Smoking and mortality among persons aged 75-94

Current and recent cigarette smoking in relation to cardiovascular and non-cardiovascular mortality in an elderly male Chinese population

OBJECTIVE

To investigate the association between current and former smoking and the risk of mortality in elderly Chinese men.

METHODS

Our study participants were elderly (≥ 60 years) men recruited in a suburban town of Shanghai. Cigarette smoking status was categorized as never smoking, remote (cessation > 5 years) and recent former smoking (cessation ≤ 5 years), and light-to-moderate (≤ 20 cigarettes/day) and heavy current smoking (> 20 cigarettes/day). Cox proportional hazards models and restricted cubic splines were used to examine the associations of interest.

RESULTS

The 1568 participants had a mean age of 68.6 ± 7.1 years. Of all participants, 311 were never smokers, 201 were remote former smokers, 133 were recent former smokers, 783 were light-to-moderate current smokers and 140 were heavy current smokers. During a median follow-up of 7.9 years, all-cause, cardiovascular and non-cardiovascular deaths occurred in 267, 106 and 161 participants, respectively. Heavy current smokers had the highest risk of all-cause and non-cardiovascular mortality, with an adjusted hazard ratio (HR) of 2.30 (95% CI: 1.34-4.07) and 3.98 (95% CI: 2.03-7.83) versus never smokers, respectively. Recent former smokers also had a higher risk of all-cause (HR = 1.62, 95% CI: 1.04-2.52) and non-cardiovascular mortality (HR = 2.40, 95% CI: 1.32-4.37) than never smokers. Cox regression restricted cubic spline models showed the highest risk of all-cause and non-cardiovascular mortality within 5 years of smoking cessation and decline thereafter. Further subgroup analyses showed interaction between smoking status and pulse rate (≥ 70 beats/min vs. < 70 beats/min) in relation to the risk of all-cause and non-cardiovascular mortality, with a higher risk in current versus never smokers in those participants with a pulse rate below 70 beats/min.

CONCLUSIONS

Cigarette smoking in elderly Chinese confers significant risks of mortality, especially when recent former smoking is considered together with current smoking.

A novel framework for classification of selection processes in epidemiological research

BACKGROUND

Selection and selection bias are terms that lack consistent definitions and have varying meaning and usage across disciplines. There is also confusion in current definitions between underlying mechanisms that lead to selection and their consequences. Consequences of selection on study validity must be judged on a case-by-case basis depending on research question, study design and analytical decisions. The overall aim of the study was to develop a simple but general framework for classifying various types of selection processes of relevance for epidemiological research.

METHODS

Several original articles from the epidemiological literature and from related areas of observational research were reviewed in search of examples of selection processes, used terminology and description of the underlying mechanisms.

RESULTS

We classified the identified selection processes in three dimensions: i) selection level (selection at the population level vs. study-specific selection), ii) type of mechanism (selection in exposure vs. selection in population composition), iii) timing of the selection (at exposure entry, during exposure/follow-up or post-outcome).

CONCLUSIONS

Increased understanding of when, how, and why selection occur is an important step towards improved validity of epidemiological research.

Health-Related Quality of Life and Associated Factors among Oldest-Old in China

OBJECTIVES

The oldest old population has become the fastest growing segment with excess need of care and social support, it is crucial to improve the health-related quality of life (HRQoL) of these populations. This study seeks to evaluate the health status and to investigate modifiable factors associated with health-related quality of life for oldest old adults in China.

DESIGN

A cross-sectional population-based study.

SETTING

Hainan Province in the south of China.

PARTICIPANTS

1,278 adults aged 80 years or older.

METHODS

HRQoL was assessed by three-level EuroQol-5D scale (EQ-5D-3L) and a visual analogue scale (VAS). Demographic and health-related variables were analysed by estimating mean values and standard deviations for continuous variables, percentages and standard deviations for categorical variables. Tobit regressions, ordinary least Squared (OLS) regressions and ordered probit regressions were adopted to determine the associated factors for overall HRQoL and for each health dimension.

