. J Anesth 2023:10.1007/s00540-023-03197-1. [PMID: 37129697 DOI: 10.1007/s00540-023-03197-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/19/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE This study aimed to investigate the association of modifiable lifestyle factors with long-term survival outcomes in patients with chronic non-cancer pain (CNCP) in South Korea. METHODS This population-based cohort study used data from the National Health Insurance Service database in South Korea. We considered three lifestyle factors from the standard health examination (smoking status, alcohol consumption, and physical activity). RESULTS A total of 1,298,314 patients with CNCP were analyzed; moreover, the 5-year all-cause mortality rate was 3.3% (42,875 patients). In the multivariable Cox regression model, in the previous-smoker and current-smoker groups, it was 5% (hazard ratio [HR]:1.05, 95% confidence interval [CI]:1.02-1.08; P = 0.003) and 65% (HR: 1.65, 95% CI: 1.60-1.69; P < 0.001) higher, respectively, than that in the never-smoker group. The 5-year all-cause mortality was 19% (HR: 1.19, 95% CI: 1.14-1.24; P < 0.001) higher in the heavy-alcohol-consumption group than in the non-alcohol-consumption group. Compared with those without mild physical activity, patients who engaged in mild physical activity for 1-3 (HR: 0.89, 95% CI: 0.87-0.92; P < 0.001), 4-5 (HR: 0.88, 95% CI: 0.86-0.91; P < 0.001), and 6-7 (HR: 0.90, 95% CI: 0.88-0.93; P < 0.001) days per week exhibited a significantly decreased 5-year all-cause mortality. The association between moderate/intensive physical activity and 5-year all-cause mortality yielded similar results. CONCLUSION Lifestyle factors, including previous/current smoking, heavy alcohol consumption, and physical activity, were associated with a higher 5-year all-cause mortality risk among patients with CNCP in South Korea.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-Ro, 173, Beon-Gil, Bundang-Gu, Seongnam, 13620, South Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, South Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-Ro, 173, Beon-Gil, Bundang-Gu, Seongnam, 13620, South Korea.
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, South Korea.
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28
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Cook S, Hirschtick JL, Barnes G, Arenberg D, Bondarenko I, Patel A, Jiminez Mendoza E, Jeon J, Levy D, Meza R, Fleischer NL. Time-varying association between cigarette and ENDS use on incident hypertension among US adults: a prospective longitudinal study. BMJ Open 2023; 13:e062297. [PMID: 37085311 PMCID: PMC10124226 DOI: 10.1136/bmjopen-2022-062297] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/06/2023] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVE Electronic nicotine delivery systems (ENDS) products have emerged as the most popular alternative to combustible cigarettes. However, ENDS products contain potentially dangerous toxicants and chemical compounds, and little is known about their health effects. The aim of the present study was to examine the prospective association between cigarette and ENDS use on self-reported incident hypertension. DESIGN Longitudinal cohort study. SETTING Nationally representative sample of the civilian, non-institutionalised population in the USA. PARTICIPANTS 17 539 adults aged 18 or older who participated at follow-up and had no self-reported heart condition or previous diagnosis of hypertension or high cholesterol at baseline. MEASURES We constructed a time-varying tobacco exposure, lagged by one wave, defined as no use, exclusive established use (every day or some days) of ENDS or cigarettes, and dual use. We controlled for demographics (age, sex, race/ethnicity and household income), clinical risk factors (family history of heart attack, obesity, diabetes and binge drinking) and smoking history (cigarette pack-years). OUTCOMES Self-reported incident hypertension diagnosis. RESULTS The self-reported incidence of hypertension was 3.7% between wave 2 and wave 5. At baseline, 18.0% (n=5570) of respondents exclusively smoked cigarettes; 1.1% (n=336) exclusively used ENDS; and 1.7% (n=570) were dual users. In adjusted models, exclusive cigarette use was associated with an increased risk of self-reported incident hypertension compared with non-use (adjusted HR (aHR) 1.21, 95% CI 1.06 to 1.38), while exclusive ENDS use (aHR 1.00, 95% CI 0.68 to 1.47) and dual use (aHR 1.15, 95% CI 0.87 to 1.52) were not. CONCLUSIONS We found that smoking increased the risk of self-reported hypertension, but ENDS use did not. These results highlight the importance of using prospective longitudinal data to examine the health effects of ENDS use.
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Affiliation(s)
- Steven Cook
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jana L Hirschtick
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Geoffrey Barnes
- Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, USA
- Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Douglas Arenberg
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Irina Bondarenko
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Akash Patel
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - David Levy
- Georgetown University, Washington, DC, USA
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Nancy L Fleischer
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
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Jeon J, Inoue-Choi M, Mok Y, McNeel TS, Tam J, Freedman ND, Meza R. Mortality Relative Risks by Smoking, Race/Ethnicity, and Education. Am J Prev Med 2023; 64:S53-S62. [PMID: 36775754 PMCID: PMC11186465 DOI: 10.1016/j.amepre.2022.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/08/2022] [Accepted: 12/15/2022] [Indexed: 02/13/2023]
Abstract
INTRODUCTION The impact of cigarette smoking on mortality is well studied, with estimates of the relative mortality risks for the overall population widely available. However, age-specific mortality estimates for different sociodemographic groups in the U.S. are lacking. METHODS Using the 1987-2018 National Health Interview Survey Linked Mortality Files through 2019, all-cause mortality relative risks (RRs) were estimated for current smokers or recent quitters and long-term quitters compared with those for never smokers. Stratified Cox proportional hazards regression models were used to estimate RRs by age, gender, race/ethnicity, and educational attainment. RRs were also assessed for current smokers or recent quitters by smoking intensity and for long-term quitters by years since quitting. The analysis was conducted in 2021-2022. RESULTS All-cause mortality RRs among current smokers or recent quitters were generally highest for non-Hispanic White individuals than for never smokers, followed by non-Hispanic Black individuals, and were lowest for Hispanic individuals. RRs varied greatly by educational attainment; generally, higher-education groups had greater RRs associated with smoking than lower-education groups. Conversely, the RRs by years since quitting among long-term quitters did not show clear differences across race/ethnicity and education groups. Age-specific RR patterns varied greatly across racial/ethnic and education groups as well as by gender. CONCLUSIONS Age-specific all-cause mortality rates associated with smoking vary considerably by sociodemographic factors. Among high-education groups, lower underlying mortality rates for never smokers result in correspondingly high RR estimates for current smoking. These estimates can be incorporated in modeling analyses to assess tobacco control interventions' impact on smoking-related health disparities between different sociodemographic groups.
