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Malin M, Luukkonen R, Majuri M, Lamminpää A, Reijula K. Collaboration between occupational health professionals in smoking cessation treatment and support. Work 2024; 78:419-430. [PMID: 38160385 DOI: 10.3233/wor-230139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Promoting health is an important part of occupational health (OH) professionals' daily practice. Occupational health services (OHS) support work ability and prevent both work-related diseases and lifestyle-related illnesses. OBJECTIVE We focused on how interprofessional collaboration (IPC), regardless of whether the OHS provider is public, private or in-house, influences the implementation of smoking cessation treatment and support (SCTS). We studied IPC of OH professionals in SCTS and whether they differ depending on OHS providers. METHODS We collected data through an online survey of a cross-sectional sample of OH professionals of physicians (n = 182), nurses (n = 296) and physiotherapists (n = 96) at two different time-points, in 2013 and 2017. The questionnaire contained questions on interprofessional SCTS practices, so that we could assess how the professionals' experiences differed from each other. We used explanatory factor analysis to study the collaboration, and the Kruskall-Wallis test to detect the differences between the OH professional groups as a post-hoc data analysis. Background OH physicians (mean 3.4, SD 1.2) and OH nurses (mean 3.2, SD 1.1) experienced smooth collaboration in SCTS whereas OH physiotherapists (mean 2.5, SD 1.1) felt excluded from IPC. In-house OH centres (mean 3.5, SD 1.0) seemed to offer the best opportunities for implementing IPC in SCTS comparing to public (mean 3.1, SD 0.9) or private (mean 2.9, SD 0.9) OHS. CONCLUSION The IPC of OH professionals in SCTS interventions need to be rearranged. This requires boundary-crossing SCTS practices involving all professionals. All OH professionals should implement IPC in SCTS and share their specific competence.
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Affiliation(s)
- Maarit Malin
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Ritva Luukkonen
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Minna Majuri
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Anne Lamminpää
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Kari Reijula
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Woloshin S, Landsman V, Miller DG, Byrne J, Graubard BI, Feuer EJ. Updating the Know Your Chances Website to Include Smoking Status as a Risk Factor for Mortality Estimates. JAMA Netw Open 2023; 6:e2317351. [PMID: 37289457 PMCID: PMC10251216 DOI: 10.1001/jamanetworkopen.2023.17351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 04/24/2023] [Indexed: 06/09/2023] Open
Abstract
Importance To make wise decisions about the health risks they face, people need information about the magnitude of the threats as well as the context, such as how risks compare. Such information is often presented by age, sex, and race but rarely accounts for smoking status, a major risk factor for many causes of death. Objective To update the National Cancer Institute's Know Your Chances website to present mortality estimates for a broad set of causes of death and all causes combined by smoking status in addition to age, sex, and race. Design, Setting, and Participants In this cohort study, mortality estimates using life table methods were calculated with the National Cancer Institute's DevCan software package, combining data from the US National Vital Statistics System, National Health Interview Survey-Linked Mortality Files, National Institutes of Health-AARP (American Association of Retired Persons), Cancer Prevention Study II, Nurses' Health and Health Professions follow-up studies, and Women's Health Initiative. Data were collected from January 1, 2009, to December 31, 2018, and analyzed from August 27, 2019, to February 28, 2023. Main Outcomes and Measures Age-conditional probabilities of dying due to various causes and all causes combined, accounting for competing causes of death, for people aged 20 to 75 years over the next 5, 10, or 20 years by sex, race, and smoking status. Results A total of 954 029 individuals aged 55 years or older (55.8% women) were included in the analysis. Regardless of sex or race, for never-smokers, coronary heart disease represented the highest 10-year chance of death after about 50 years of age, which is higher than for any malignant neoplasm. Among current smokers, the 10-year chance of death due to lung cancer was almost as high as for coronary heart disease in each group. For Black and White female current smokers aged from the mid-40s onward, the 10-year probability of death due to lung cancer was substantially higher than for breast cancer. After 40 years of age, the observed effect of never vs current smoking on the 10-year chance of death due to all causes approximated adding 10 years of age. After 40 years of age when conditioning on smoking status, mortality risk for Black individuals was approximately that of White individuals 5 years older. Conclusions and Relevance Using life table methods and accounting for competing risks, the revised Know Your Chances website presents age-conditional mortality estimates according to smoking status for a broad set of causes in the context of other conditions and all-cause mortality. The findings of this cohort study suggest that failing to account for smoking status results in inaccurate mortality estimates for many causes-namely, they are too low for smokers and too high for nonsmokers.
