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Padrón‐Monedero A. A pathological convergence theory for non-communicable diseases. Aging Med (Milton) 2023; 6:328-337. [PMID: 38239708 PMCID: PMC10792334 DOI: 10.1002/agm2.12273] [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: 07/18/2023] [Revised: 10/11/2023] [Accepted: 10/16/2023] [Indexed: 01/22/2024] Open
Abstract
The current paradigm considers the study of non-communicable diseases (NCDs), which are the main causes of mortality, as individual disorders. Nevertheless, this conception is being solidly challenged by numerous remarkable studies. The clear fact that the mortality, by virtually all NCDs, tends to cluster at old ages (with the exception of congenital malformations and certain types of cancer, among a few others); makes us intuitive to assume that the common convergence mechanism that exponentially increases mortality by almost all NCDs in older ages is cell aging. Moreover, when we study NCDs, we are not analyzing which disorders cause the mortality of the populations, rather that which disorders kill us before others do, because the aging of the individuals causes inevitably their death by one cause or another. This is not a defeatist perspective, but a challenging and efficient one. These intuitive assumptions have been supported by studies from the pathophysiologic, epidemiologic, and genetic fields, leading to the affirmation that, as NCDs share genetic and pathophysiological mechanisms (derived from mostly the same risk factors), they should no longer be considered independently. Those studies should make us reconsider our current conceptions of studying NCDs as individual disorders, and to hypothesize about a paradigm that would consider most NCDs (cancer, neurological pathologies, cardiovascular diseases, type II diabetes mellitus, chronic respiratory diseases, osteoarthritis, and osteoporosis, among others) different manifestations of the same process: the cell aging.
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Lee PN, Coombs KJ, Hamling JS. Evidence relating cigarette, cigar and pipe smoking to lung cancer and chronic obstructive pulmonary disease: Meta-analysis of recent data from three regions. World J Meta-Anal 2023; 11:228-252. [DOI: 10.13105/wjma.v11.i5.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/10/2023] [Accepted: 05/30/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND There is a need to have up-to-date information for various diseases on the risk related to the use of different smoked products and the use of other nicotine-containing products. Here, we contribute to the information pool by presenting up-to-date quantitative evidence for North America, Europe and Japan and for both lung cancer and chronic obstructive pulmonary disease (COPD) on the relative risk (RR) relating to current vs never product use for each of the three smoked tobacco products, cigarettes, cigars and pipes.
AIM To estimate lung cancer and COPD current smoking RRs for the three products using recent data for the three regions.
METHODS Publications in English from 2010 to 2020 were considered that, based on epidemiological studies in the three regions, estimated the current smoking RR of lung cancer and/or COPD for one or more of the three products. The studies should involve at least 100 cases of the disease considered, not be restricted to specific lung cancer types or populations with specific medical conditions, and should be of cohort or nested case-control study design or randomized controlled trials. Literature searches were conducted on MEDLINE separately for lung cancer and for COPD, examining titles and abstracts initially, and then full texts. Additional papers were sought from reference lists of selected papers, reviews and meta-analyses. For each study identified, the most recent available data on each product were entered on current smoking, as well as on characteristics of the study and the RR estimates. Combined RR estimates were derived using random-effects meta-analysis. For cigarette smoking, where far more data were available, heterogeneity was studied by a wide range of factors. For cigar and pipe smoking, a more limited heterogeneity analysis was carried out. Results were compared with those from previous meta-analyses published since 2000.
RESULTS Current cigarette smoking: For lung cancer, 44 studies (26 North American, 14 European, three Japanese, and one in multiple continents), gave an overall estimate of 12.14 [95% confidence interval (CI) 10.30-14.30]. The estimates were higher (heterogeneity P < 0.001) for North American (15.15, CI 12.77-17.96) and European studies (12.30, CI 9.77-15.49) than for Japanese studies (3.61, CI 2.87-4.55), consistent with previous evidence of lower RRs for Asia. RRs were higher (P < 0.05) for death (14.85, CI 11.99-18.38) than diagnosis (10.82, CI 8.61-13.60). There was some variation (P < 0.05) by study population, with higher RRs for international and regional studies than for national studies and studies of specific populations. RRs were higher in males, as previously reported, the within-study male/female ratio of RRs being 1.52 (CI 1.20-1.92). RRs did not vary significantly (P ≥ 0.05) by other factors. For COPD, RR estimates were provided by 18 studies (10 North American, seven European, and one Japanese). The overall estimate of 9.19 (CI 6.97-12.13), was based on heterogeneous data (P < 0.001), and higher than reported earlier. There was no (P > 0.1) variation by sex, region or exclusive use, but limited evidence (0.05 < P < 0.1) that RR estimates were greater where cases occurring shortly after baseline were ignored; where bronchiectasis was excluded from the COPD definition; and with greater confounder adjustment. Within-study comparisons showed adjusted RRs exceeded unadjusted RRs. Current cigar smoking: Three studies gave an overall lung cancer RR of 2.73 (CI 2.36-3.15), with no heterogeneity, lower than the 4.67 (CI 3.49-6.25) reported in an earlier review. Only one study gave COPD results, the RR (2.44, CI 0.98-6.05) being imprecise. Current pipe smoking: Four studies gave an overall lung cancer RR of 4.93 (CI 1.97-12.32), close to the 5.20 (CI 3.50-7.73) given earlier. However, the estimates were heterogeneous, with two above 10, and two below 3. Only one study gave COPD results, the RR (1.12, CI 0.29-4.40), being imprecise. For both diseases, the lower RR estimates for cigars and for pipes than for current smoking of cigarettes aligns with earlier published evidence.
