Smoking and All-cause Mortality in Older Adults: Results From the CHANCES Consortium

INTRODUCTION: Smoking is known to be a major cause of death among middle-aged adults, but evidence on its impact and the benefits of smoking cessation among older adults has remained limited. Therefore, we aimed to estimate the influence of smoking and smoking cessation on all-cause mortality in people aged ≥60 years.

METHODS: Relative mortality and mortality rate advancement periods (RAPs) were estimated by Cox proportional hazards models for the population-based prospective cohort studies from Europe and the U.S. (CHANCES [Consortium on Health and Ageing: Network of Cohorts in Europe and the U.S.]), and subsequently pooled by individual participant meta-analysis. Statistical analyses were performed from June 2013 to March 2014.

RESULTS: A total of 489,056 participants aged ≥60 years at baseline from 22 population-based cohort studies were included. Overall, 99,298 deaths were recorded. Current smokers had 2-fold and former smokers had 1.3-fold increased mortality compared with never smokers. These increases in mortality translated to RAPs of 6.4 (95% CI=4.8, 7.9) and 2.4 (95% CI=1.5, 3.4) years, respectively. A clear positive dose-response relationship was observed between number of currently smoked cigarettes and mortality. For former smokers, excess mortality and RAPs decreased with time since cessation, with RAPs of 3.9 (95% CI=3.0, 4.7), 2.7 (95% CI=1.8, 3.6), and 0.7 (95% CI=0.2, 1.1) for those who had quit <10, 10 to 19, and ≥20 years ago, respectively.

CONCLUSIONS: Smoking remains as a strong risk factor for premature mortality in older individuals and cessation remains beneficial even at advanced ages. Efforts to support smoking abstinence at all ages should be a public health priority.

Quantification of the smoking-associated cancer risk with rate advancement periods: meta-analysis of individual participant data from cohorts of the CHANCES consortium

BACKGROUND: Smoking is the most important individual risk factor for many cancer sites but its association with breast and prostate cancer is not entirely clear. Rate advancement periods (RAPs) may enhance communication of smoking related risk to the general population. Thus, we estimated RAPs for the association of smoking exposure (smoking status, time since smoking cessation, smoking intensity, and duration) with total and site-specific (lung, breast, colorectal, prostate, gastric, head and neck, and pancreatic) cancer incidence and mortality.

METHODS: This is a meta-analysis of 19 population-based prospective cohort studies with individual participant data for 897,021 European and American adults. For each cohort we calculated hazard ratios (HRs) for the association of smoking exposure with cancer outcomes using Cox regression adjusted for a common set of the most important potential confounding variables. RAPs (in years) were calculated as the ratio of the logarithms of the HRs for a given smoking exposure variable and age. Meta-analyses were employed to summarize cohort-specific HRs and RAPs.

RESULTS: Overall, 140,205 subjects had a first incident cancer, and 53,164 died from cancer, during an average follow-up of 12 years. Current smoking advanced the overall risk of developing and dying from cancer by eight and ten years, respectively, compared with never smokers. The greatest advancements in cancer risk and mortality were seen for lung cancer and the least for breast cancer. Smoking cessation was statistically significantly associated with delays in the risk of cancer development and mortality compared with continued smoking.

CONCLUSIONS: This investigation shows that smoking, even among older adults, considerably advances, and cessation delays, the risk of developing and dying from cancer. These findings may be helpful in more effectively communicating the harmful effects of smoking and the beneficial effect of smoking cessation.

Association of smoking and nicotine dependence with pre-diabetes in young and healthy adults.

INTRODUCTION: Several studies have shown an increased risk of type 2 diabetes among smokers. Therefore, the aim of this analysis was to assess the relationship between smoking, cumulative smoking exposure and nicotine dependence with pre-diabetes. METHODS: We performed a cross-sectional analysis of healthy adults aged 25-41 in the Principality of Liechtenstein. Individuals with known diabetes, Body Mass Index (BMI) >35 kg/m² and prevalent cardiovascular disease were excluded. Smoking behaviour was assessed by self-report. Pre-diabetes was defined as glycosylated haemoglobin between 5.7% and 6.4%. Multivariable logistic regression models were done. RESULTS: Of the 2142 participants (median age 37 years), 499 (23.3%) had pre-diabetes. There were 1,168 (55%) never smokers, 503 (23%) past smokers and 471 (22%) current smokers, with a prevalence of pre-diabetes of 21.2%, 20.9% and 31.2%, respectively (p <0.0001). In multivariable regression models, current smokers had an odds ratio (OR) of pre-diabetes of 1.82 (95% confidential interval (CI) 1.39; 2.38, p <0.0001). Individuals with a smoking exposure of <5, 5-10 and >10 pack-years had an OR (95% CI) for pre-diabetes of 1.34 (0.90; 2.00), 1.80 (1.07; 3.01) and 2.51 (1.80; 3.59) (p linear trend <0.0001) compared with never smokers. A Fagerström score of 2, 3-5 and >5 among current smokers was associated with an OR (95% CI) for pre-diabetes of 1.27 (0.89; 1.82), 2.15 (1.48; 3.13) and 3.35 (1.73; 6.48) (p linear trend <0.0001). DISCUSSION: Smoking is strongly associated with pre-diabetes in young adults with a low burden of smoking exposure. Nicotine dependence could be a potential mechanism of this relationship.