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Affiliation(s)
- Steven Woloshin
- Center for Medicine and the Media, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
- Lisa Schwartz Foundation for Truth in Medicine, Norwich, Vermont
| | - Victoria Landsman
- Institute of Work and Health and University of Toronto, Toronto, Ontario, Canada
| | | | - Jeffrey Byrne
- Information Management Services, Inc, Calverton, Maryland
| | - Barry I. Graubard
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Eric J. Feuer
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
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Mazeli MI, Pahrol MA, Abdul Shakor AS, Kanniah KD, Omar MA. Cardiovascular, respiratory and all-cause (natural) health endpoint estimation using a spatial approach in Malaysia. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 874:162130. [PMID: 36804978 DOI: 10.1016/j.scitotenv.2023.162130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/14/2023] [Accepted: 02/05/2023] [Indexed: 06/18/2023]
Abstract
In 2016, the World Health Organization (WHO) estimated that approximately 4.2 million premature deaths worldwide were attributable to exposure to particulate matter 2.5 μm (PM2.5). This study assessed the environmental burden of disease attributable to PM2.5 at the national level in Malaysia. We estimated the population-weighted exposure level (PWEL) of PM10 concentrations in Malaysia for 2000, 2008, and 2013 using aerosol optical density (AOD) data from publicly available remote sensing satellite data (MODIS Terra). The PWEL was then converted to PM2.5 using Malaysia's WHO ambient air conversion factor. We used AirQ+ 2.0 software to calculate all-cause (natural), ischemic heart disease (IHD), stroke, chronic obstructive pulmonary disease (COPD), lung cancer (LC), and acute lower respiratory infection (ALRI) excess deaths from the National Burden of Disease data for 2000, 2008 and 2013. The average PWELs for annual PM2.5 for 2000, 2008, and 2013 were 22 μg m-3, 18 μg m-3 and 24 μg m-3, respectively. Using the WHO 2005 Air Quality Guideline cut-off point of PM2.5 of 10 μg m-3, the estimated excess deaths for 2000, 2008, and 2013 from all-cause (natural) mortality were between 5893 and 9781 (95 % CI: 3347-12,791), COPD was between 164 and 957 (95 % CI: 95-1411), lung cancer was between 109 and 307 (95 % CI: 63-437), IHD was between 3 and 163 deaths, according to age groups (95 % CI: 2-394) and stroke was between 6 and 155 deaths, according to age groups (95 % CI: 3-261). An increase in estimated health endpoints was associated with increased estimated PWEL PM2.5 for 2013 compared to 2000 and 2008. Adhering the ambient PM2.5 level to the Malaysian Air Quality Standard IT-2 would reduce the national health endpoints mortality.
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Affiliation(s)
- Mohamad Iqbal Mazeli
- Environmental Health Research Centre, Institute for Medical Research, National Institute of Health Malaysia, Ministry of Health Malaysia, 40170 Shah Alam, Selangor Darul Ehsan, Malaysia.
| | - Muhammad Alfatih Pahrol
- Environmental Health Research Centre, Institute for Medical Research, National Institute of Health Malaysia, Ministry of Health Malaysia, 40170 Shah Alam, Selangor Darul Ehsan, Malaysia.
| | - Ameerah Su'ad Abdul Shakor
- Environmental Health Research Centre, Institute for Medical Research, National Institute of Health Malaysia, Ministry of Health Malaysia, 40170 Shah Alam, Selangor Darul Ehsan, Malaysia.
| | - Kasturi Devi Kanniah
- Faculty of Built Environment and Surveying, Universiti Teknologi Malaysia, 81310 Johor Bahru, Johor, Malaysia; Centre for Environmental Sustainability and Water Security (IPASA), Research Institute for Sustainable Environment (RISE), Universiti Teknologi Malaysia, 81310 Johor Bahru, Johor, Malaysia.
| | - Mohd Azahadi Omar
- Sector for Biostatistics and Data Repository, Office of NIH Manager, National Institute of Health Malaysia, Ministry of Health Malaysia, 40170 Shah Alam, Selangor Darul Ehsan, Malaysia.