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Affiliation(s)
- Jihyoun Jeon
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan.
| | - Maki Inoue-Choi
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland
| | - Yoonseo Mok
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada
| | | | - Jamie Tam
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Neal D Freedman
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada
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Fatty Acid-Binding Protein 5 Gene Deletion Enhances Nicotine-Conditioned Place Preference: Illuminating the Putative Gateway Mechanisms. FUTURE PHARMACOLOGY 2023; 3:108-116. [PMID: 36864947 PMCID: PMC9969817 DOI: 10.3390/futurepharmacol3010007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Emerging evidence indicates that the endogenous cannabinoid system modulates the behavioral and physiological effects of nicotine. Fatty acid-binding proteins (FABPs) are among the primary intracellular trafficking mechanisms of endogenous cannabinoids, such as anandamide. To this end, changes in FABP expression may similarly impact the behavioral manifestations associated with nicotine, particularly its addictive properties. FABP5 +/+ and FABP5 -/- mice were tested for nicotine-conditioned place preference (CPP) at two different doses (0.1 or 0.5 mg/kg). The nicotine-paired chamber was assigned as their least preferred chamber during preconditioning. Following 8 days of conditioning, the mice were injected with either nicotine or saline. The mice were allowed to access to all the chambers on the test day, and their times spent in the drug chamber on the preconditioning versus the test days were used to examine the drug preference score. The CPP results showed that the FABP5 -/- mice displayed a higher place preference for 0.1 mg/kg nicotine than the FABP5 +/+ mice, while no CPP difference was observed for 0.5 mg/kg nicotine between the genotypes. In conclusion, FABP5 plays an important role in regulating nicotine place preference. Further research is warranted to identify the precise mechanisms. The results suggest that dysregulated cannabinoid signaling may impact nicotine-seeking behavior.
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Zhang Y, Zhai X, Liu K, Ma W, Li S, Zeng J, Yang M, Zhou F, Xiang B, Cao J, Eshak ES. Association of Beta-2 Microglobulin with Stroke and All-Cause Mortality in Adults Aged ≥40 in U.S.: NHANES III. Rev Cardiovasc Med 2023; 24:43. [PMID: 39077409 PMCID: PMC11273124 DOI: 10.31083/j.rcm2402043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 11/19/2022] [Accepted: 11/24/2022] [Indexed: 07/31/2024] Open
Abstract
Background Stroke is the predominant cause of death worldwide. We aimed to investigate the association of serum beta-2 microglobulin ( β 2M) concentrations with risk of stroke and all-cause mortalities in a cohort study. Methods Overall, 4914 U.S. adults (mean age = 63.0 years, 44.3% male) were recruited from the National Health and Nutrition Examination Survey (NHANES Ⅲ). During a median follow-up of 19.4 years, 254 stroke deaths and 3415 all-cause deaths were identified by the National Center for Health Statistics. The associations of β 2M with stroke and all-cause mortalities were investigated by using weighted Cox proportional hazard regression models. Results β 2M was positively associated with stroke and all-cause mortality in unadjusted models and multivariable-adjusted models. The multivariable HR (95% CI) for stroke mortality in Q5 VS Q1 of serum β 2M concentrations was 3.45 (1.33-8.91; p for trend = 0.001) and that for all-cause mortality was 3.95 (3.05-5.12; p for trend < 0.001). In subgroup analyses, the association of β 2M and stroke mortality did not vary by different levels of sociodemographic and general stroke risk factors (p interaction > 0.05). In addition, the magnitude of positive association between β 2M with all-cause mortality did vary by age, ratio of family income to poverty, smoking status, and history of hypertensive (p interaction < 0.05). Conclusions Our findings suggest that support that β 2M may be a marker of stroke and all-cause mortality, which provides a new perspective for the study of cerebrovascular health and long-term survival in the future.
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Affiliation(s)
- Yanan Zhang
- Research Center for Health Promotion in Women, Youth and Children, Hubei
Province Key Laboratory of Occupational Hazard Identification and Control, School
of Public Health, Wuhan University of Science and Technology, 430065 Wuhan,
Hubei, China
| | - Xiaobing Zhai
- Research Center for Health Promotion in Women, Youth and Children, Hubei
Province Key Laboratory of Occupational Hazard Identification and Control, School
of Public Health, Wuhan University of Science and Technology, 430065 Wuhan,
Hubei, China
| | - Keyang Liu
- Public Health, Department of Social Medicine, Osaka University Graduate
School of Medicine, 565-0871 Osaka, Japan
| | - Wenzhi Ma
- Department of Epidemiology and Biostatistics, School of Health Sciences,
Wuhan University, 430071 Wuhan, Hubei, China
| | - Shiyang Li
- Department of Epidemiology and Biostatistics, School of Health Sciences,
Wuhan University, 430071 Wuhan, Hubei, China
| | - Jing Zeng
- Research Center for Health Promotion in Women, Youth and Children, Hubei
Province Key Laboratory of Occupational Hazard Identification and Control, School
of Public Health, Wuhan University of Science and Technology, 430065 Wuhan,
Hubei, China
| | - Mei Yang
- Research Center for Health Promotion in Women, Youth and Children, Hubei
Province Key Laboratory of Occupational Hazard Identification and Control, School
of Public Health, Wuhan University of Science and Technology, 430065 Wuhan,
Hubei, China
| | - Feng Zhou
- Research Center for Health Promotion in Women, Youth and Children, Hubei
Province Key Laboratory of Occupational Hazard Identification and Control, School
of Public Health, Wuhan University of Science and Technology, 430065 Wuhan,
Hubei, China
| | - Bing Xiang
- Research Center for Health Promotion in Women, Youth and Children, Hubei
Province Key Laboratory of Occupational Hazard Identification and Control, School
of Public Health, Wuhan University of Science and Technology, 430065 Wuhan,
Hubei, China
| | - Jinhong Cao
- Department of Epidemiology and Biostatistics, School of Health Sciences,
Wuhan University, 430071 Wuhan, Hubei, China
| | - Ehab S. Eshak
- Public Health and Community Medicine, Faculty of Medicine, Minia
University, Mainroad Shalabyland, 61519 Minia, Egypt
- Advanced Clinical Epidemiology, Medical Data Science Unit, Public Health
Osaka University Graduate School of Medicine, 565-0871 Osaka, Japan
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Ng AE, Turpin R, Connor EM, Slopen N. Retrospective reports of socioeconomic disadvantage in childhood and mortality risk: are associations consistent across measures and sex? GeroScience 2023; 45:105-118. [PMID: 35635680 PMCID: PMC9886746 DOI: 10.1007/s11357-022-00594-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 05/19/2022] [Indexed: 02/03/2023] Open
Abstract
Although prior research has established associations between childhood socioeconomic disadvantage and all-cause mortality, there is still limited research investigating (1) the consistency between subjective and objective reports of childhood socioeconomic status, (2) sex differences in the associations between childhood socioeconomic disadvantage and all-cause mortality, and (3) potential mediators within these associations. Drawing on data from the Midlife in the United States (MIDUS) cohort (N = 7425), we examined the associations between three distinct indicators of childhood socioeconomic disadvantage and all-cause mortality risk, and whether these associations differ for males and females. Among males only, lower perceived relative childhood financial status, lower levels of parents' education, and receipt of welfare during childhood were associated with excess mortality risk, adjusted for age and minority status, with adjusted hazard ratios ranging from 1.24 (95% confidence interval (CI): 1.02, 1.51) for perceived childhood financial status to 1.28 (95% CI: 1.11, 1.47) for welfare in childhood. When additionally adjusted for education, substance use, depression, and underlying health conditions, only childhood welfare status maintained an association with mortality (AHR, 1.17; 95% CI, 1.02-1.35). Mediation analyses among males revealed that education, substance use, depression, and underlying health conditions accounted for substantial proportions of these associations, ranging from 31.03 to 57.63%, across indicators of childhood socioeconomic disadvantage. Future research is needed to clarify the developmental mechanisms that lead to sex differences and identify effective strategies to intervene on the relation between childhood socioeconomic position and excess mortality risk among males.