RESULTS

Anxiety/depression was the least reported problem while mobility was the most frequently reported with problem. Female respondents had lower EQ-5D score (0.76 vs. 0.86) and VAS score (66.55 vs. 69.84) than male respondents. Better health-related quality of life was significantly associated with higher BMI, no drinking habit, more leisure activities, living with family members, good sleeping quality, closer social and family connections, fewer numbers of drugs consumed per day, without having hearing or visual impairment, and fewer chronic conditions, after controlling for potential confounders.

CONCLUSION

Findings from this study suggested that quality of life was not only associated with age-related diseases, but also correlated with a range of health-related lifestyles, and factors indicating social and family support.

Long-Term Survival after Acute Myocardial Infarction in Lithuania during Transitional Period (1996-2015): Data from Population-Based Kaunas Ischemic Heart Disease Register

Background and Objective: There is a lack of reliable epidemiological data on the long-term survival after acute myocardial infarction (AMI) in the Lithuanian population. The aim of the study was to evaluate the long-term (36 months) survival after AMI among persons aged 25–64 years, who had experienced AMI in four time-periods 1996, 2003–2004, 2008, and 2012. Material and Methods: The source of the data was Kaunas population-based Ischemic heart disease (IHD) register. Long-term survival after AMI (36 months) was evaluated using the Kaplan–Meier method. The survival curves significantly differed when p < 0.05. Hazard ratio for all-cause mortality and their 95% CIs, adjusted for baseline characteristics, were estimated with the Cox proportional hazards regression model. Results: The analysis of data on 36 months long-term survival among Kaunas population by sex and age groups showed that the survival rates among men and women were 83.4% and 87.6%, respectively (p < 0.05) and among 25–54 years-old and 55–64 years-old persons, 89.2% and 81.7%, respectively (p < 0.05). The rates of long-term survival of post-AMI Kaunas population were better in past periods than in first period. According to the data of the Kaplan-Meier survival analysis, long-term survival of 25 to 64-year-old post-AMI Kaunas population was without significantly difference in 1996, 2003–2004, 2008 and 2012 (Log-rank = 6.736, p = 0.081). The adjusted risk of all-cause mortality during 36 months among men and 25 to 54-year-old patients was on the average by 35% and 60% lower in 2012 than in 1996, respectively. Conclusion: It was found that 36 months survival post MI among women and younger (25–54 years) persons was significant better compared to men and older (55–64 years) persons. Long-term survival among 55 to 64-year-old post-AMI Kaunas population had a tendency to decrease during last period, while among 25–54 years old persons long-term survival was without significant changes. The results highlight the fact that AMI survivors, especially in youngest age, remain a high-risk group and reinforce the importance of primary and secondary prevention for the improvement of long-term prognosis of AMI patients.

Precision medicine and the cursed dimensions

Our intuition regarding "average" is rooted in one-dimensional thinking, such as the distribution of height across a population. This intuition breaks down in higher dimensions when multiple measurements are combined: fewer individuals are close to average for many measurements simultaneously than for any single measurement alone. This phenomenon is known as the curse of dimensionality. In medicine, diagnostic sophistication generally increases through the addition of more predictive factors. Disease classes themselves become more dissimilar as a result, increasing the difficulty of incorporating (i.e., averaging) multiple patients into a single class for guiding treatment of new patients. Failure to consider the curse of dimensionality will ultimately lead to inherent limits on the degree to which precision medicine can extend the advances of evidence-based medicine for selecting suitable treatments. One strategy to compensate for the curse of dimensionality involves incorporating predictive observation models into the patient workup.

Longitudinal Associations of Local Cigarette Prices and Smoking Bans with Smoking Behavior in the Multi-Ethnic Study of Atherosclerosis

BACKGROUND

Few studies have examined associations of geographically proximal cigarette prices with within-person changes in smoking outcomes or assessed interactions between cigarette prices and smoking bans.