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Ma H, Wang X, Xue Q, Li X, Liang Z, Heianza Y, Franco OH, Qi L. Cardiovascular Health and Life Expectancy Among Adults in the United States. Circulation 2023; 147:1137-1146. [PMID: 37036905 PMCID: PMC10165723 DOI: 10.1161/circulationaha.122.062457] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 02/08/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Cardiovascular disease may be the main reason for stagnant growth in life expectancy in the United States since 2010. The American Heart Association recently released an updated algorithm for evaluating cardiovascular health (CVH)-Life's Essential 8 (LE8) score. We aimed to quantify the associations of CVH levels, estimated by the LE8 score, with life expectancy in a nationally representative sample of US adults. METHODS We included 23 003 nonpregnant, noninstitutionalized participants aged 20 to 79 years who participated in the National Health and Nutrition Examination Survey from 2005 to 2018 and whose mortality was identified through linkage to the National Death Index through December 31, 2019. The overall CVH was evaluated by the LE8 score (range, 0-100), as well as the score for each component of diet, physical activity, tobacco/nicotine exposure, sleep duration, body mass index, non-high-density lipoprotein cholesterol, blood glucose, and blood pressure. Life table method was used to estimate life expectancy by levels of the CVH. RESULTS During a median of 7.8 years of follow-up, 1359 total deaths occurred. The estimated life expectancy at age 50 years was 27.3 years (95% CI, 26.1-28.4), 32.9 years (95% CI, 32.3-33.4), and 36.2 years (95% CI, 34.2-38.2) in participants with low (LE8 score <50), moderate (50≤ LE8 score <80), and high (LE8 score ≥80) CVH, respectively. Equivalently, participants with high CVH had an average 8.9 (95% CI, 6.2-11.5) more years of life expectancy at age 50 years compared with those with low CVH. On average, 42.6% of the gained life expectancy at age 50 years from adhering to high CVH was attributable to reduced cardiovascular disease death. Similarly significant associations of CVH with life expectancy were observed in men and women, respectively. Similarly significant associations of CVH with life expectancy were observed in White participants and Black participants but not in Mexican participants. CONCLUSIONS Adhering to a high CVH, defined as the LE8 score, is related to a considerably increased life expectancy in US adults, but more research needs to be done in other races and ethnicities (eg, Hispanic and Asian).
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Affiliation(s)
- Hao Ma
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Xuan Wang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Qiaochu Xue
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Xiang Li
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Zhaoxia Liang
- Obstetrical Department, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yoriko Heianza
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Oscar H. Franco
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
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Kuhlmann PK, Oyekunle T, Klaassen Z, Amling CL, Aronson WJ, Cooperberg MR, Kane CJ, Terris MK, Freedland SJ. A modeling study to estimate prostate cancer-specific mortality on active surveillance for men with favorable intermediate-risk prostate cancer: Results from the SEARCH cohort. Cancer Med 2023; 12:10931-10938. [PMID: 37031461 DOI: 10.1002/cam4.5805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 02/26/2023] [Accepted: 02/27/2023] [Indexed: 04/11/2023] Open
Abstract
PURPOSE Limited data exist to help surgeons decide between active surveillance (AS) versus treatment for men with favorable intermediate risk (FIR) prostate cancer. To estimate the theoretical excess risk of prostate cancer-specific mortality (PCSM) with AS versus radical prostatectomy (RP), we determined the risk of PCSM in FIR men undergoing RP and modeled the PCSM risk for AS using a range of increased PSCM scenarios ranging from 1.25x to 2x higher relative to RP. MATERIALS AND METHODS We retrospectively reviewed data from men undergoing RP from 1988 to 2017 at 8 Veterans Affairs hospitals within the SEARCH cohort. Men with FIR PC were identified using the NCCN risk criteria. Risk of PCSM at 5, 10, and 15 years after RP was estimated. Using these estimates, PCSM was then modeled for AS using a range of increased risk of PCSM relative to RP ranging from 1.25x to 2x higher. RESULTS For the 920 FIR men identified, 5-, 10-, and 15-year survival estimates for PCSM after RP were 99.9%, 99.0%, and 97.8%, respectively. If the risk of PCSM on AS were 1.25-2x greater than RP, there would be 0.54%-2.17% excess risk of PCSM at 15 years. CONCLUSIONS The risk of death for FIR after RP is very low. Assuming even modestly increased PCSM with AS versus RP, the excess risk of death for AS in FIR is low even up to 15 years. These data support the consideration of AS as a relatively safe alternative to RP in FIR men, though prospective randomized trials are needed to validate these findings.