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Affiliation(s)
- Amanda E Ng
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, 20740, USA.
| | - Rodman Turpin
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, 20740, USA
| | - Eric M Connor
- Department of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN, 55455, USA
| | - Natalie Slopen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Center on the Developing Child, Harvard University, Boston, MA, 02115, USA
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Dehry SE, Krueger PM. Excess Deaths in the United States Compared to 18 Other High-Income Countries. POPULATION RESEARCH AND POLICY REVIEW 2023; 42:27. [PMID: 36970708 PMCID: PMC10030346 DOI: 10.1007/s11113-023-09762-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 12/04/2022] [Indexed: 03/24/2023]
Abstract
The U.S. is exceptional among high-income countries for poor survival outcomes. Understanding the distribution of excess deaths by age, sex, and cause of death, is essential for bringing U.S. mortality in line with international peers. We use 2016 data from the World Health Organization Mortality Database and the Human Mortality Database to calculate excess deaths in the U.S. relative to each of 18 high-income comparison countries. The U.S. experiences excess mortality in every age and sex group, and for 16 leading causes of death. For example, the U.S. could potentially prevent 884,912 deaths by achieving the lower mortality rates of Japan, the comparison country yielding the largest number of excess deaths, which would be comparable to eliminating all deaths from heart disease, unintentional injuries, and diabetes mellitus. In contrast, the U.S. could potentially prevent just 176,825 deaths by achieving the lower mortality rates of Germany, the comparison country yielding the smallest number of excess deaths, which would be comparable to eliminating all deaths from chronic lower respiratory diseases and assault (homicide). Existing research suggests that policies that improve social conditions and health behaviors are more likely to bring U.S. mortality in line with peer countries than policies that support health care access or new biomedical technologies. Achieving the death rates of peer countries could result in mortality reductions comparable to eliminating leading causes of death.
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Affiliation(s)
- Sarah E. Dehry
- grid.241116.10000000107903411Department of Health & Behavioral Sciences, University of Colorado Denver, Campus Box 188, P.O. Box 173364, Denver, CO 80217-3364 USA
| | - Patrick M. Krueger
- grid.241116.10000000107903411Department of Health & Behavioral Sciences, University of Colorado Denver, Campus Box 188, P.O. Box 173364, Denver, CO 80217-3364 USA
- grid.266190.a0000000096214564University of Colorado Population Center, University of Colorado Boulder, Boulder, USA
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Hill TD, Bostean G, Upenieks L, Bartkowski JP, Ellison CG, Burdette AM. (Un)holy Smokes? Religion and Traditional and E-Cigarette Use in the United States. JOURNAL OF RELIGION AND HEALTH 2022; 62:906-931. [PMID: 36520262 DOI: 10.1007/s10943-022-01682-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 05/26/2023]
Abstract
This study employed national cross-sectional survey data from the 2021 Crime, Health, and Politics Survey (n = 1578 to 1735) to model traditional cigarette and e-cigarette use as a function of religious affiliation, general religiosity, biblical literalism, religious struggles, and the sense of divine control. Although the odds of abstaining from cigarettes and e-cigarettes were comparable for conservative Protestants and non-affiliates, conservative Protestants were more likely to cut down on cigarettes and e-cigarettes during the pandemic. Religiosity increased the odds of abstaining from cigarettes (not e-cigarettes) and reduced pandemic consumption of cigarettes and e-cigarettes. Biblical literalism was unrelated to abstaining from cigarettes and pandemic changes in cigarette use; however, biblical literalists were more likely to cut e-cigarette use during the pandemic. While the sense of divine control was unrelated to abstaining from cigarettes and e-cigarettes, these beliefs increased the odds of cessation from traditional and e-cigarette use. Finally, our religious struggles index was unrelated to smoking behavior. Our study is among the first to report any association between religion and lower e-cigarette use.
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Affiliation(s)
- Terrence D Hill
- Department of Sociology, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, 78249-1644, USA.
| | - Georgiana Bostean
- Department of Sociology and Environmental Science & Policy Program, Chapman University, Orange, USA
| | | | - John P Bartkowski
- Department of Sociology, University of Texas at San Antonio, San Antonio, USA
| | | | - Amy M Burdette
- Department of Sociology and Public Health Program, Florida State University, Tallahassee, USA
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35
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Chan KH, Wright N, Xiao D, Guo Y, Chen Y, Du H, Yang L, Millwood IY, Pei P, Wang J, Turnbull I, Gilbert S, Avery D, Kartsonaki C, Yu C, Chen J, Lv J, Clarke R, Collins R, Peto R, Li L, Wang C, Chen Z. Tobacco smoking and risks of more than 470 diseases in China: a prospective cohort study. Lancet Public Health 2022; 7:e1014-e1026. [PMID: 36462513 PMCID: PMC7613927 DOI: 10.1016/s2468-2667(22)00227-4] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/25/2022] [Accepted: 08/26/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Tobacco smoking is estimated to account for more than 1 million annual deaths in China, and the epidemic continues to increase in men. Large nationwide prospective studies linked to different health records can help to periodically assess disease burden attributed to smoking. We aimed to examine associations of smoking with incidence of and mortality from an extensive range of diseases in China. METHODS We analysed data from the prospective China Kadoorie Biobank, which recruited 512 726 adults aged 30-79 years, of whom 210 201 were men and 302 525 were women. Participants who had no major disabilities were identified through local residential records in 100-150 administrative units, which were randomly selected by use of multistage cluster sampling, from each of the ten diverse study areas of China. They were invited and recruited between June 25, 2004, and July 15, 2008. Upon study entry, trained health workers administered a questionnaire assessing detailed smoking behaviours and other key characteristics (eg, sociodemographics, lifestyle, and medical history). Participants were followed up via electronic record linkages to death and disease registries and health insurance databases, from baseline to Jan 1, 2018. During a median 11-year follow-up (IQR 10-12), 285 542 (55·7%) participants were ever hospitalised, 48 869 (9·5%) died, and 5252 (1·0%) were lost to follow-up during the age-at-risk of 35-84 years. Cox regression yielded hazard ratios (HRs) associating smoking with disease incidence and mortality, adjusting for multiple testing. FINDINGS At baseline, 74·3% of men and 3·2% of women (overall 32·4%) ever smoked regularly. During follow-up, 1 137 603 International Classification of Diseases, 10th revision (ICD-10)-coded incident events occurred, involving 476 distinct conditions and 85 causes of death, each with at least 100 cases. Compared with never-regular smokers, ever-regular smokers had significantly higher risks for nine of 18 ICD-10 chapters examined at age-at-risk of 35-84 years. For individual conditions, smokers had significantly higher risks of 56 diseases (50 for men and 24 for women) and 22 causes of death (17 for men and nine for women). Among men, ever-regular smokers had an HR of 1·09 (95% CI 1·08-1·11) for any disease incidence when compared with never-regular smokers, and significantly more episodes and longer duration of hospitalisation, particularly those due to cancer and respiratory diseases. For overall mortality, the HRs were greater in men from urban areas than in men from rural areas (1·50 [1·42-1·58] vs 1·25 [1·20-1·30]). Among men from urban areas who began smoking at younger than 18 years, the HRs were 2·06 (1·89-2·24) for overall mortality and 1·32 (1·27-1·37) for any disease incidence. In this population, 19·6% of male (24·3% of men residing in urban settings and 16·2% of men residing in rural settings) and 2·8% of female deaths were attributed to ever-regular smoking. INTERPRETATION Among Chinese adults, smoking was associated with higher risks of morbidity and mortality from a wide range of diseases. Among men, the future smoking-attributed disease burden will increase further, highlighting a pressing need for reducing consumption through widespread cessation and uptake prevention. FUNDING British Heart Foundation, Cancer Research UK, Chinese Ministry of Science and Technology, Kadoorie Charitable Foundation, UK Medical Research Council, National Natural Science Foundation of China, Wellcome Trust.