METHODS

We linked neighborhood cigarette prices (inflation-adjusted) at chain supermarkets and drug stores and bar/restaurant smoking ban policies to cohort participants (632 smokers from the Multi-Ethnic Study of Atherosclerosis, 2001-2012, baseline mean age 58 years) using geocoded retailer and participant addresses. We used fixed-effects models to investigate associations of within-person changes in price and ban exposures with within-person changes in five smoking outcomes: current smoking, heavy (≥10 cigarettes) smoking, cessation, relapse, and intensity (average number of cigarettes smoked per day, natural log transformed). We assessed intensity associations among all smokers, and heavy (≥10 cigarettes per day) and light (<10) baseline smokers. Finally, we tested interactions between cigarette price and bans.

RESULTS

A $1 increase in price was associated with a 3% reduction in risk of current smoking (adjusted risk ratio [aRR]: 0.97; 95% confidence interval [CI] = 0.93, 1.0), a 7% reduction in risk of heavy smoking (aRR: 0.93; CI = 0.87, 0.99), a 20% increase in risk of smoking cessation (aRR: 1.2; CI = 0.99, 1.4), and a 35% reduction in the average number of cigarettes smoked per day by heavy baseline smokers (ratio of geometric means: 0.65; CI = 0.45, 0.93). We found no association between smoking bans and outcomes, and no evidence that price effects were modified by the presence of bans.

CONCLUSIONS

Results underscore the importance of local prices, but not hospitality smoking bans, in influencing older adults' smoking behaviors.

Physical activity, fitness, and all-cause mortality: An 18-year follow-up among old people

BACKGROUND

Little is known about change in physical activity (PA) and its relationship to all-cause mortality among old people. There is even less information about the association between PA, fitness, and all-cause mortality among people aged 80 years and above. The objective is to investigate persistence and change in PA over 5 years as a predictor of all-cause mortality, and fitness as a mediator of this association, among people aged 80 and 85 years at the beginning of an 18-year mortality follow-up period.

METHODS

Using Evergreen Project data (started in 1989), 4 study groups were formed according to self-reported changes in PA level, over a 5-year period (starting in 1989-1990 and ending in 1994-1995): remained active (RA, control group), changed to inactive (CI), remained inactive (RI), and changed to active (CA). Mortality was followed up over the 18-year period (1994-2012). Cox models with different covariates such as age, sex, use of alcohol, smoking, chronic diseases, and a 10 m walking test were used to analyze the association between change in PA level and mortality.

RESULTS

Compared to RA, those who decreased their PA level (CI) between baseline and follow-up had higher all-cause mortality (hazard ratio (HR = 2.09; 95%CI: 1.63-2.69) when adjusted for age, gender, and chronic diseases. RI showed the highest all-cause mortality (HR = 2.16; 95%CI: 1.59-2.93). In CA, when compared against RA, the risk of all-cause mortality was not statistically significant (HR = 1.51; 95%CI: 0.95-2.38). In comparison with RA, when walking speed over 10 m was added as a covariate, all-cause mortality risk was almost statistically significant only in CI (HR = 1.37; 95%CI: 1.00-1.87).

CONCLUSION

Persistence and change in PA level was associated with mortality. This association was largely explained by fitness status. Randomized controlled studies are needed to test whether maintaining or increasing PA level could lengthen the life of old people.

Predictors of Smoking Cessation in Old-Old Age

INTRODUCTION

There is a dearth of knowledge on smoking cessation in older adults. This study examined predictors of smoking cessation in persons over age 75.

METHODS

This study is a secondary analysis of a prospective longitudinal study. A sample of 619 older persons aged 75-94 was drawn from a representative cohort of older persons in Israel and was examined longitudinally. By means of interviews, we assessed smoking, health, Activities of Daily Living (ADL), Instrumental ADL, cognitive dysfunction, and well-being.

RESULTS

Continuing smokers tended to be lonelier. Participants who quit smoking took more medications and had greater cognitive dysfunction compared to those who continued smoking.

CONCLUSIONS

Greater cognitive dysfunction and high medication use or the physical causes for high medication use may precipitate smoking cessation in persons aged 75-94, potentially through a greater influence of caregivers on one's lifestyle.