Risk factors for head and neck cancer in young adults: a pooled analysis in the INHANCE consortium.

BACKGROUND: Increasing incidence of head and neck cancer (HNC) in young adults has been reported. We aimed to compare the role of major risk factors and family history of cancer in HNC in young adults and older patients. METHODS: We pooled data from 25 case-control studies and conducted separate analyses for adults ≤45 years old ('young adults', 2010 cases and 4042 controls) and >45 years old ('older adults', 17 700 cases and 22 704 controls). Using logistic regression with studies treated as random effects, we estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: The young group of cases had a higher proportion of oral tongue cancer (16.0% in women; 11.0% in men) and unspecified oral cavity / oropharynx cancer (16.2%; 11.1%) and a lower proportion of larynx cancer (12.1%; 16.6%) than older adult cases. The proportions of never smokers or never drinkers among female cases were higher than among male cases in both age groups. Positive associations with HNC and duration or pack-years of smoking and drinking were similar across age groups. However, the attributable fractions (AFs) for smoking and drinking were lower in young when compared with older adults (AFs for smoking in young women, older women, young men and older men, respectively, = 19.9% (95% CI = 9.8%, 27.9%), 48.9% (46.6%, 50.8%), 46.2% (38.5%, 52.5%), 64.3% (62.2%, 66.4%); AFs for drinking = 5.3% (-11.2%, 18.0%), 20.0% (14.5%, 25.0%), 21.5% (5.0%, 34.9%) and 50.4% (46.1%, 54.3%). A family history of early-onset cancer was associated with HNC risk in the young [OR = 2.27 (95% CI = 1.26, 4.10)], but not in the older adults [OR = 1.10 (0.91, 1.31)]. The attributable fraction for family history of early-onset cancer was 23.2% (8.60% to 31.4%) in young compared with 2.20% (-2.41%, 5.80%) in older adults. CONCLUSIONS: Differences in HNC aetiology according to age group may exist. The lower AF of cigarette smoking and alcohol drinking in young adults may be due to the reduced length of exposure due to the lower age. Other characteristics, such as those that are inherited, may play a more important role in HNC in young adults compared with older adults.

Association between smoking and recurrence of venous thromboembolism and bleeding in elderly patients with past acute venous thromboembolism.

BACKGROUND: While the association between smoking and arterial cardiovascular events has been well established, the association between smoking and venous thromboembolism (VTE) remains controversial. OBJECTIVES: To assess the association between smoking and the risk of recurrent VTE and bleeding in patients who have experienced acute VTE. PATIENTS/METHODS: This study is part of a prospective Swiss multicenter cohort that included patients aged ≥65years with acute VTE. Three groups were defined according to smoking status: never, former and current smokers. The primary outcome was the time to a first symptomatic, objectively confirmed VTE recurrence. Secondary outcomes were the time to a first major and clinically relevant non-major bleeding. Associations between smoking status and outcomes were analysed using proportional hazard models for the subdistribution of a competing risk of death. RESULTS: Among 988 analysed patients, 509 (52%) had never smoked, 403 (41%) were former smokers, and 76 (8%) current smokers. After a median follow-up of 29.6months, we observed a VTE recurrence rate of 4.9 (95% confidence interval [CI] 3.7-6.4) per 100 patient-years for never smokers, 6.6 (95% CI 5.1-8.6) for former smokers, and 5.2 (95% CI 2.6-10.5) for current smokers. Compared to never smokers, we found no association between current smoking and VTE recurrence (adjusted sub-hazard ratio [SHR] 1.05, 95% CI 0.49-2.28), major bleeding (adjusted SHR 0.59, 95% CI 0.25-1.39), and clinically relevant non-major bleeding (adjusted SHR 1.21, 95% CI 0.73-2.02). CONCLUSIONS: In this multicentre prospective cohort study, we found no association between smoking status and VTE recurrence or bleeding in elderly patients with VTE.