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Affiliation(s)
- Ka Hung Chan
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Oxford British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, UK
| | - Neil Wright
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Dan Xiao
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yu Guo
- National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yiping Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Huaidong Du
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ling Yang
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Iona Y Millwood
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Pei Pei
- Peking University Center for Public Health and Epidemic Preparedness and Response, Peking University, Beijing, China
| | - Junzheng Wang
- Licang Center of Disease Control and Prevention, Qingdao, China
| | - Iain Turnbull
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Simon Gilbert
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Daniel Avery
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Christiana Kartsonaki
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Peking University Center for Public Health and Epidemic Preparedness and Response, Peking University, Beijing, China
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment, Beijing, China
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Peking University Center for Public Health and Epidemic Preparedness and Response, Peking University, Beijing, China
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rory Collins
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Richard Peto
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Peking University Center for Public Health and Epidemic Preparedness and Response, Peking University, Beijing, China.
| | - Chen Wang
- WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
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Mason TB, Martinez C, Dunton GF, Belcher BR, Pang RD. Understanding daily life experiences of women who smoke: The role of smoking-related weight control expectancies. Addict Behav 2022; 134:107413. [PMID: 35728423 PMCID: PMC9755458 DOI: 10.1016/j.addbeh.2022.107413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 04/15/2022] [Accepted: 06/14/2022] [Indexed: 11/26/2022]
Abstract
Smoking-related weight control expectancies are a motivational factor for maintaining cigarette use, particularly among women. Yet, less research has investigated the physiological and behavioral daily life weight-related experiences of women with smoking-related weight control expectancies. Increased research could contribute to understanding of maintenance factors for this group of smokers as well as unique intervention targets. Female smokers completed a baseline survey of smoking-related weight control expectancies and 35-days of ecological momentary assessment of physiological (i.e., smoking-related reduction in hunger, end-of-day perceived weight gain and bloating) and behavioral (i.e., daily exercise and sitting) weight-related experiences. Higher smoking-related weight control expectancies were associated with perceived smoking-related reductions in hunger and end-of-day perceived weight gain. Smoking-related weight control expectancies did not significantly associate with end-of-day bloating, daily exercise, or sitting. Given these findings, smoking-related weight control expectancies may maintain smoking in order to reduce hunger and to cope with perceived fluctuations in weight in daily life. It is critical for smoking cessation programs to assess smoking-related weight control expectancies and implement targeted treatments for these women.
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Affiliation(s)
- Tyler B Mason
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, CA, United States.
| | - Cheldy Martinez
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Genevieve F Dunton
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, CA, United States; Department of Psychology, University of Southern California, Los Angeles, CA, United States
| | - Britni R Belcher
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Raina D Pang
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, CA, United States; Department of Psychology, University of Southern California, Los Angeles, CA, United States
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DeCicca P, Kenkel D, Lovenheim MF. The Economics of Tobacco Regulation: A Comprehensive Review. JOURNAL OF ECONOMIC LITERATURE 2022; 60:883-970. [PMID: 37075070 PMCID: PMC10072869 DOI: 10.1257/jel.20201482] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Tobacco regulation has been a major component of health policy in the developed world since the UK Royal College of Physicians' and the US Surgeon General's reports in the 1960s. Such regulation, which has intensified in the past two decades, includes cigarette taxation, place-based smoking bans in areas ranging from bars and restaurants to workplaces, and regulations designed to make tobacco products less desirable. More recently, the availability of alternative products, most notably e-cigarettes, has increased dramatically, and these products are just starting to be regulated. Despite an extensive body of research on tobacco regulations, there remains substantial debate regarding their effectiveness, and ultimately, their impact on economic welfare. We provide the first comprehensive review of the state of research in the economics of tobacco regulation in two decades.
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Piñeiro B, Trias-Llimós S, Spijker JJA, Blanes Llorens A, Permanyer I. Estimation of smoking-related mortality and its contribution to educational inequalities in life expectancy in Spain: an observational study, 2016-2019. BMJ Open 2022; 12:e059370. [PMID: 35948385 PMCID: PMC9379492 DOI: 10.1136/bmjopen-2021-059370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To estimate smoking-related mortality and its contribution to educational inequalities in life expectancy in Spain. DESIGN Nationwide, observational study from 2016 to 2019. Population-attributable fractions were used to estimate age, sex and education-specific cause-of-death smoking-attributable mortality. Life table techniques and decomposition methods were used to estimate potential gains in life expectancy at age 35 and the cause-specific contributions of smoking-related mortality to life expectancy differences across educational groups. SETTING Spain. PARTICIPANTS We use cause-specific mortality data from population registers and smoking prevalence from the National and the European Health Survey for Spain from 2017 and 2019/2020, respectively. RESULTS We estimated 219 086 smoking-related deaths during 2016-2019, equalling 13% of all deaths, 83.7% of those in men. In the absence of smoking, potential gains in male life expectancy were higher among the low-educated than the high-educated (3.1 vs 2.1 years). For women, educational differences were less and also in the opposite direction (0.6 vs 0.9 years). The contribution of smoking to life expectancy differences between high-educated and low-educated groups accounted for 1.5 years among men, and -0.2 years among women. For men, the contribution of smoking to these differences was mostly driven by cancer in middle age, cardiometabolic diseases at younger ages and respiratory diseases at older ages. For women, the contribution to this gap, although negligible, was driven by cancer at older ages among the higher educated. CONCLUSIONS Smoking remains a relevant preventable risk factor of premature mortality in Spain, disproportionately affecting life expectancy of low-educated men.