CONCLUSION Current cigarette smoking substantially increases lung cancer and COPD risk, more so in North America and Europe than Japan. Limited evidence confirms lower risks for cigars and pipes than cigarettes.
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Affiliation(s)
- Peter Nicholas Lee
- Medical Statistics and Epidemiology, P.N.Lee Statistics and Computing Ltd., Sutton SM2 5DA, Surrey, United Kingdom
| | - Katharine J Coombs
- Statistics, P.N.Lee Statistics and Computing Ltd, Sutton SM2 5DA, Surrey, United Kingdom
| | - Jan S Hamling
- Statistics, RoeLee Statistics Ltd, Sutton SM2 5DA, United Kingdom
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Yang JJ, Yu D, Shu XO, Wen W, Rahman S, Abe S, Saito E, Gupta PC, He J, Tsugane S, Gao YT, Yuan JM, Koh WP, Sadakane A, Tomata Y, Tsuji I, Sugawara Y, Matsuo K, Ahn YO, Park SK, Chen Y, Inoue M, Kang D, Zheng W. Reduction in total and major cause-specific mortality from tobacco smoking cessation: a pooled analysis of 16 population-based cohort studies in Asia. Int J Epidemiol 2022; 50:2070-2081. [PMID: 34999862 PMCID: PMC8743132 DOI: 10.1093/ije/dyab087] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Little is known about the time course of mortality reduction following smoking cessation in Asians who have smoking behaviours distinct from their Western counterparts. We evaluated the level of reduction in all-cause, cardiovascular disease (CVD) and lung cancer mortality by years since quitting smoking, in Asia. METHODS Using Cox regression, we analysed individual participant data (n = 709 151) from 16 prospective cohorts conducted in China, Japan, Korea/Singapore, and India/Bangladesh, separately by cohorts. Cohort-specific hazard ratios (HRs) were combined using a random-effects meta-analysis. RESULTS During a mean follow-up of 12.0 years, 108 287 deaths were ascertained-35 658 from CVD and 7546 from lung cancer. Among Asian men, a dose-response relationship of risk reduction in deaths from all causes, CVD and lung cancer was observed with an increase in years after smoking cessation. Compared with never smokers, however, all-cause and CVD mortality among former smokers remained elevated 10-14 years after quitting [multivariable-adjusted HR (95% confidence interval (CI) = 1.25 (1.13-1.37) and 1.20 (1.02-1.41), respectively]. Lung cancer mortality stayed almost 2-fold higher than among never smokers 15-19 years after smoking cessation [1.97 (1.41-2.73)], particularly among former heavy smokers [2.62 (1.71-4.00)]. Women who quitted for ≥5 years retained a significantly elevated mortality from all causes, CVD and lung cancer. Overall patterns of the cessation-mortality associations were similar across countries. CONCLUSIONS Our findings suggest that adverse effects of tobacco smoking persist for an extended time period, even for more than two decades, which is beyond the time windows defined in current clinical guidelines for risk assessment of lung cancer and CVD.
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Affiliation(s)
- Jae Jeong Yang
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Danxia Yu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Wanqing Wen
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shafiur Rahman
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Division of Prevention, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Sarah Abe
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Eiko Saito
- Division of Cancer Statistics and Integration, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Prakash C Gupta
- Healis—Sekhsaria Institute for Public Health, Mahape, Navi Mumbai, India
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Yu-Tang Gao
- State Key Laboratory of Oncogene and Related Genes & Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China
| | - Jian-Min Yuan
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Woon-Puay Koh
- Health Services and Systems Research, Duke-NUS Medical School Singapore, Singapore, Republic of Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Republic of Singapore
| | | | - Yasutake Tomata
- Division of Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ichiro Tsuji
- Division of Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yumi Sugawara
- Department of Health Informatics and Public Health, Division of Epidemiology, Tohoku University School of Public Health, Graduate School of Medicine, Miyagi Prefecture, Japan
| | - Keitaro Matsuo
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
- Division of Cancer Epidemiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoon-Ok Ahn
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Sue K Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea
- Cancer Research Institute, Seoul National University, Seoul, South Korea
| | - Yu Chen
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Manami Inoue
- Division of Prevention, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Daehee Kang
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea
- Cancer Research Institute, Seoul National University, Seoul, South Korea
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
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Lee PN, Fry JS, Gilliland S, Campbell P, Joyce AR. Estimating the reduction in US mortality if cigarettes were largely replaced by e-cigarettes. Arch Toxicol 2022; 96:167-176. [PMID: 34677631 PMCID: PMC8748352 DOI: 10.1007/s00204-021-03180-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/06/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Recent estimates indicated substantially replacing cigarettes by e-cigarettes would, during 2016-2100, reduce US deaths and life-years lost (millions) by 6.6 and 86.7 (Optimistic Scenario) and 1.6 and 20.8 (Pessimistic). To provide additional insight we use alternative modelling based on a shorter period (1991-2040), four main smoking-associated diseases, deaths aged 30-79 years, and a full product history. We consider variations in: assumed effective dose of e-cigarettes versus cigarettes (F); their relative quitting rate (Q); proportions smoking after 10 years (X); and initiation rate (I) of vaping, relative to smoking. METHODS We set F = 0.05, X = 5%, Q = 1.0 and I = 1.0 (Main Scenario) and F = 0.4, X = 10%, Q = 0.5 and I = 1.5 (Pessimistic Scenario). Sensitivity Analyses varied Main Scenario parameters singly; F from 0 to 0.4, X 0.01% to 15%, and Q and I 0.5 to 1.5. To allow comparison with prior work, individuals cannot be dual users, re-initiate, or switch except from cigarettes to e-cigarettes. RESULTS Main Scenario reductions were 2.52 and 26.23 million deaths and life-years lost; Pessimistic Scenario reductions were 0.76 and 8.31 million. These were less than previously, due to the more limited age-range and follow-up, and restriction to four diseases. Reductions in deaths (millions) varied most for X, from 3.22 (X = 0.01%) to 1.31 (X = 15%), and F, 2.74 (F = 0) to 1.35 (F = 0.4). Varying Q or I had little effect. CONCLUSIONS Substantial reductions in deaths and life-years lost were observed even under pessimistic assumptions. Estimates varied most for X and F. These findings supplement literature indicating e-cigarettes can importantly impact health challenges from smoking.