The impact of tobacco control policies on university students' smoking in Ontario

Objective. Despite steady declines in the prevalence of tobacco use among Canadians, young adult tobacco use has remained stubbornly high over the past two decades (CTUMS, 2005a). Currently in Ontario, young adults have the highest proportion of smokers of all age cohorts at 26%. A growing body of evidence shows that smoking restrictions and other tobacco control policies can reduce tobacco use and consumption among adults and deter initiation among youth; whether young adult university students' smoking participation is influenced by community smoking restrictions, campus tobacco control policies or both remains an empirical question. The purpose of this study is to examine the relationship among current smoking status of students on university campuses across Ontario and various tobacco control policies, 3including clean air bylaws of students' home towns, clean air by-laws of the community where the university is situated, and campus policies. Methods. Two data sets were used. The 200512006 Tobacco Use in a Representative Sample of Post-Secondary Students data set provides information about the tobacco use of 10,600 students from 23 universities and colleges across Ontario. Data screening for this study reduced the sample to 5,114 17-to-24 year old undergraduate students from nine universities. The second data set is researcher-generated and includes information about strength and duration of, and students' exposure to home town, local and campus tobacco control policies. Municipal by-laws (of students' home towns and university towns) were categorized as weak, moderate or strong based on criteria set out in the Ontario Municipal By-law Report; campus policies were categorized in a roughly parallel fashion. Durations of municipal and campus policies were calculated; and length of students' exposure to the policies was estimated (all in months). Multinomial logistic regression analyses were used to examine the relationship between students' current smoking status (daily, less-than-daily, never-smokers) and the following policy measures: strength of, duration of, and students' exposure to campus policy; strength of, duration of, and students' exposure to the by-law in the university town; and, strength of, duration of, and students' exposure to the by-law in the home town they grew up in. Sociodemographic variables were controlled for. Results. Among the Ontario university students surveyed, 7.0% currently use tobacco daily and 15.4% use tobacco less-than-daily. The proportions of students experiencing strong tobacco control policies in their home town, the community in which their university is located and at their current university were 33.9%,64.1 %, and 31.3% respectively. However, 13.7% of students attended a university that had a weak campus policy. Multinomial logistic regressions suggested current smoking status was associated with university town by-law strength, home town by-law strength and the strength of the campus tobacco control policy. In the fmal model, after controlling for sociodemographic factors, a strong by-law in the university town and a strong by-law in students' home town were associated with reduced odds of being both a less-than-daily (OR = 0.64, 95%CI: 0.48-0.86; OR = 0.80, 95%CI: 0.66-0.95) and daily smoker (OR = 0.59, 95%CI: 0.39-0.89; OR = 0.76, 95%CI: 0.58-0.99), while a weak campus tobacco control policy was associated with higher odds of being a daily smoker (OR = 2.08, 95%CI: 1.31-3.30) (but unrelated to less-than-daily smoking). Longer exposure to the municipal by-law (OR = 0.93; 95%CI: 0.90-0.96) was also related to smoking status. Conclusions. Students' smoking prevalence was associated with the strength of the restrictions in university, and with campus-specific tobacco control policies. Lessthan- daily smoking was not as strongly associated with policy measures as daily smoking was. University campuses may wish to adopt more progressive campus policies and support clean air restrictions in the broader community. More research is needed to determine the direction of influence between tobacco control policies and students' smoking.

Consommation alimentaire d’antioxydants et risque de cancer du poumon : une étude cas-témoins montréalaise

Objectif : Examiner l’association entre la consommation alimentaire de caroténoïdes (β-carotène, α-carotène, β-cryptoxanthine, lutéine/zéaxanthine, lycopène) et de vitamine C et le risque de cancer du poumon, selon le sexe, l’intensité de tabagisme et le sous-type histologique de la tumeur. Méthodes : Les données proviennent d’une étude cas-témoins menée à Montréal, Canada. Des entrevues ont été effectuées auprès de 1 105 cas incidents de cancer du poumon et 1 449 témoins issus de la population générale. Leur fréquence de consommation moyenne de 49 fruits et légumes deux ans auparavant a été convertie en apports en antioxydants. Les rapports de cotes (RC) et les intervalles de confiance (IC) à 95% caractérisant l’association entre les antioxydants et le risque de cancer du poumon ont été estimés à l’aide de modèles de régression logistique et polytomée, en tenant compte de facteurs de confusion potentiels. Résultats : Une consommation élevée en antioxydants était généralement associée à une diminution du risque de cancer du poumon de l’ordre de 30%. Un effet protecteur a été observé chez les hommes et les femmes, pour les non fumeurs, les fumeurs quelque soit l’intensité de tabagisme, ainsi que pour les carcinomes à petites cellules, épidermoïde et l’adénocarcinome. Conclusions : Plusieurs antioxydants alimentaires protégeraient du cancer du poumon. Les efforts de prévention bénéficieraient de cibler la promotion de la consommation de fruits et de légumes riches en caroténoïdes et en vitamine C.