IMPLICATIONS

Cognitive dysfunction and high medication use predicted smoking cessation. Smoking cessation for long time smokers may be influenced by greater ill health. Influence of caregivers may augment smoking cessation. Given these findings, for persistent smokers into old age, smoking cessation may occur at the time of physical and functional decline during the end of life period.

Association of Behavioral Risk Factors for Chronic Diseases With Physical and Mental Health in European Adults Aged 50 Years or Older, 2004-2005

INTRODUCTION

Noncommunicable diseases are the leading cause of illness and death worldwide; behavioral risk factors (BRFs) contribute to these diseases. We assessed the presence of multiple BRFs among European adults according to their physical and mental health status.

METHODS

We used data from 26,026 adults aged 50 years or older from 11 countries that participated in the Survey of Health, Ageing and Retirement in Europe (2004-2005). BRFs (overweight or obesity, smoking, physical inactivity, and risky alcohol consumption) were assessed according to physical health (ie, presence of chronic diseases, disease symptoms, or limitations in activities of daily living) and mental health (depression) through multiple regression estimations.

RESULTS

Overweight or obesity in men and physical inactivity in women were the most prevalent BRFs. Compared with physically active adults, physically inactive adults had a higher mean number of chronic diseases (1.33 vs 1.26) and chronic disease symptoms (1.55 vs 1.47). Risky alcohol consumption (≥4 servings of an alcohol beverage ≥3 times a week) was associated with a higher mean depression score (2.84 vs 2.47). Compared with adults with 0 or 1 BRF, adults with 2 or more BRFs had significantly higher odds of having 1 or more chronic diseases (men: 1.52; women: 1.73) and functional limitations (men: 1.65; women: 1.79) and higher prevalence of high blood pressure (37.8% vs 28.2). Belgian adults with BRFs had the highest mean number of chronic diseases or functional limitations among those who were overweight or obese and the highest mean number of chronic diseases and disease symptoms among those who smoked and were physically inactive.

CONCLUSION

We found revealed significant positive associations between BRFs and poor health among middle-aged and older European adults. Primary health care intervention programs should focus on developing ways to reduce BRF prevalence in this population.

Smoking and mortality in a prospective cohort study of elderly Chinese in Hong Kong

BACKGROUND AND AIMS

Large cohort studies on smoking and mortality in elderly people are scarce, and few studies examined smokers aged 85+ years separately. We estimated the risks of all-cause and cause-specific mortality due to smoking in an elderly Chinese cohort in Hong Kong.

DESIGN

A population-based prospective cohort of 65,510 Chinese enrolled from 1998 to 2001 and followed until May 2012.

SETTING

All 18 Elderly Health Service centres in Hong Kong, China.

PARTICIPANTS

Elderly people aged 65+ years.

MEASUREMENTS

Self-reported smoking status was assessed at baseline interview and categorized as never, former and current smokers.

FINDINGS

Compared with never smokers, after adjustment for sex, age, education, social security assistance, housing type, monthly expenditure, alcohol use, depressive symptoms and health status, the hazard ratio (HR) for current smokers was 1.89 [95% confidence interval (CI) = 1.81-1.98] for all participants aged 65+ years at baseline, corresponding to an attributable fraction (AF) of about 50%, which is based on AF = (HR-1)/HR. As the effect of smoking varied with age (P for age interaction <0.001), subgroup analysis by age group showed that the adjusted HR for current smokers aged 65-84 years was 1.93 (95% CI = 1.84-2.03), and for 85+ years was 1.29 (95% CI = 1.05-1.58). All the risk estimates did not vary by sex (P for sex interaction ranged 0.74-0.89).

CONCLUSIONS

In Hong Kong, the risk of death from smoking appears to be the same for Chinese women as it is for men. Half of all deaths in Chinese smokers aged 65 years and older and a quarter of all deaths in Chinese smokers aged 85 years and older are caused by smoking-attributable diseases.