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Affiliation(s)
- Peter N Lee
- P N Lee Statistics and Computing Ltd, 17 Cedar Road, Sutton, SM2 5DA, Surrey, UK.
| | - John S Fry
- RoeLee Statistics Ltd, 17 Cedar Road, Sutton, SM2 5DA, Surrey, UK
| | - Stanley Gilliland
- Consilium Sciences, LLC, 7400 Beaufont Springs Drive, Suite 300, N. Chesterfield, 23325, VA, USA
| | - Preston Campbell
- Consilium Sciences, LLC, 7400 Beaufont Springs Drive, Suite 300, N. Chesterfield, 23325, VA, USA
| | - Andrew R Joyce
- Consilium Sciences, LLC, 7400 Beaufont Springs Drive, Suite 300, N. Chesterfield, 23325, VA, USA
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Lee PN, Abrams D, Bachand A, Baker G, Black R, Camacho O, Curtin G, Djurdjevic S, Hill A, Mendez D, Muhammad-Kah RS, Murillo JL, Niaura R, Pithawalla YB, Poland B, Sulsky S, Wei L, Weitkunat R. Estimating the Population Health Impact of Recently Introduced Modified Risk Tobacco Products: A Comparison of Different Approaches. Nicotine Tob Res 2021; 23:426-437. [PMID: 32496514 PMCID: PMC7885777 DOI: 10.1093/ntr/ntaa102] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/29/2020] [Indexed: 01/23/2023]
Abstract
Introduction Various approaches have been used to estimate the population health impact of introducing a Modified Risk Tobacco Product (MRTP). Aims and Methods We aimed to compare and contrast aspects of models considering effects on mortality that were known to experts attending a meeting on models in 2018. Results Thirteen models are described, some focussing on e-cigarettes, others more general. Most models are cohort-based, comparing results with or without MRTP introduction. They typically start with a population with known smoking habits and then use transition probabilities either to update smoking habits in the “null scenario” or joint smoking and MRTP habits in an “alternative scenario”. The models vary in the tobacco groups and transition probabilities considered. Based on aspects of the tobacco history developed, the models compare mortality risks, and sometimes life-years lost and health costs, between scenarios. Estimating effects on population health depends on frequency of use of the MRTP and smoking, and the extent to which the products expose users to harmful constituents. Strengths and weaknesses of the approaches are summarized. Conclusions Despite methodological differences, most modellers have assumed the increase in risk of mortality from MRTP use, relative to that from cigarette smoking, to be very low and have concluded that MRTP introduction is likely to have a beneficial impact. Further model development, supplemented by preliminary results from well-designed epidemiological studies, should enable more precise prediction of the anticipated effects of MRTP introduction. Implications There is a need to estimate the population health impact of introducing modified risk nicotine-containing products for smokers unwilling or unable to quit. This paper reviews a variety of modeling methodologies proposed to do this, and discusses the implications of the different approaches. It should assist modelers in refining and improving their models, and help toward providing authorities with more reliable estimates.
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Affiliation(s)
- Peter N Lee
- Medical Statistics and Epidemiology, P N Lee Statistics and Computing Ltd, Sutton, Surrey, UK
| | - David Abrams
- Social and Behavioral Sciences, NYU School of Public Health, New York, NY
| | | | - Gizelle Baker
- Clinical Science and Epidemiology, Philip Morris R&D, Philip Morris Products SA, Neuchâtel, Switzerland
| | - Ryan Black
- Regulatory Affairs, Altria Client Services LLC, Richmond, VA
| | - Oscar Camacho
- Computational Tools and Statistics, British American Tobacco (Investments) Ltd, Group R&D, Southampton, UK
| | - Geoffrey Curtin
- Scientific and Regulatory Affairs, Reynolds American Inc Services Company, Winston-Salem, NC
| | - Smilja Djurdjevic
- Clinical Science and Epidemiology, Philip Morris R&D, Philip Morris Products SA, Neuchâtel, Switzerland
| | - Andrew Hill
- Modelling, Ventana Systems UK Ltd, Salisbury, UK
| | - David Mendez
- Department of Health Management and Policy School of Public Health, University of Michigan, Ann Arbor, MI
| | | | | | - Raymond Niaura
- Social and Behavioral Sciences, NYU School of Public Health, New York, NY
| | | | - Bill Poland
- Strategic Consulting, Certara USA Inc, Menlo Park, CA
| | - Sandra Sulsky
- Health Sciences, Ramboll US Corporation, Amherst, MA
| | - Lai Wei
- Regulatory Affairs, Altria Client Services LLC, Richmond, VA
| | - Rolf Weitkunat
- Clinical Science and Epidemiology, Philip Morris R&D, Philip Morris Products SA, Neuchâtel, Switzerland
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Rugge M, Sugano K, Scarpignato C, Sacchi D, Oblitas WJ, Naccarato AG. Gastric cancer prevention targeted on risk assessment: Gastritis OLGA staging. Helicobacter 2019; 24:e12571. [PMID: 30773732 DOI: 10.1111/hel.12571] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 12/24/2022]
Abstract
Gastric cancer (GC) ranks among the most lethal epithelial malignancies, and its striking mortality rate prompts a global prevention strategy. Helicobacter pylori (H. pylori) gastritis is the main GC promoter, and the 2014 Global Kyoto conference recognized H. pylori gastritis as a (treatable) infectious disease. It is therefore plausible that any large-scale intervention for H. pylori eradication would result in cleansing the world of the fifth cause of cancer-related death. Atrophic gastritis is the cancerization field in which GCs (both intestinal and diffuse histotypes) mainly develop. Discontinuing the inflammatory cascade triggered by H. pylori is tantamount to preventing GC. For patients (still infected or eradicated) who have already developed gastric atrophy, the severity/topography of the atrophic changes correlates with their cancer risk. Gastritis OLGA (Operative Link for Gastritis Assessment) staging consistently ranks the atrophy-associated cancer risk, providing a solid clinical/biological rationale for establishing patient-specific surveillance programs. By combining primary and secondary prevention strategies, gastric cancer is a preventable disease.