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Affiliation(s)
- Bárbara Piñeiro
- Centre d'Estudis Demogràfics, Centres de Recerca de Catalunya (CERCA), Universitat Autònoma de Barcelona, Bellaterra-Barcelona, Catalonia, Spain
| | - Sergi Trias-Llimós
- Centre d'Estudis Demogràfics, Centres de Recerca de Catalunya (CERCA), Universitat Autònoma de Barcelona, Bellaterra-Barcelona, Catalonia, Spain
| | - Jeroen J A Spijker
- Centre d'Estudis Demogràfics, Centres de Recerca de Catalunya (CERCA), Universitat Autònoma de Barcelona, Bellaterra-Barcelona, Catalonia, Spain
| | - Amand Blanes Llorens
- Centre d'Estudis Demogràfics, Centres de Recerca de Catalunya (CERCA), Universitat Autònoma de Barcelona, Bellaterra-Barcelona, Catalonia, Spain
| | - Iñaki Permanyer
- Centre d'Estudis Demogràfics, Centres de Recerca de Catalunya (CERCA), Universitat Autònoma de Barcelona, Bellaterra-Barcelona, Catalonia, Spain
- ICREA, Passeig de Lluís Companys 23, Barcelona, Spain
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Woo J, Lawrence E, Mollborn S. Racial/ethnic and gender differences in smoking in early middle adulthood. SSM Popul Health 2022; 18:101119. [PMID: 35652089 PMCID: PMC9149197 DOI: 10.1016/j.ssmph.2022.101119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 10/25/2022] Open
Abstract
Research has documented important differences in smoking rates across race/ethnicity, gender, and age. Much of the research has either focused on smoking initiation among adolescents or cessation among adults, but little is known about racial/ethnic patterns in intermittent and daily smoking across young and early middle adulthood. We therefore use the life course perspective to identify how racial/ethnic and gender differences in smoking unfold across adulthood. Analyses investigate whether racial/ethnic and gender differences exist in the likelihood of daily smoking in early middle adulthood and whether these disparities persist after the inclusion of adolescent and early midlife sociodemographic characteristics and young adult smoking patterns. Descriptive statistics and multivariate binary logistic regression analyses employ recent data from a nationally representative sample of adults using the National Longitudinal Study of Adolescent to Adult Health (Add Health; N = 8,506). We find evidence that life course patterns of smoking differ across race/ethnicity and gender subgroups. In early middle adulthood (ages 33-44), White women are more likely to smoke daily than Black or Hispanic women. In contrast, there are no significant differences between White and Black men, but White men are more likely to smoke daily than Hispanic men. These racial/ethnic differences are no longer significant for men when previous smoking is controlled, suggesting that early young adult smoking plays an important role in the development of smoking disparities across race/ethnicity. Further, we find that young adult intermittent smoking is associated with daily smoking in early midlife, and this relationship is stronger for Black, compared to White, men and women. Although Black women display lower odds of daily smoking in early midlife compared to White women, they exhibit a higher risk of transitioning from intermittent to daily smoking. These results highlight the importance of considering a greater diversity of life course patterns in smoking across race/ethnicity and gender in future research and policies.
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Affiliation(s)
- Juhee Woo
- Appalachian State University, Department of Sociology, ASU Box 32115, 209 Chapell Wilson Hall, 480 Howard Street, Boone, NC, 28608, USA
| | - Elizabeth Lawrence
- University of Nevada, Las Vegas, Department of Sociology, CBC-B 243, Las Vegas, USA
| | - Stefanie Mollborn
- Stockholm University, Department of Sociology, SE-106 91, Stockholm, Sweden
- University of Colorado Boulder, Institute of Behavioral Science, UCB 483, Boulder, CO 80309-0483, USA
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Huang Y, Lin Y, Zhai X, Cheng L. Association of Beta-2-Microglobulin With Coronary Heart Disease and All-Cause Mortality in the United States General Population. Front Cardiovasc Med 2022; 9:834150. [PMID: 35647083 PMCID: PMC9136227 DOI: 10.3389/fcvm.2022.834150] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/24/2022] [Indexed: 11/18/2022] Open
Abstract
Few prospective studies explored the association of beta-2-microglobulin (B2M) with coronary heart disease (CHD) mortality. The primary objective of this study was to examine the association of serum B2M with CHD and all-cause mortality. This is a prospective cohort study of a nationally representative sample of 4,885 adults, aged 40–85 years, who participated in the National Health and Nutrition Examination Survey (NHANES III) from 1988 to 1994. The relationships between B2M and CHD and all-cause mortality were estimated using Cox proportional hazards regression models. During a median follow-up of 15.5 years, 845 CHD and 3,388 all-cause deaths occurred among 4,885 participants [2,568 women (55.7%); mean (S.D.) age, 66.4 (12.5) years], respectively. In the unadjusted model, B2M concentration was strongly linearly associated with CHD and all-cause mortality (p-trend < 0.001). After adjusting multivariable factors, a positive linear association between B2M and all-cause mortality was still observed (H.R. for Q4 vs. Q1 5.90; 95% CI: 5.31–6.57; p-trend < 0.001). In the multivariable adjustment model, B2M was significantly associated with an increased risk of CHD mortality (H.R. for Q4 vs. Q1 2.72; 95% CI: 2.07–3.57; p-trend < 0.001). In the stratified analyses, the associations of B2M with CHD and all-cause mortality varied by risk factors, such as age, smoking status, and history of hypertension. The findings suggest a significant relationship between the higher serum B2M concentration and increased risk for CHD and all-cause mortality. Further large-scale follow-up studies are also needed to validate this association.