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Affiliation(s)
- Paige K Kuhlmann
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Taofik Oyekunle
- Section of Urology, Durham VA Medical Center, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Zachary Klaassen
- Department of Surgery, Section of Urology, Augusta University - Medical College of Georgia, Augusta, Georgia, USA
| | - Christopher L Amling
- Department of Urology, Oregon Health and Science University School of Medicine, Portland, Oregon, USA
| | - William J Aronson
- Department of Urology, University of California, Los Angeles, California, USA
- Wadsworth VA Medical Center, Los Angeles, California, USA
| | | | - Christopher J Kane
- Department of Urology, University of California, San Diego, California, USA
- San Diego Healthcare System, San Diego, California, USA
| | - Martha K Terris
- Department of Surgery, Section of Urology, Augusta University - Medical College of Georgia, Augusta, Georgia, USA
- Section of Urology, Charlie Norwood VA Medical Center, Augusta, Georgia, USA
| | - Stephen J Freedland
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Section of Urology, Durham VA Medical Center, Durham, North Carolina, USA
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Stefanescu Schmidt AC, Abrahamyan L, Muthuppalaniappan A, Gorocica Romero R, Ephrem G, Everett K, Lee DS, Osten M, Benson LN, Horlick EM. Outcomes of Patent Foramen Ovale Transcatheter Closure: Should a Short Aortic Rim Preclude Closure? JACC. ADVANCES 2023; 2:100257. [PMID: 38938308 PMCID: PMC11198134 DOI: 10.1016/j.jacadv.2023.100257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 11/10/2022] [Accepted: 12/13/2022] [Indexed: 06/29/2024]
Abstract
Background The risk of erosion of an atrial septal closure device, in particular the Amplatzer Septal Occluder, has been described as higher in patients with a short aortic rim. Similar concern has been applied to patent foramen ovale (PFO) closure devices, but there are only rare reported cases of erosion. It may be that smaller devices are chosen due to fear of device erosion in PFO patients when this is not necessarily an issue. Objectives The authors aimed to assess outcomes after PFO closure with the Amplatzer PFO device in patients with a short (<9 mm) aortic rim. Methods We performed a retrospective analysis of PFO closure for any indication, between 2006 and 2017 at a quaternary center. Preprocedural transesophageal echocardiographic parameters including the aortic rim were remeasured. Long-term outcomes were obtained by linkage to provincial administrative databases. Results Over the study period, 324 patients underwent PFO closure with the Amplatzer PFO device, with a mean age of 49.8 years; 61% had a short aortic rim (<9 mm). The most common indication was cryptogenic stroke (72%); those with longer aortic distance were more likely to have a non-stroke indication for closure, diabetes (15% vs 6.5%, P = 0.04), and heart failure (15.7% vs 4%, P < 0.001). Over a median 7 years of follow-up, there were no cases of device erosion or embolization requiring cardiac surgery. Conclusions In a large cohort with long-term administrative follow-up (1,394 patient-years), implantation of an Amplatzer PFO device was performed safely even in patients with a short aortic rim.
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Affiliation(s)
- Ada C. Stefanescu Schmidt
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lusine Abrahamyan
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital, Toronto, Ontario, Canada
| | - Annamalar Muthuppalaniappan
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Gleneagles Hospital Penang, Pulau Pinang, Malaysia
| | - Ricardo Gorocica Romero
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Mexican Institution of Social Security, UMAE No. 1, Merida, Yucatan, Mexico
| | - Georges Ephrem
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | | | - Mark Osten
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Leland N. Benson
- Division of Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eric M. Horlick
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
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van der Linden BWA, Bovio N, Arveux P, Bergeron Y, Bulliard JL, Fournier E, Germann S, Konzelmann I, Maspoli M, Rapiti E, Chiolero A, Guseva Canu I. Estimating 10-year risk of lung and breast cancer by occupation in Switzerland. Front Public Health 2023; 11:1137820. [PMID: 37033038 PMCID: PMC10076749 DOI: 10.3389/fpubh.2023.1137820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/27/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Lung and breast cancer are important in the working-age population both in terms of incidence and costs. The study aims were to estimate the 10-year risk of lung and breast cancer by occupation and smoking status and to create easy to use age-, and sex-specific 10-year risk charts. Methods New lung and breast cancer cases between 2010 and 2014 from all 5 cancer registries of Western Switzerland, matched with the Swiss National Cohort were used. The 10-year risks of lung and breast cancer by occupational category were estimated. For lung cancer, estimates were additionally stratified by smoking status using data on smoking prevalence from the 2007 Swiss Health Survey. Results The risks of lung and breast cancer increased with age and were the highest for current smokers. Men in elementary professions had a higher 10-year risk of developing lung cancer compared to men in intermediate and managerial professions. Women in intermediate professions had a higher 10-year risk of developing lung cancer compared to elementary and managerial professions. However, women in managerial professions had the highest risk of developing breast cancer. Discussion The 10-year risk of lung and breast cancer differs substantially between occupational categories. Smoking creates greater changes in 10-year risk than occupation for both sexes. The 10-year risk is interesting for both patients and professionals to inform choices related to cancer risk, such as screening and health behaviors. The risk charts can also be used as public health indicators and to inform policies to protect workers.