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Affiliation(s)
- Massimo Rugge
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padova, Padova, Italy.,Veneto Tumor Registry (RTV), Veneto Regional Authority, Padova, Italy
| | - Kentaro Sugano
- Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Carmelo Scarpignato
- Department of Medicine and Surgery, Clinical Pharmacology and Pathophysiology Unit, School of Medicine and Dentistry, University of Parma, Parma, Italy
| | - Diana Sacchi
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padova, Padova, Italy
| | | | - Antonio Giuseppe Naccarato
- Department of Translational Research and of New Surgical and Medical Technologies, Pathology Section, University of Pisa, Pisa, Italy
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Patanavanich R, Aekplakorn W, Suriyawongpaisal P. Trend analysis of smoking-attributable hospitalizations in Thailand, 2007-2014. Tob Induc Dis 2018; 16:52. [PMID: 31516449 PMCID: PMC6659483 DOI: 10.18332/tid/98913] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 09/14/2018] [Accepted: 10/10/2018] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Tobacco use is a major preventable risk factor for many noncommunicable diseases. Smoking-attributable mortality has been well described. However, the prevalence of smoking-attributable hospitalization (SAH) and associated costs have been less documented, especially in low- and middle-income countries. Our objective was to estimate the number of hospital admissions and expenditure attributable to tobacco use during 2007-2014 in Thailand. METHODS Hospitalization data between 2007 and 2014 were used for the analysis. SAHs were derived by applying smoking-attributable fractions, based on Thailand's estimates of smoking prevalence data and relative risks extracted from the published literature, to hospital admissions related to smoking according to the International Classification of Diseases version 10. Age-adjusted SAHs among adults age 35 and older were calculated. Joinpoint regression analysis was used to detect changes in trends among genders and geographical areas, based on annual per cent change (APC) and average annual per cent change (AAPC). Costs related to SAHs were also estimated. RESULTS During 2007-2014, among adults age 35 years and older, smoking accounted for almost 3.6 million hospital admissions, with attributable hospital costs calculated at more than US$572 million annually, which represents 16.8% of the national hospital budget. While the age-adjusted rate of SAHs had been relatively stable (AAPC=1.12), the age-adjusted rate of SAHs due to cancers increased significantly for both sexes (AAPC=2.33). Cardiovascular diseases related to smoking increased significantly among men (AAPC=2.5), whereas, COPD, the most common smoking-related conditions decreased significantly during 2011-2014 (APC= -7.21). Furthermore, more provinces in the northeastern and the southern regions where smoking prevalence was higher than the national average have a significantly higher AAPC of SAH than other parts of the country. CONCLUSIONS Smoking remains a significant health and economic burden in Thailand. Findings from this study pose compelling evidence for Thailand to advance tobacco control efforts to reduce the financial and social burden of diseases attributable to smoking.
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Affiliation(s)
| | - Wichai Aekplakorn
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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8
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Lee PN. Improving the conduct of meta-analyses of observational studies. World J Meta-Anal 2018; 6:21-28. [DOI: 10.13105/wjma.v6.i3.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/16/2018] [Accepted: 08/04/2018] [Indexed: 02/06/2023] Open
Abstract
The author, who has published numerous meta-analyses of epidemiological studies, particularly on tobacco, comments on various aspects of their content. While such meta-analyses, even when well conducted, are more difficult to draw inferences from than are meta-analyses of clinical trials, they allow greater insight into an association than do simple qualitative reviews. This editorial starts with a discussion of some problems relating to hypothesis definition. These include the definition of the outcome, the exposure and the population to be considered, as well as the study inclusion and exclusion criteria. Under literature searching, the author argues against restriction to studies published in peer-reviewed journals, emphasising the fact that relevant data may be available from other sources. Problems of identifying studies and double counting are discussed, as are various issues in regard to data entry. The need to check published effect estimates is emphasised, and techniques to calculate estimates from material provided in the source publication are described. Once the data have been collected and an overall effect estimate obtained, tests for heterogeneity should be conducted in relation to different study characteristics. Though some meta-analysts recommend classifying studies by an overall index of study quality, the author prefers to separately investigate heterogeneity by those factors which contribute to the assessment of quality. Reasons why an association may not actually reflect a true causal relationship are also discussed, with the editorial describing techniques for investigating the relevance of confounding, and referring to problems resulting from misclassification of key variables. Misclassification of disease, exposure and confounding variables can all produce a spurious association, as can misclassification of the variable used to determine whether an individual can enter the study, and the author points to techniques to adjust for this. Issues relating to publication bias and the interpretation of “statistically significant” results are also discussed. The editorial should give the reader insight into the difficulties of producing a good meta-analysis.