Comparación entre los pacientes con diagnóstico clínico de EPOC vs los confirmados por Espirometría en un hospital de segundo nivel en Bogotá DC, 2011

Introducción: La enfermedad pulmonar obstructiva crónica (EPOC), está caracterizada por la limitación del flujo aéreo, de forma progresiva y casi irreversible, asociada a la reacción inflamatoria atribuida a diferentes factores, principalmente a la exposición al humo de tabaco. Es considerada un problema de salud pública en Colombia y en el mundo, con un aumento acelerado de la condición crónica en la actualidad. Objetivo: Identificar las diferencias sociodemográficas, clínicas y de tratamiento, entre los pacientes con diagnóstico clínico y espirométricos de EPOC vs los pacientes con diagnóstico clínico y descartados por espirometría en el Hospital de Suba. Material y Métodos: Estudio observacional, descriptivo, retrospectivo como un componente exploratorio para comparar los grupos con diagnóstico de EPOC clínico y confirmado o descartado por espirometría, entre Enero y Agosto del 2011. Se utilizó estadística descriptiva para calcular las medidas de tendencia central, los datos cuantitativos se expresaron como la media de la variable ± desviación estándar, y los cualitativos como porcentaje, la t de Student para analizar diferencia de las variables cuantitativas de medias entre grupos y la prueba de Pearson para analizar la relación entre los datos cualitativos para aquellos con valores esperados menores a 5 se aplicó test exacto de Fisher, tuvimos en cuenta un α de 0.05 para el análisis bivariado y medidas de asociación. Todos los análisis se realizaron con el paquete estadístico SPSS 19,0 Versión corporativa. Resultados: De los 398 pacientes, solo 287 cumplían con criterios de inclusión. El promedio de edad del total de los pacientes fue de 70,29 + 11,18 años, y 59,5% de la población fue de sexo femenino. Del total de pacientes evaluados, 171 pacientes (59.6%) se descartó el diagnóstico de EPOC (VEF1/ VEC > 0,70). Al comparar los grupos de pacientes a los que se les confirmo el diagnóstico de EPOC contras los descartados por espirometría se encontró que no hay diferencias estadísticamente significativas entre la edad; en los pacientes con EPOC predomino el sexo femenino (p 0.02); en los factores de riesgo existe clara asociación entre EPOC y la exposición a humo de leña (p <0.001), y en cuanto al tabaquismo solo se encontró asociación con ex fumador (p 0,011). Para analizar las diferencias en el tratamiento se estratifico por las posible combinaciones de inhaladores con o sin teofilina, encontrando una diferencia estadísticamente significativa para los tratamientos de tres inhaladores (p 0,015), dos inhaladores + teofilina (p 0,05), tres inhaladores + teofilina (p <0.001), y en los pacientes no tratados (p <0,001).

Mudanças no hábito de fumar e ganho de peso gestacional : um estudo de coorte em capitais brasileiras

Objetivo: Avaliar a influência de mudanças no hábito de fumar sobre o ganho de peso gravídico materno. Métodos: Foram entrevistadas 5.564 gestantes com 20 anos ou mais, sem diabetes mellitus prévio em serviços de pré-natal geral de seis capitais brasileiras, entre 1991 e 1995, e acompanhamos, através de revisão de prontuários, as gestações até o parto, identificando 4.000 gestantes com peso pré-gravídico relatado, peso medido no terceiro trimestre, hábito de fumar e época de sua eventual modificação, quando disponíveis. Resultados: Entre as gestantes ex-fumantes (915, 23% do total), 240 (26%) pararam de fumar durante a gravidez. A mediana de cigarros/dia das que continuaram fumantes (717, 18%) foi reduzida de 10 para 5 após o início da gravidez. Após ajustar para idade, escolaridade, cor da pele, IMC pré-gravídico, paridade e centro clínico, as ex-fumantes ganharam 1.030 g (IC95% 590 a 1.460) a mais que as nunca fumantes, sendo maior a diferença (1.540, IC95% 780 a 2.300 g) nas que pararam após a concepção. O ganho do peso na gravidez se correlacionou, tanto em fumantes quanto em ex-fumantes, com o número de cigarros diminuídos na gravidez. Conclusão: Diminuir ou parar de fumar na gravidez, embora importante para uma gestação saudável, é fator de risco para ganho de peso materno.