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Affiliation(s)
- Bernadette Wilhelmina Antonia van der Linden
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
- Fribourg Cancer Registry, Fribourg, Switzerland
- *Correspondence: Bernadette Wilhelmina Antonia van der Linden
| | - Nicolas Bovio
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Patrick Arveux
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | | | - Jean-Luc Bulliard
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- Neuchâtel and Jura Cancer Registry, Neuchâtel, Switzerland
| | - Evelyne Fournier
- Geneva Cancer Registry, University of Geneva, Geneva, Switzerland
| | - Simon Germann
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | | | | | | | - Arnaud Chiolero
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
- Valais Cancer Registry, Valais Health Observatory, Sion, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- School of Population and Global Health, McGill University, Montréal, Canada
| | - Irina Guseva Canu
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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Chen B, Silvestri GA, Dahne J, Lee K, Carpenter MJ. The Cost-Effectiveness of Nicotine Replacement Therapy Sampling in Primary Care: a Markov Cohort Simulation Model. J Gen Intern Med 2022; 37:3684-3691. [PMID: 35091913 PMCID: PMC9585132 DOI: 10.1007/s11606-021-07335-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Pharmacotherapies remain a central focus of successful tobacco control, but uptake remains very low. OBJECTIVE To estimate the cost effectiveness of a primary care nicotine replacement therapy (NRT) sampling intervention. DESIGN A Markov cohort simulation model was constructed to conduct cost-effectiveness analyses. Clinical trial results were used to initialize the Markov model. All other model parameters were derived from the literature. The study was conducted over a lifetime horizon, from the payers' budgetary perspective. PARTICIPANTS Smokers with a primary care visit. INTERVENTION Medication sampling, which provided short, starter packets of NRT (nicotine patch and lozenge) to smokers in the primary care setting. MAIN MEASURES Lifetime healthcare expenditures, quality-adjusted life years, and life years. KEY RESULTS Medication sampling was the dominant strategy compared to standard care. Our intervention cost $75, yielding a discounted lifetime savings of $1065 in healthcare expenditures, and increased both discounted quality-adjusted life years and discounted life years by 0.01. One-way sensitivity analyses showed that medication sampling remained dominant in plausible ranges except when it failed to increase cessation relative to standard care. Probabilistic sensitivity analyses confirmed that medication sampling was dominant in 94.1% of the simulated cases, with an implementation cost of $74 (95% CI $73-$76) and discounted lifetime savings in health expenditures of $1061 (- $1106 to - $1,017), increasing quality-adjusted life years by 0.008 (0.0085-0.0093) and life years by 0.008 (0.0081-0.0089). CONCLUSION Medication sampling, an easily implementable, scalable and low-cost intervention to encourage smoking cessation, is cost saving and improves quality of life.