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Affiliation(s)
- Peter N Lee
- P.N. Lee Statistics and Computing Ltd., Sutton SM2 5DA, Surrey, United Kingdom
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Xu J, Shang Y, Cai F, Zhang S, Xiao Z, Wang H, Fan Y, Li T, Sheng S, Fu Y, Chi F, Zhou C. Correlation between lung cancer and the HHIP polymorphisms of chronic obstructive pulmonary disease (COPD) in the Chinese Han population. Genes Immun 2018; 20:273-280. [PMID: 29915314 DOI: 10.1038/s41435-018-0033-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 04/10/2018] [Accepted: 04/17/2018] [Indexed: 11/09/2022]
Abstract
To further investigate the relationship between lung cancer and hedgehog interacting protein (HHIP) polymorphisms of chronic obstructive pulmonary disease (COPD) patients, we conducted a case-control study in a Chinese Han population. Six HHIP SNPs with minor allele frequencies >5% (rs1489758, rs1489759, rs10519717, rs13131837, rs1492820, and rs7689420) were analyzed in 1,017 COPD patients (767 males and 246 females) and 430 non-COPD patients. Using logistic regression analysis, we found that rs7689420 was significantly associated with lung cancer in COPD patients in the Chinese Han population (P < 0.001). The recessive allele of rs7689420 was associated with the occurrence of lung cancer in all COPD patients (odds ratios [OR] of 0.609 and 0.424 for the CT and TT genotypes, respectively) as well as in serious COPD patients (OR of 0.403 and 0.305 for CT and TT, respectively). Additionally, rs1489759 and rs3131837 were associated with lung cancer in various genetic models. rs1489758, rs1489759, and rs10519717 were also associated with lung cancer in serious COPD patients. However, none of the SNPs were significantly associated with lung cancer in mild COPD patients or healthy subjects. Therefore, the HHIP SNPs of COPD patients likely play a role in lung cancer pathology in the Chinese Han population.
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Affiliation(s)
- Jing Xu
- Department of Respiratory Medicine, Seventh People's Hospital of Shanghai University of TCM, 200137, Shanghai, China.
| | - Yan Shang
- Department of Respiratory and Critical Care Medicine, Changhai Hospital, Second Military Medical University, 200433, Shanghai, China
| | - Feng Cai
- Department of Respiratory Medicine, Seventh People's Hospital of Shanghai University of TCM, 200137, Shanghai, China
| | - Shu Zhang
- Department of Respiratory Medicine, Seventh People's Hospital of Shanghai University of TCM, 200137, Shanghai, China
| | - Zhong Xiao
- Department of Respiratory Medicine, Seventh People's Hospital of Shanghai University of TCM, 200137, Shanghai, China
| | - Haitao Wang
- Department of Respiratory Medicine, Seventh People's Hospital of Shanghai University of TCM, 200137, Shanghai, China
| | - Yanhong Fan
- Department of Respiratory Medicine, Seventh People's Hospital of Shanghai University of TCM, 200137, Shanghai, China
| | - Ting Li
- Department of Respiratory Medicine, Seventh People's Hospital of Shanghai University of TCM, 200137, Shanghai, China
| | - Shuhong Sheng
- Department of Respiratory Medicine, Seventh People's Hospital of Shanghai University of TCM, 200137, Shanghai, China
| | - Youhui Fu
- Department of Respiratory Medicine, Seventh People's Hospital of Shanghai University of TCM, 200137, Shanghai, China
| | - Feng Chi
- Department of Respiratory Medicine, Seventh People's Hospital of Shanghai University of TCM, 200137, Shanghai, China
| | - Chen Zhou
- Department of Respiratory Medicine, Seventh People's Hospital of Shanghai University of TCM, 200137, Shanghai, China
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10
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Abstract
BACKGROUND Opinions differ on the relationship between tar level and risk of smoking-related disease. However, except for lung cancer, few reviews have evaluated the epidemiological evidence. Here the relationship of tar level to risk of the four main smoking-related diseases is considered. METHODS Papers comparing risk of lung cancer, COPD, heart disease or stroke in smokers of lower and higher tar yield cigarettes were identified from reviews and searches, relative risk estimates being extracted comparing the lowest and highest tar groups. Meta-analyses investigated heterogeneity by various study characteristics. RESULTS Twenty-six studies were identified, nine of prospective design and 17 case-control. Two studies grouped cigarettes by nicotine rather than tar. Seventeen studies gave results for lung cancer, 16 for heart disease, five for stroke and four for COPD. Preferring relative risks adjusted for daily amount smoked, where adjusted and unadjusted estimates were available, combined estimates for lowest versus highest tar (or nicotine) groups were 0.78 (95% confidence interval 0.70-0.88) for lung cancer, 0.86 (0.81-0.91) for heart disease, 0.77 (0.62-0.95) for stroke and 0.81 (0.65-1.02) for COPD. Lower risks were generally evident in subgroups by publication period, gender, study design, location and extent of confounder adjustment. Estimates were similar preferring data unadjusted for amount smoked or excluding nicotine-based estimates. CONCLUSIONS Despite evidence that smokers substantially compensate for reduced cigarette yields, the results clearly show lower risks in lower tar smokers. Limitations of the evidence are discussed, but seem unlikely to affect this conclusion.