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Affiliation(s)
- Yangxi Huang
- The Nursing School, Nanjing Medical University, Nanjing, China
| | - Yufeng Lin
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Xiaobing Zhai
- Child and Adolescent Health, School of Medicine, Wuhan University of Science and Technology, Wuhan, China
- *Correspondence: Long Cheng,
| | - Long Cheng
- Department of Cardiovascular Medicine, Shanghai Pudong New Area Gongli Hospital, Shanghai, China
- *Correspondence: Long Cheng,
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Zhang H, Tian W, Sun Y. Development, validation, and visualization of a web-based nomogram to predict 5-year mortality risk in older adults with hypertension. BMC Geriatr 2022; 22:392. [PMID: 35509033 PMCID: PMC9069777 DOI: 10.1186/s12877-022-03087-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/20/2022] [Indexed: 11/16/2022] Open
Abstract
Background Hypertension-related mortality has been increasing in older adults, resulting in serious burden to society and individual. However, how to identify older adults with hypertension at high-risk mortality remains a great challenge. The purpose of this study is to develop and validate the prediction nomogram for 5-year all-cause mortality in older adults with hypertension. Methods Data were extracted from National Health and Nutrition Examination Survey (NHANES). We recruited 2691 participants aged 65 years and over with hypertension in the NHANES 1999-2006 cycles (training cohort) and 1737 participants in the NHANES 2007-2010 cycles (validation cohort). The cohorts were selected to provide at least 5 years follow-up for evaluating all-cause mortality by linking National Death Index through December 31, 2015. We developed a web-based dynamic nomogram for predicting 5-year risk of all-cause mortality based on a logistic regression model in training cohort. We conducted internal validation by 1000 bootstrapping resamples and external validation in validation cohort. The discrimination and calibration of nomogram were evaluated using concordance index (C-index) and calibration curves. Results The final model included eleven independent predictors: age, sex, diabetes, cardiovascular disease, body mass index, smoking, lipid-lowering drugs, systolic blood pressure, hemoglobin, albumin, and blood urea nitrogen. The C-index of model in training and validation cohort were 0.759 (bootstrap-corrected C-index 0.750) and 0.740, respectively. The calibration curves also indicated that the model had satisfactory consistence in two cohorts. A web-based nomogram was established (https://hrzhang1993.shinyapps.io/dynnomapp). Conclusions The novel developed nomogram is a useful tool to accurately predict 5-year all-cause mortality in older adults with hypertension, and can provide valuable information to make individualized intervention. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03087-3.
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Affiliation(s)
- Huanrui Zhang
- Department of Geriatrics, The First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Shenyang, 110001, China
| | - Wen Tian
- Department of Geriatrics, The First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Shenyang, 110001, China
| | - Yujiao Sun
- Department of Geriatrics, The First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Shenyang, 110001, China.
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Shartle K. Do high school friends still matter for health behavior in adulthood? Variations in smoking trajectories by adolescent peer smoking networks, race/ethnicity, and gender. SSM Popul Health 2021; 16:100925. [PMID: 34604496 PMCID: PMC8473763 DOI: 10.1016/j.ssmph.2021.100925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 11/19/2022] Open
Abstract
Peers play an influential role in the initiation of smoking during adolescence. However, there has been limited literature examining whether adolescent peers are associated with longer-term patterns of smoking. This study uses data from the National Longitudinal Study of Adolescent to Adult Health to examine whether age-based trajectories of smoking likelihood from adolescence to adulthood are associated with the number of adolescent friends who smoked and how this association differs by race/ethnicity and gender. Findings using multilevel growth curve models indicate that individuals who have more adolescent friends who smoked have higher probabilities of smoking during adolescence than those with no adolescent smoking friends. As individuals age into adulthood, the association between adolescent friends' smoking behavior and individual-level smoking begin to dissipate but does not completely disappear. Further analyses show that there are no differences in this association by gender, but there are differences by race/ethnicity. These findings suggest that high school friends continue to be associated with trajectories of smoking even twenty years after high school. These results indicate that anti-smoking campaigns should take a network approach to preventing smoking in adolescence as well as recognize that the same campaign strategy may not work for all groups.
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Affiliation(s)
- Kaitlin Shartle
- Department of Sociology, University of North Carolina – Chapel Hill, 155 Pauli Murray Hall, Chapel Hill, NC, 27599-3100, United States
- Carolina Population Center, University of North Carolina – Chapel Hill, United States
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Fukuda M. Nicotine-free electronic-cigarettes for smoking cessation: Occasional reinforcement during extinction. LEARNING AND MOTIVATION 2021. [DOI: 10.1016/j.lmot.2021.101766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Shuval K, Marroquin EM, Li Q, Knell G, Pettee Gabriel K, Drope J, Yaroch AL, Chartier KG, Fennis BM, Qadan M. Long-term weight loss success and the health behaviours of adults in the USA: findings from a nationally representative cross-sectional study. BMJ Open 2021; 11:e047743. [PMID: 34261685 PMCID: PMC8281097 DOI: 10.1136/bmjopen-2020-047743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To describe the relationship between long-term weight loss (LTWL) success and lifestyle behaviours among US adults. DESIGN Serial cross-sectional data from National Health and Nutrition Examination Survey cycles 2007-2014. SETTING AND PARTICIPANTS Population-based nationally representative sample. The analytic sample included 3040 adults aged 20-64 years who tried to lose weight in the past year. MEASURES Participants were grouped into five LTWL categories (<5%, 5%-9.9%, 10%-14.9%, 15%-19.9% and ≥20%). Lifestyle-related behaviours included the following: alcohol intake, physical activity, smoking, fast-food consumption, dietary quality (Healthy Eating Index (HEI)) and caloric intake. Multivariable regression was employed adjusting for age, sex, race/ethnicity, marital status, education, household income and size, current body mass index and self-reported health status. RESULTS Individuals in the 15%-19.9% LTWL group differed significantly from the reference group (<5% LTWL) in their physical activity and dietary quality (HEI) but not caloric intake. Specifically, they had a higher HEI score (β=3.19; 95% CI 0.39 to 5.99) and were more likely to meet physical activity guidelines (OR=1.99; 95% CI 1.11 to 3.55). In comparison, the ≥20% LTWL group was significantly more likely to smoke (OR=1.63; 95% CI 1.03 to 2.57) and to consume lower daily calories (β=-202.91; 95% CI -345.57 to -60.25) than the reference group; however, dietary quality and physical activity did not significantly differ. CONCLUSION Among a national sample of adults, a higher level of LTWL success does not necessarily equate to healthy weight loss behaviours. Future research should attempt to design interventions aimed at facilitating weight loss success while encouraging healthy lifestyle behaviours.