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Affiliation(s)
- Brian Chen
- Arnold School of Public Health, University of South Carolina, 915 Greene St. #354, Columbia, SC, 29208, USA.
| | - Gerard A Silvestri
- Department of Medicine, Medical University of South Carolina (MUSC), Charleston, USA
- Hollings Cancer Center, MUSC, Charleston, USA
| | - Jennifer Dahne
- Hollings Cancer Center, MUSC, Charleston, USA
- Department of Psychiatry & Behavioral Sciences, MUSC, Charleston, USA
| | - Kyueun Lee
- University of Pittsburgh, Pittsburgh, USA
| | - Matthew J Carpenter
- Hollings Cancer Center, MUSC, Charleston, USA
- Department of Psychiatry & Behavioral Sciences, MUSC, Charleston, USA
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Sandoval GA, Totanes R, David AM, Fu D, Bettcher D, Prasad V, Arnold V. Case for investment in tobacco cessation: a population-based analysis in low- and middle-income countries. Rev Panam Salud Publica 2022; 46:e71. [PMID: 36211243 PMCID: PMC9534346 DOI: 10.26633/rpsp.2022.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/11/2022] [Indexed: 11/24/2022] Open
Abstract
This study aimed to estimate the return on investments of three population-level tobacco cessation strategies and three pharmacological interventions. The analysis included 124 low- and middle-income countries, and assumed a 10-year investment period (2021–2030). The results indicate that all six cessation programmes could help about 152 million tobacco users quit and save 2.7 million lives during 2021–2030. If quitters were followed until 65 years of age, 16 million lives could be saved from quitting. The combined investment cost was estimated at 1.68 United States dollars (US$) per capita a year, or US$ 115 billion over the period 2021–2030, with Caribbean countries showing the lowest investment cost at US$ 0.50 per capita a year. Return on investments was estimated at 0.79 (at the end of 2030) and 7.50 if benefits were assessed by the time quitters reach the age of 65 years. Disaggregated results by country income level and region also showed a return on investments less than 1.0 in the short term and greater than 1.0 in the medium-to-long term. In all countries, population-level interventions were less expensive and yielded a return on investments greater than 1.0 in the short and long term, with investment cost estimated at US$ 0.21 per capita a year, or US$ 14.3 billion over 2021–2030. Pharmacological interventions were more expensive and became cost beneficial over a longer time. These results are likely conservative and provide support for a phased approach implementing population-level strategies first, where most countries would reach break-even before 2030.
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Affiliation(s)
- Guillermo A. Sandoval
- Pan American Health Organization/World Health Organization, Washington, DC, United States of America
| | | | - Annette M. David
- Guam State Epidemiological Outcomes Workgroup, Tamuning, Guam, USA
| | - Dongbo Fu
- World Health Organization, Geneva, Switzerland
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Cho H, Wang Z, Yabroff KR, Liu B, McNeel T, Feuer EJ, Mariotto AB. Estimating life expectancy adjusted by self-rated health status in the United States: national health interview survey linked to the mortality. BMC Public Health 2022; 22:141. [PMID: 35057780 PMCID: PMC8772174 DOI: 10.1186/s12889-021-12332-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Life expectancy is increasingly incorporated in evidence-based screening and treatment guidelines to facilitate patient-centered clinical decision-making. However, life expectancy estimates from standard life tables do not account for health status, an important prognostic factor for premature death. This study aims to address this research gap and develop life tables incorporating the health status of adults in the United States. Methods Data from the National Health Interview Survey (1986–2004) linked to mortality follow-up through to 2006 (age ≥ 40, n = 729,531) were used to develop life tables. The impact of self-rated health (excellent, very good, good, fair, poor) on survival was quantified in 5-year age groups, incorporating complex survey design and weights. Life expectancies were estimated by extrapolating the modeled survival probabilities. Results Life expectancies incorporating health status differed substantially from standard US life tables and by health status. Poor self-rated health more significantly affected the survival of younger compared to older individuals, resulting in substantial decreases in life expectancy. At age 40 years, hazards of dying for white men who reported poor vs. excellent health was 8.5 (95% CI: 7.0,10.3) times greater, resulting in a 23-year difference in life expectancy (poor vs. excellent: 22 vs. 45), while at age 80 years, the hazards ratio was 2.4 (95% CI: 2.1, 2.8) and life expectancy difference was 5 years (5 vs. 10). Relative to the US general population, life expectancies of adults (age < 65) with poor health were approximately 5–15 years shorter. Conclusions Considerable shortage in life expectancy due to poor self-rated health existed. The life table developed can be helpful by including a patient perspective on their health and be used in conjunction with other predictive models in clinical decision making, particularly for younger adults in poor health, for whom life tables including comorbid conditions are limited. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12332-0.