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Affiliation(s)
- Peter N Lee
- a P.N. Lee Statistics and Computing Ltd , Sutton , Surrey , UK
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11
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Lee PN, Forey BA, Thornton AJ, Coombs KJ. The relationship of cigarette smoking in Japan to lung cancer, COPD, ischemic heart disease and stroke: A systematic review. F1000Res 2018; 7:204. [PMID: 30800285 PMCID: PMC6367657 DOI: 10.12688/f1000research.14002.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2018] [Indexed: 02/06/2023] Open
Abstract
Background: To present up-to-date meta-analyses of evidence from Japan relating smoking to major smoking-related diseases. Methods: We restricted attention to lung cancer, chronic obstructive pulmonary disease (COPD), ischemic heart disease (IHD) and stroke, considering relative risks (RRs) for current and ex-smokers relative to never smokers. Evidence by amount smoked and time quit was also considered. For IHD and stroke only, studies had to provide age-adjusted RRs, with age-specific results considered. For each disease we extended earlier published databases to include more recent studies. Meta-analyses were conducted, with random-effects RRs and tests of heterogeneity presented. Results: Of 40 studies, 26 reported results for lung cancer and 7 to 9 for each other disease. For current smoking, RRs (95%CIs) were lung cancer 3.59 (3.25-3.96), COPD 3.57 (2.72-4.70), IHD 2.21 (1.96-2.50) and stroke 1.40 (1.25-1.57). Ex-smoking RRs were lower. Data for lung cancer and IHD showed a clear tendency for RRs to rise with increasing amount smoked and decrease with increasing time quit. Dose-response data were unavailable for COPD and unclear for stroke, where the association was weaker. Conclusions: Compared to studies in other Asian and Western countries, current smoking RRs were quite similar for IHD and stroke. The comparison is not clear for COPD, where the Japanese data, mainly from cross-sectional studies, is limited. For lung cancer, the RRs are similar to those in other Asian countries, but substantially lower than in Western countries. Explanations for this are unclear, but less accurate reporting of smoking by Japanese may contribute to the difference.
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Affiliation(s)
- Peter N. Lee
- P.N. Lee Statistics and Computing Ltd., Sutton, SM2 5DA, UK
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12
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Martin F, Vuillaume G, Baker G, Sponsiello-Wang Z, Ricci PF, Lüdicke F, Weitkunat R. Quantifying the risk-reduction potential of new Modified Risk Tobacco Products. Regul Toxicol Pharmacol 2018; 92:358-369. [PMID: 29258927 DOI: 10.1016/j.yrtph.2017.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 12/04/2017] [Accepted: 12/15/2017] [Indexed: 12/31/2022]
Abstract
Quantitative risk assessment of novel Modified Risk Tobacco Products (MRTP) must rest on indirect measurements that are indicative of disease development prior to epidemiological data becoming available. For this purpose, a Population Health Impact Model (PHIM) has been developed to estimate the reduction in the number of deaths from smoking-related diseases following the introduction of an MRTP. One key parameter of the model, the F-factor, describes the effective dose upon switching from cigarette smoking to using an MRTP. Biomarker data, collected in clinical studies, can be analyzed to estimate the effects of switching to an MRTP as compared to quitting smoking. Based on transparent assumptions, a link function is formulated that translates these effects into the F-factor. The concepts of 'lack of sufficiency' and 'necessity' are introduced, allowing for a parametrization of a family of link functions. These can be uniformly sampled, thus providing different 'scenarios' on how biomarker-based evidence can be translated into the F-factor to inform the PHIM.
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Affiliation(s)
- Florian Martin
- Philip Morris International Research & Development, Neuchâtel, Switzerland
| | - Gregory Vuillaume
- Philip Morris International Research & Development, Neuchâtel, Switzerland
| | - Gizelle Baker
- Philip Morris International Research & Development, Neuchâtel, Switzerland
| | | | | | - Frank Lüdicke
- Philip Morris International Research & Development, Neuchâtel, Switzerland
| | - Rolf Weitkunat
- Philip Morris International Research & Development, Neuchâtel, Switzerland.
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13
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Lüdicke F, Picavet P, Baker G, Haziza C, Poux V, Lama N, Weitkunat R. Effects of Switching to the Menthol Tobacco Heating System 2.2, Smoking Abstinence, or Continued Cigarette Smoking on Clinically Relevant Risk Markers: A Randomized, Controlled, Open-Label, Multicenter Study in Sequential Confinement and Ambulatory Settings (Part 2). Nicotine Tob Res 2018; 20:173-182. [PMID: 28177498 PMCID: PMC5896432 DOI: 10.1093/ntr/ntx028] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 02/06/2017] [Indexed: 11/13/2022]
Abstract
Introduction Modified-risk tobacco products are expected to reduce exposure to harmful and potentially harmful constituents of cigarette smoke, and ultimately reduce the health burden of smoking-related diseases. Clinically relevant risk markers of smoking-related diseases inform about the risk profile of new tobacco products in the absence of in-market epidemiological data. The menthol Tobacco Heating System 2.2 (mTHS) is a modified-risk tobacco product in development as an alternative to cigarettes (conventional cigarettes [CCs]). Methods In this parallel-group study, Japanese adult smokers (23-65 years; ≥10 mCCs/day) were randomized to mTHS, menthol CCs (mCC), or smoking abstinence (SA) for 5 days in confinement and 85 days in ambulatory settings. Endpoints included biomarkers of exposure to harmful and potentially harmful constituents and clinically relevant risk markers of smoking-related diseases. Results One-hundred and sixty participants were randomized to the mTHS (n = 78), mCC (n = 42), and SA (n = 40) groups. Switching to the mTHS was associated with reductions in biomarkers of exposure compared with continuing mCCs. Reductions in 8-epi-prostaglandin F2α (biomarker of oxidative stress), 11-dehydro-thromboxane B2 (biomarker of platelet activation), soluble intracellular adhesion molecule-1 (biomarker of endothelial function), and an increase in high-density lipoprotein cholesterol (biomarker of lipid metabolism) and forced expiratory volume in 1 second (biomarker of lung function) occurred in the mTHS group compared with the mCC group. The changes in the mTHS group approached those in the SA group. Conclusions Switching from mCCs to mTHS was associated with improvements in clinically relevant risk markers linked to mechanistic pathways involved in smoking-related diseases. Implications In this three-way randomized study, switching from menthol cigarettes to mTHS for 5 days in confinement and 85 days in ambulatory settings was associated with reductions in biomarkers of exposure to cigarette smoke, and changes were observed in clinically relevant biomarkers of oxidative stress (8-epi-prostaglandin F2α), platelet activity (11-dehydro-thromboxane B2), endothelial function (soluble intracellular adhesion molecule-1), lipid metabolism (high-density lipoprotein cholesterol) and lung function (forced expiratory volume in 1 second), similar to the SA group. The results suggest that switching to the mTHS has the potential to reduce the adverse health effects of conventional cigarettes.