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Affiliation(s)
- Kerem Shuval
- School of Business Administration, Faculty of Social Sciences, University of Haifa, Haifa, Israel
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
- The Cooper Institute, Dallas, Texas, USA
| | - Elisa Morales Marroquin
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
- The Center for Pediatric Population Health, The University of Texas Health Science Center at Houston (UTHealth), Dallas, Texas, USA
| | - Qing Li
- American Cancer Society, Atlanta, Georgia, USA
| | - Gregory Knell
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
- The Center for Pediatric Population Health, The University of Texas Health Science Center at Houston (UTHealth), Dallas, Texas, USA
- Children's Health Andrews Institute for Orthopaedics and Sports Medicine, Plano, Texas, USA
| | - Kelley Pettee Gabriel
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jeffrey Drope
- Department of Health Policy and Administration, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Amy L Yaroch
- Gretchen Swanson Center for Nutrition, Omaha, Nebraska, USA
| | - Karen G Chartier
- School of Social Work and Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Bob M Fennis
- Department of Marketing, Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
| | - Mahmoud Qadan
- School of Business Administration, Faculty of Social Sciences, University of Haifa, Haifa, Israel
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Wei Y, Lv Y, Zhou J, Gao X, Duan J, Zhao C, Yin Z, Kang Q, Wu B, Chen C, Mao C, Li J, Shi X. Smoking cessation in late life is associated with increased risk of all-cause mortality amongst oldest old people: a community-based prospective cohort study. Age Ageing 2021; 50:1298-1305. [PMID: 33492360 DOI: 10.1093/ageing/afaa280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE we aimed to investigate the association of smoking cessation with risk of all-cause mortality amongst oldest old people (aged ≥ 80 years). DESIGN this was a prospective cohort study. SETTING the Chinese Longitudinal Healthy Longevity Survey, implemented in 23 provinces of China. PARTICIPANTS a total of 28,643 community-dwelling oldest old people (mean age, 92.9 ± 7.5 years) were included. METHODS in this community-based cohort study, Cox proportional hazards models were used to examine the association of smoking cessation with risk of all-cause mortality. RESULTS during 136,585 person-years of follow-up from baseline to 1 September 2014, compared with never smokers, hazard ratios and 95% confidence intervals for all-cause mortality were 1.06 (1.02-1.10) for current smokers, 1.23 (1.09-1.39) for transient quitters (≤1 consecutive years since smoking cessation), 1.22 (1.12-1.32) for recent quitters (2-6 consecutive years since smoking cessation) and 1.11 (1.02-1.22) for long-term quitters (>6 consecutive years since smoking cessation). Cox models with penalised splines revealed an increased risk of all-cause mortality after smoking cessation; the highest mortality risk was observed within 2-4 years after smoking cessation and the risk gradually decreased with duration of smoking cessation. We further conducted subgroup analyses and sensitivity analyses to reduce the impact of reverse causation. CONCLUSIONS smoking is harmful to health in all populations. Our study findings indicated smoking cessation in late life to be associated with increased risk of all-cause mortality amongst oldest old people who have smoked for a long time.
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Affiliation(s)
- Yuan Wei
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
- Department of Hygienic Inspection, School of Public Health, Jilin University, Jilin, China
| | - Yuebin Lv
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jinhui Zhou
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiang Gao
- Nutritional Epidemiology Lab, Pennsylvania State University, University Park, PA, USA
| | - Jun Duan
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chao Zhao
- Department of Hygienic Inspection, School of Public Health, Jilin University, Jilin, China
| | - Zhaoxue Yin
- Office of Non-communicable Disease and Ageing Health Management, Chinese Center for Disease Control and Prevention Beijing, China
| | - Qi Kang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Jilin, China
| | - Bing Wu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Chen Chen
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chen Mao
- Division of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Juan Li
- Department of Hygienic Inspection, School of Public Health, Jilin University, Jilin, China
| | - Xiaoming Shi
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
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Siegel SD, Brooks M, Bourke J, Curriero FC. Reducing Exposure to Tobacco Retailers with Residential Zoning Policy: Insights from a Geospatial Analysis of Wilmington, Delaware. CITIES & HEALTH 2021; 6:752-764. [PMID: 36570619 PMCID: PMC9783014 DOI: 10.1080/23748834.2021.1935141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/21/2021] [Indexed: 01/03/2023]
Abstract
Cigarette use remains the leading preventable cause of premature mortality in the US, with declines in smoking rates slowing in recent years. One promising target for improved tobacco control is the expanded regulation of tobacco retailers. Evaluations of such policy attempts have largely produced mixed results to date. The objective of this study was to the assess the potential of using a novel, residentially-focused zoning approach to produce a more targeted and equitable reduction in tobacco retailers in high-risk urban settings. We focused on Wilmington, Delaware, a city characterized by high poverty rates, a majority Black population, a disparate number of tobacco retailers, and an elevated smoking prevalence. Through the use of geospatial analyses, we observed disproportionately higher counts of convenience store tobacco retailers in medium- and high-density residential zones in Wilmington relative to the surrounding county. By linking electronic health record (EHR) data from a local health care system and US Census Bureau data, we further found that approximately 80% of Wilmington smokers and 60% of Wilmington youth lived in these residential zones. These findings highlight the potential to more equitably reduce tobacco retailer exposure through a residentially-focused zoning approach. Tobacco control policy and research implications are considered.
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Affiliation(s)
- Scott D. Siegel
- Institute for Research on Equity and Community Health, Christiana Care Health System
- Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System
| | - Madeline Brooks
- Institute for Research on Equity and Community Health, Christiana Care Health System
| | | | - Frank C. Curriero
- Johns Hopkins Spatial Science for Public Health Center, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
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Kim MN, Han K, Yoo J, Ha Y, Chon YE, Lee JH, Simon TG, Chan AT, Hwang SG. Body weight variability and the risk of cardiovascular outcomes in patients with nonalcoholic fatty liver disease. Sci Rep 2021; 11:9154. [PMID: 33911167 PMCID: PMC8080815 DOI: 10.1038/s41598-021-88733-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/13/2021] [Indexed: 02/06/2023] Open
Abstract
We investigated the association between body weight variability and the risks of cardiovascular disease and mortality in patients with nonalcoholic fatty liver disease (NAFLD) using large-scale, nationwide cohort data. We included 726,736 individuals with NAFLD who underwent a health examination between 2009 and 2010. NAFLD was defined as a fatty liver index ≥ 60, after excluding significant alcohol intake, viral hepatitis, and liver cirrhosis. Body weight variability was assessed using four indices, including variability independent of the mean (VIM). During a median 8.1-year follow-up, we documented 11,358, 14,714, and 22,164 cases of myocardial infarction (MI), stroke, and all-cause mortality, respectively. Body weight variability was associated with an increased risk of MI, stroke, and mortality after adjusting for confounding variables. The hazard ratios (HRs) (95% confidence intervals) for the highest quartile, compared with the lowest quartile, of VIM for body weight were 1.15 (1.10-1.20), 1.22 (1.18-1.26), and 1.56 (1.53-1.62) for MI, stroke, and all-cause mortality, respectively. Body weight variability was associated with increased risks of MI, stroke, and all-cause mortality in NAFLD patients. Appropriate interventions to maintain a stable weight could positively affect health outcomes in NAFLD patients.
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Affiliation(s)
- Mi Na Kim
- Division of Gastroenterology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-ro, Bundang-gu, Seongnam, 13496, Republic of Korea.
- Clinical and Translational Hepatology Laboratory, Seongnam, Republic of Korea.