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Zhang JJ, Rothberg MB, Misra-Hebert AD, Gupta NM, Taksler GB. Assessment of Physician Priorities in Delivery of Preventive Care. JAMA Netw Open 2020; 3:e2011677. [PMID: 32716515 PMCID: PMC8103855 DOI: 10.1001/jamanetworkopen.2020.11677] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
IMPORTANCE Primary care physicians have limited time to discuss preventive care, but it is unknown how they prioritize recommended services. OBJECTIVE To understand primary care physicians' prioritization of preventive services. DESIGN, SETTING, AND PARTICIPANTS This online survey was administered to primary care physicians in a large health care system from March 17 to May 12, 2017. Physicians were asked whether they prioritize preventive services and which factors contribute to their choice (5-point Likert scale). Results were analyzed from July 8, 2017, to September 19, 2019. EXPOSURES A 2 × 2 factorial design of 2 hypothetical patients: (1) a 50-year-old white woman with hypertension, type 2 diabetes, hyperlipidemia, obesity, a 30-pack-year history of smoking, and a family history of breast cancer; and (2) a 45-year-old black man with hypertension, hyperlipidemia, obesity, a 30-pack-year history of smoking, and a family history of colorectal cancer. Two visit lengths (40 minutes vs 20 minutes) were given. Each patient was eligible for at least 11 preventive services. MAIN OUTCOMES AND MEASURES Physicians rated their likelihood of discussing each service during the visit and reported their top 3 priorities for patients 1 and 2. Physician choices were compared with the preventive services most likely to improve life expectancy, using a previously published mathematical model. RESULTS Of 241 physicians, 137 responded (57%), of whom 74 (54%) were female and 85 (62%) were younger than 50 years. Physicians agreed they prioritized preventive services (mean score, 4.27 [95% CI, 4.12-4.42] of 5.00), mostly by ability to improve quality (4.56 [95% CI, 4.44-4.68] of 5.00) or length (4.53 [95% CI, 4.40-4.66] of 5.00) of life. Physicians reported more prioritization in the 20- vs 40-minute visit, indicating that they were likely to discuss fewer services during the shorter visit (median, 5 [interquartile range {IQR}, 3-8] vs 11 [IQR, 9-13] preventive services for patient 1, and 4 [IQR, 3-6] vs 9 [IQR, 8-11] for patient 2). Physicians reported similar top 3 priorities for both patients: smoking cessation, hypertension control, and glycemic control for patient 1 and smoking cessation, hypertension control, and colorectal cancer screening for patient 2. Physicians' top 3 priorities did not usually include diet and exercise or weight loss (ranked in their top 3 recommendations for either patient by only 48 physicians [35%]), although these were among the 3 preventive services most likely to improve life expectancy based on the mathematical model. CONCLUSIONS AND RELEVANCE In this survey study, physicians prioritized preventive services under time constraints, but priorities did not vary across patients. Physicians did not prioritize lifestyle interventions despite large potential benefits. Future research should consider whether physicians and patients would benefit from guidance on preventive care priorities.
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Affiliation(s)
- Jessica J. Zhang
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Michael B. Rothberg
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
- Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Anita D. Misra-Hebert
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
- Medicine Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | | | - Glen B. Taksler
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
- Medicine Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
- Center for Health Care Research and Policy, Case Western Reserve University and MetroHealth Medical Center, Cleveland, Ohio
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Shoots-Reinhard B, Erford B, Romer D, Evans AT, Shoben A, Klein EG, Peters E. Numeracy and memory for risk probabilities and risk outcomes depicted on cigarette warning labels. Health Psychol 2020; 39:721-730. [PMID: 32496078 DOI: 10.1037/hea0000879] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Greater numeracy is associated with higher likelihood to quit smoking. We examined whether numeracy supports learning of numeric health-risk information and, in turn, greater risk perceptions and quit intentions. METHOD Adult smokers (N = 696) viewed text warnings with numeric risk information four times each in one of three warning-label types (text-only, low-emotion pictorial [i.e., with image], high-emotion pictorial). They completed posttest measures immediately or 6 weeks later. Emotional reactions to warnings were reported the second time participants viewed the warnings. Numeracy, memory for risk probabilities and risk outcomes, risk perceptions, and quit intentions were assessed postexposures. RESULTS Memory for risk probabilities and risk outcomes depended on warning-label type and posttest timing. Consistent with memory-consolidation theory, memory