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Affiliation(s)
- Frank Lüdicke
- Philip Morris Products S.A., PMI Research and Development, Neuchâtel, Switzerland
| | - Patrick Picavet
- Philip Morris Products S.A., PMI Research and Development, Neuchâtel, Switzerland
| | - Gizelle Baker
- Philip Morris Products S.A., PMI Research and Development, Neuchâtel, Switzerland
| | - Christelle Haziza
- Philip Morris Products S.A., PMI Research and Development, Neuchâtel, Switzerland
| | - Valerie Poux
- Philip Morris Products S.A., PMI Research and Development, Neuchâtel, Switzerland
| | - Nicola Lama
- Philip Morris Products S.A., PMI Research and Development, Neuchâtel, Switzerland
| | - Rolf Weitkunat
- Philip Morris Products S.A., PMI Research and Development, Neuchâtel, Switzerland
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14
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Kojima G, Iliffe S, Jivraj S, Liljas A, Walters K. Does current smoking predict future frailty? The English longitudinal study of ageing. Age Ageing 2018; 47:126-131. [PMID: 28985256 DOI: 10.1093/ageing/afx136] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 07/18/2017] [Indexed: 12/25/2022] Open
Abstract
Background smoking is the single most preventable cause of morbidity and mortality. The evidence on independent associations between smoking in later life and incident frailty is scarce. Objectives to examine the effect of current smoking in older people on the risk of developing frailty, controlling for important confounders. Methods we used data of 2,542 community-dwelling older people aged ≥60 years in England. Participants were classified as current smokers or non-smokers. Frailty was defined using modified Fried criteria. Multivariable logistic regression models were used to examine risk of 4-year incident frailty in current smokers compared with non-smokers, adjusted for demographic, socioeconomic and health variables. Results of 2,542 participants, 261 and 2,281 were current smokers and non-smokers, respectively. The current smokers were significantly frailer, younger, with lower BMI, less educated, less wealthy and lonelier compared with non-smokers at baseline. In multivariable logistic regression models adjusting for age and gender, current smokers were twice as likely to develop frailty compared with non-smokers (odds ratio (OR) = 2.07, 95% confidence interval (CI) = 1.39-3.39, P = 0.001). The association is attenuated largely by controlling for socioeconomic status. Smoking remains significantly associated with incident frailty in fully adjusted models including age, gender, socioeconomic status, alcohol use, cognitive function and loneliness (OR = 1.60, 95% CI = 1.02-2.51, P = 0.04). The relationship is however attenuated when taking account of non-response bias through multiple imputation. Conclusions current smokers compared with non-smokers were significantly more likely to develop frailty over 4 years among community-dwelling older people. Given that smoking is a modifiable lifestyle factor, smoking cessation may potentially prevent or delay developing frailty, even in old age.
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Affiliation(s)
- Gotaro Kojima
- Department of Primary Care and Population Health, University College London, London, UK
| | - Steve Iliffe
- Department of Primary Care and Population Health, University College London, London, UK
| | - Stephen Jivraj
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Ann Liljas
- Department of Primary Care and Population Health, University College London, London, UK
| | - Kate Walters
- Department of Primary Care and Population Health, University College London, London, UK
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15
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Lee PN, Fry JS, Hamling JF, Sponsiello-Wang Z, Baker G, Weitkunat R. Estimating the effect of differing assumptions on the population health impact of introducing a Reduced Risk Tobacco Product in the USA. Regul Toxicol Pharmacol 2017; 88:192-213. [PMID: 28651854 DOI: 10.1016/j.yrtph.2017.06.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/25/2017] [Accepted: 06/20/2017] [Indexed: 01/16/2023]
Abstract
We use Population Health Impact Modelling to assess effects on tobacco prevalence and mortality of introducing a Reduced Risk Tobacco Product (RRP). Simulated samples start in 1990 with a US-representative smoking prevalence. Individual tobacco histories are updated annually until 2010 using estimated probabilities of switching between never/current/former smoking where the RRP is not introduced, with current users subdivided into cigarette/RRP/dual users where it is. RRP-related mortality reductions from lung cancer, IHD, stroke and COPD are derived from the histories and the assumed relative risks of the RRP. A basic analysis assumes a hypothetical RRP reduces effective dose 80% in users and 40% in dual users, with an uptake rate generating ∼10% RRP and ∼6% dual users among current users after 10 years. Sensitivity study changes in tobacco prevalence and mortality from varying effective doses, current smoking risks, quitting half-lives and rates of initiation, switching, re-initiation and cessation. They also study extreme situations (e.g. everyone using RRP), and investigate assumptions which might eliminate the RRP-related mortality reduction. The mortality reduction is proportional to the dose reduction, increasing rapidly with time of follow-up. Plausible increases in re-initiation or dual users' consumption, or decreased quitting by smokers would not eliminate the drop.