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Juhwan Yoo
- Department of Biomedicine and Health Science, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yeonjung Ha
- Division of Gastroenterology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-ro, Bundang-gu, Seongnam, 13496, Republic of Korea
| | - Young Eun Chon
- Division of Gastroenterology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-ro, Bundang-gu, Seongnam, 13496, Republic of Korea
| | - Ju Ho Lee
- Division of Gastroenterology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-ro, Bundang-gu, Seongnam, 13496, Republic of Korea
| | - Tracey G Simon
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Liver Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Seong Gyu Hwang
- Division of Gastroenterology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-ro, Bundang-gu, Seongnam, 13496, Republic of Korea.
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Dogan M, Akdogan M, Gulyesil FF, Sabaner MC, Gobeka HH. Cigarette smoking reduces deep retinal vascular density. Clin Exp Optom 2021; 103:838-842. [DOI: 10.1111/cxo.13070] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 02/05/2020] [Accepted: 03/13/2020] [Indexed: 12/12/2022] Open
Affiliation(s)
- Mustafa Dogan
- Department of Ophthalmology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey,
| | - Muberra Akdogan
- Department of Ophthalmology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey,
| | - Furkan Fatih Gulyesil
- Department of Ophthalmology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey,
| | - Mehmet Cem Sabaner
- Department of Ophthalmology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey,
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Ye L, Yang J, Li J, Cheng N, Zhang Y, Lu X, Zhou Z, Wang Z, Liu L, Huang X, Song Y, Xing S, Wang D, Li J, Wang B, Tang G, Qin X, Zalloua P, Zhang H, Yan F, Xu X. Cigarette smoking and all-cause mortality in rural Chinese male adults: 15-year follow-up of the Anqing cohort study. BMC Public Health 2021; 21:696. [PMID: 33836720 PMCID: PMC8034075 DOI: 10.1186/s12889-021-10691-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 03/23/2021] [Indexed: 11/24/2022] Open
Abstract
Background According to the Global Burden of Disease Study 2017, smoking is one of the leading four risk factors contributing to deaths in China. We aimed to evaluate the associations of smoking with all-cause mortality in a Chinese rural population. Methods Male participants over age 45 (n = 5367) from a large familial aggregation study in rural China, were included in the current analyses. A total of 528 former smokers and 3849 current smokers accounted for 10 and 71.7% of the cohort, respectively. Generalized Estimating Equations were used to evaluate the association between baseline smoking status and mortality, adjusting for pertinent covariates. Results There were 579 recorded deaths during the 15-year follow-up. Current smokers (odds ratio [OR],1.60; 95% CI,1.23–2.08) had higher all-cause mortality risks than nonsmokers. Relative to nonsmokers, current smokers of more than 40 pack-years ([OR],1.85; 95% CI,1.33–2.56) had a higher all-cause mortality risk. Compared to nonsmokers, current smokers who started smoking before age 20 ([OR],1.91; 95% CI,1.43–2.54) had a higher all-cause mortality risk, and former smokers in the lower pack-year group who quit after age 41 (median) ([OR],3.19; 95% CI,1.83–5.56) also had a higher risk of death after adjustment. Furthermore, former smokers who were also former drinkers had the highest significant risk of mortality than never smokers or drinkers. (P for interaction = 0.034). Conclusions This study provides evidence that current smokers and former smokers have a higher mortality risk than nonsmokers and would benefit from cessation at a younger age. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10691-2.
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Affiliation(s)
- Lijing Ye
- State Key Laboratory of Natural Medicines, Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, 210009, China
| | - Jie Yang
- State Key Laboratory of Natural Medicines, Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, 210009, China
| | - Jingyi Li
- State Key Laboratory of Natural Medicines, Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, 210009, China
| | - Nannan Cheng
- State Key Laboratory of Natural Medicines, Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, 210009, China
| | - Yue Zhang
- State Key Laboratory of Natural Medicines, Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, 210009, China
| | - Xiaofan Lu
- State Key Laboratory of Natural Medicines, Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, 210009, China
| | - Ziyi Zhou
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Zhuo Wang
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Lishun Liu
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Xiao Huang
- Department of Cardiovascular Medicine, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yun Song
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China.,Institute of Biomedicine, Anhui Medical University, Hefei, China
| | - Shibo Xing
- Health Center of Dongguo Center, Tengzhou, Shandong, China
| | | | - Junnong Li
- Weinan Central Hospital, Weinan, Shanxi, China
| | - Binyan Wang
- Institute of Biomedicine, Anhui Medical University, Hefei, China.,Shenzhen Evergreen Medical Institute, Shenzhen, China
| | - Genfu Tang
- School of Health Administration, Anhui Medical University, Hefei, China
| | - Xianhui Qin
- National Clinical Research Study Center for Kidney Disease; The State Key Laboratory for Organ Failure Research; Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Pierre Zalloua
- School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Huisheng Zhang
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Fangrong Yan
- State Key Laboratory of Natural Medicines, Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, 210009, China.
| | - Xiping Xu
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China.,National Clinical Research Study Center for Kidney Disease; The State Key Laboratory for Organ Failure Research; Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Zhu D, Zhao G, Wang X. Association of Smoking and Smoking Cessation With Overall and Cause-Specific Mortality. Am J Prev Med 2021; 60:504-512. [PMID: 33745522 DOI: 10.1016/j.amepre.2020.11.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 11/10/2020] [Accepted: 11/16/2020] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Smoking remains a strong risk factor for premature death. This study examines the associations of nondaily smoking, daily smoking, and smoking cessation with the risks of mortality from all causes, cardiovascular disease, and cancer. METHODS This study used data from the National Health and Nutrition Examination Survey, a population-based, cross-sectional study. Data analysis was conducted in the U.S. from January to October 2020. Cox proportional hazard regression models were used to obtain adjusted hazard ratios. RESULTS During 255,100 person-years of follow-up, 2,008 participants died (347 from cardiovascular diseases and 501 from cancer). A significant increase in the risk of all-cause mortality was observed for nondaily smokers (hazard ratio=1.50, 95% CI=1.08, 2.08) compared with that for those who had never smoked. For daily smokers, the adjusted hazard ratios for all-cause mortality were 1.54 (95% CI=1.24, 1.90) for those smoking <20 cigarettes per day, 2.09 (95% CI=1.65, 2.63) for those smoking 20-40 cigarettes per day, and 2.78 (95% CI=1.75, 4.43) for those smoking ≥40 cigarettes per day. An increased risk of cardiovascular disease and cancer mortality was also observed for daily smokers. Former smokers with ≥5 years since cessation had a lower risk of all-cause mortality than current smokers. CONCLUSIONS This study suggests that nondaily smokers have a higher risk of all-cause mortality. The association of daily smoking with the risk of mortality increased as the number of cigarettes smoked per day increased. Among former smokers, the risk decreased with longer cessation. Tobacco control efforts should be targeted not only toward daily smokers but also toward nondaily smokers to reduce the risk of premature death owing to smoking.
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Affiliation(s)
- Di Zhu
- Department of Maternal and Child Health, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Gang Zhao
- Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, China
| | - Xia Wang
- Department of Maternal and Child Health, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa.
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