Evaluation of hospitalized patients in terms of their knowledge related to smoking

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Smoking enhances bone loss in anterior teeth in a Brazilian population: A retrospective cross-sectional study

The aim of the present study was to radiographically evaluate the effect of smoking on bone loss resulting from chronic periodontitis. Periapical radiographs were analyzed of 80 patients with chronic periodontitis (40 current or former smokers and 40 never-smokers) that attended a private periodontal practice. The smokers or former-smokers with a minimum consumption of 10 cigarettes/day for a period of over 10 years were selected. Interproximal radiographic bone loss was considered as the distance between the cementum-enamel junction and the alveolar bone crest. Bone loss for smokers was higher than that observed in never-smokers (p < 0.05) (3.33 ± 1.09 mm and 2.24 ± 0.76 mm; mean ± standard deviation for smokers and non-smokers, respectively). When each region of the mouth was comparatively evaluated, it was observed that the smokers' incisors presented the highest bone loss when compared with the other groups of teeth (p < 0.01). Within the limits of the present investigation it can be concluded that smoking enhances the bone loss resulting from periodontitis and that the incisors are the teeth most affected.

Response of molars and non-molars to a strict supragingival control in periodontal patients

The posterior position in the arches is one of the factors that underlies the poor prognosis of molar teeth (M). It is speculated that M do not benefit from the oral hygiene routine as well as non-molars (NM) do. This study evaluated the response of M and NM to supragingival control during a 6-month period in 25 smokers (S) and 25 never-smokers (NS) with moderate-to-severe periodontitis. One calibrated examiner assessed visible plaque (VPI) and gingival bleeding (GBI) indexes, periodontal probing depth (PPD), bleeding on probing (BOP), and clinical attachment loss (CAL) at days 0 (baseline), 30 and 180. At baseline, M showed significantly higher mean values of VPI (p = 0.017) and PPD (p < 0.001) compared with NM; CAL was also greater in M (p < 0.001) and was affected by smoking (p = 0.007). The reductions obtained for periodontal indicators at day 180 showed similar responses between M and NM. For CAL, M (NS 0.57 ± 0.50; S 0.67 ± 0.64) and NM (NS 0.38 ± 0.23; S 0.50 ± 0.33) reached an almost significant difference (p = 0.05). Smoking did not influence the response to treatment. Multilevel analysis revealed that, only for PDD reductions, the interaction between sites, teeth and patient was significant (p < 0.001). It was concluded that M benefit from an adequate regimen of supragingival biofilm control; therefore, supragingival condition should be considered in the prognosis of molar teeth.

Efeito do controle de placa bacteriana supragengival sobre parâmetros subgengivais

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Does ethnic ancestry play a role in smoking?

A maior proporção de fumantes entre negros no Brasil tem sido atribuída a desigualdades socioeconômicas, mas fatores genéticos também poderiam contribuir para esse achado. Este estudo visou investigar associações entre status tabágico com ancestralidade definida geneticamente e características socioeconômicas em brasileiros. Amostras de sangue foram colhidas de 448 voluntários (66,7% homens; idade: 37,1±11,4 anos) classificados como fumantes atuais (FA: 60,9%), ex-fumantes (EF:8,9%) e não fumantes (NF:30,1%).Misturas éticas individuais foram determinadas empregando-se um painel informativo de ancestralidade composto por 48 polimorfismos de deleções e inserções. FA mostraram menor proporção de ancestralidade europeia do que NF (0,837±0,243 X 0,883±0,194; p≤0,05) e EF (0,837±0,243 X 0,864±0,230; p≤0,05), e maior proporção de ancestralidade africana sub-saárica do que EF (0,128±0,222 X 0,07±0,174, p≤0,05) e NF (0,128±0,222 X 0,085±0,178, p≤0,05). NF informaram maior número de anos de escola do que FA (11,2±3,7 X 8,9±3,8; p≤0,001). FA foram menos comuns na Classe econômica A (30%) e mais comuns na Classe B (56,8%). Em análise multivariada, apenas menor número de anos escolares e menor classe econômica estiveram associados com chances maiores para FA. O uso de marcadores de genética molecular para caracterizar o background étnico confirmou que diferenças socioeconômicas são os principais determinantes de maiores taxas de tabagismo entre negros no Brasil.

Vitamina D em mulhers adultas fumantes e ex-fumantes: ingestão, concentração sérica e associação com variáveis ecocardiográficas

Pós-graduação em Fisiopatologia em Clínica Médica - FMB