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Affiliation(s)
- Peter N Lee
- P N Lee Statistics and Computing Ltd, 17 Cedar Road, Sutton, Surrey, SM2 5DA, United Kingdom.
| | - John S Fry
- P N Lee Statistics and Computing Ltd, 17 Cedar Road, Sutton, Surrey, SM2 5DA, United Kingdom
| | - John F Hamling
- P N Lee Statistics and Computing Ltd, 17 Cedar Road, Sutton, Surrey, SM2 5DA, United Kingdom
| | - Zheng Sponsiello-Wang
- Philip Morris International Research and Development, Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Gizelle Baker
- Philip Morris International Research and Development, Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Rolf Weitkunat
- Philip Morris International Research and Development, Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
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16
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Hill A, Camacho OM. A system dynamics modelling approach to assess the impact of launching a new nicotine product on population health outcomes. Regul Toxicol Pharmacol 2017; 86:265-278. [PMID: 28342844 DOI: 10.1016/j.yrtph.2017.03.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 03/07/2017] [Accepted: 03/10/2017] [Indexed: 01/02/2023]
Abstract
In 2012 the US FDA suggested the use of mathematical models to assess the impact of releasing new nicotine or tobacco products on population health outcomes. A model based on system dynamics methodology was developed to project the potential effects of a new nicotine product at a population level. A model representing traditional smoking populations (never, current and former smokers) and calibrated using historical data was extended to a two-product model by including electronic cigarettes use statuses. Smoking mechanisms, such as product initiation, switching, transition to dual use, and cessation, were represented as flows between smoking statuses (stocks) and the potential effect of smoking renormalisation through a feedback system. Mortality over a 50-year period (2000-2050) was the health outcome of interest, and was compared between two scenarios, with and without e-cigarettes being introduced. The results suggest that by 2050, smoking prevalence in adults was 12.4% in the core model and 9.7% (including dual users) in the counterfactual. Smoking-related mortality was 8.4% and 8.1%, respectively. The results suggested an overall beneficial effect from launching e-cigarettes and that system dynamics could be a useful approach to assess the potential population health effects of nicotine products when epidemiological data are not available.
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Affiliation(s)
- Andrew Hill
- Ventana Systems UK Ltd., Alexandra House, St Johns Street, Salisbury, SP1 2SB, UK.
| | - Oscar M Camacho
- British American Tobacco (Investments) Ltd., Group R&D, Regents Park Road, Southampton, SO15 8TL, UK.
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17
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Using the Negative Exponential Model to Describe Changes in Risk of Smoking-Related Diseases following Changes in Exposure to Tobacco. ACTA ACUST UNITED AC 2015. [DOI: 10.1155/2015/487876] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Recently published analyses for four smoking-related diseases show that the declining excess relative risk by time quit is well fitted by the negative exponential model. These analyses estimated the half-life of this excess, that is, the time after quitting when the excess relative risk reaches half that for continuing smokers. We describe extensions of the simple model. One quantifies the decline following an exposure reduction. We show that this extension satisfactorily predicts results from studies investigating the effect of reducing cigarette consumption. It may also be relevant to exposure reductions following product-switching. Another extension predicts changes in excess relative risk occurring following multiple exposure changes over time. Suitable published epidemiological data are unavailable to test this, and we recommend its validity to be investigated using large studies with data recorded on smoking habits at multiple time points in life. The basic formulae described assume that the excess relative risk for a continuing smoker is linearly related to exposure and that the half-life is invariant of age. We describe model adaptations to allow for nonlinear dose-response and for age-dependence of the half-life. The negative exponential model, though relatively simple, appears to have many potential uses in epidemiological research for summarizing variations in risk with exposure changes.
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18
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Weitkunat R, Lee PN, Baker G, Sponsiello-Wang Z, González-Zuloeta Ladd AM, Lüdicke F. A novel approach to assess the population health impact of introducing a Modified Risk Tobacco Product. Regul Toxicol Pharmacol 2015; 72:87-93. [PMID: 25819932 DOI: 10.1016/j.yrtph.2015.03.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 03/18/2015] [Accepted: 03/23/2015] [Indexed: 01/22/2023]
Abstract
Based on the Food and Drug Administration's Modified Risk Tobacco Product (MRTP) Application draft guideline, Philip Morris International (PMI) has developed a Population Health Impact Model to estimate the reduction in the number of deaths over a period following the introduction of an MRTP. Such a model is necessary to assess the effect that its introduction would have on population health, given the lack of epidemiological data available prior to marketing authorization on any risks from MRTPs. The model is based on publicly available data on smoking prevalence and on the relationships between smoking-related disease-specific mortality and various aspects of the smoking of conventional cigarettes (CCs), together with an estimate of exposure from the MRTP relative to that from CCs, and allows the exploration of possible scenarios regarding the effect of MRTP introduction on the prevalence of CC and MRTP use, individually and in combination. By comparing mortality attributable in a scenario where the MRTP is introduced with one where it is not, the model can estimate the mortality attributable to CCs and the MRTP, as well as the reduction in the deaths attributable to the introduction of the MRTP.
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Affiliation(s)
- Rolf Weitkunat
- Philip Morris International Research & Development, Quai Jeanrenaud 5, 2000 Neuchâtel, Switzerland.
| | - Peter N Lee
- P N Lee Statistics and Computing Ltd, 17 Cedar Road, Sutton, Surrey SM2 5DA, United Kingdom
| | - Gizelle Baker
- Philip Morris International Research & Development, Quai Jeanrenaud 5, 2000 Neuchâtel, Switzerland
| | - Zheng Sponsiello-Wang
- Philip Morris International Research & Development, Quai Jeanrenaud 5, 2000 Neuchâtel, Switzerland
| | | | - Frank Lüdicke
- Philip Morris International Research & Development, Quai Jeanrenaud 5, 2000 Neuchâtel, Switzerland
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