for high- versus low-emotion labels was lower immediately, but declined less for high-than low-emotion labels. Label memory was similar between conditions at 6 weeks. Numeracy predicted overall superior memory (especially for risk probabilities) controlling for health literacy and education. It also indirectly predicted greater risk perceptions and quit intentions via memory. In exploratory analyses, however, the superior recall of risk probabilities of smoking among those higher in numeracy was associated with lower risk perceptions. CONCLUSIONS Numeracy is associated with superior risk memory, which relates to greater risk perceptions and quit intentions. More numerate and educated smokers may be better able to quit due to their superior learning of smoking's risks. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Current Controversies in Cardiothoracic Imaging: Low-dose Computerized Tomographic Overdiagnosis of Lung Cancer is Substantial; Its Consequences are Underappreciated-Point. J Thorac Imaging 2019; 34:154-156. [PMID: 30882498 DOI: 10.1097/rti.0000000000000406] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Lung cancer seems an ideal screening candidate because of its frequency and lethality, its well-known risk factors, and because it can often be identified at a curable stage with noninvasive procedures. The lethality of clinically diagnosed lung cancers rendered the possibility of material overdiagnosis (OD) (by means of screening) implausible in the judgment of experienced clinicians. Increased experience with lung cancer screening trials, which showed an excess of cases in screened versus control cohorts, led to broader acceptance of its existence. The magnitude of OD and the appropriate methodology for its assessment are disputed. Overdiagnosed individuals experience substantial surgical mortality and their loss of pulmonary reserve leads, in many, to a material reduction in the duration and quality of life. To estimate the scale of computerized tomographic OD, taken as the excess of screen-identified cases versus unscreened controls, we pooled the long-term findings in the 3 reporting European trials comprising 10,675 subjects. There were 263 detected lung cancers in the low-dose, computerized tomographic-screened versus 153 in controls, a 42% excess.
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Johnson L, Ma Y, Fisher SL, Ramsey AT, Chen LS, Hartz SM, Culverhouse RC, Grucza RA, Saccone NL, Baker TB, Bierut LJ. E-cigarette Usage Is Associated With Increased Past-12-Month Quit Attempts and Successful Smoking Cessation in Two US Population-Based Surveys. Nicotine Tob Res 2019; 21:1331-1338. [PMID: 30304476 PMCID: PMC6751520 DOI: 10.1093/ntr/nty211] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 10/04/2018] [Indexed: 11/13/2022]
Abstract
INTRODUCTION We examined past-12-month quit attempts and smoking cessation from 2006 to 2016 while accounting for demographic shifts in the US population. In addition, we sought to understand whether the current use of electronic cigarettes was associated with a change in past-12-month quit attempts and successful smoking cessation at the population level. METHODS We analyzed data from 25- to 44-year-olds from the National Health Interview Survey (NHIS) from 2006 to 2016 (N = 26,354) and the Tobacco Use Supplement to the Current Population Survey (TUS-CPS) in 2006-2007, 2010-2011, and 2014-2015 (N = 33,627). Data on e-cigarette use were available in the 2014-2016 NHIS and 2014-2015 TUS-CPS surveys. RESULTS Past-12-month quit attempts and smoking cessation increased in recent years compared with 2006. Current e-cigarette use was associated with higher quit attempts (adjusted odds ratio [aOR] = 2.29, 95% confidence interval [CI] = 1.87 to 2.81, p < .001) and greater smoking cessation (aOR = 1.64, 95% CI = 1.21 to 2.21, p = .001) in the NHIS. Multivariable logistic regression of the TUS-CPS data showed that current e-cigarette use was similarly significantly associated with increased past-12-month quit attempts and smoking cessation. Significant interactions were found for smoking frequency (everyday and some-day smoking) and current e-cigarette use for both outcomes (p < .0001) with the strongest positive effects seen in everyday smokers. CONCLUSIONS Compared with 2006, past-12-month quit attempts and smoking cessation increased among adults aged 25-44 in recent years. Current e-cigarette use was associated with increased past-12-month quit attempts and successful smoking cessation among established smokers. These findings are relevant to future tobacco policy decisions. IMPLICATIONS E-cigarettes were introduced into the US market over the past decade. During this period, past-12-month quit attempts and smoking cessation have increased among US adults aged 25-44. These trends are inconsistent with the hypothesis that e-cigarette use is delaying quit attempts and leading to decreased smoking cessation. In contrast, current e-cigarette use was associated with significantly higher past-12-month quit attempts and past-12-month cessation. These findings suggest that e-cigarette use contributes to a reduction in combustible cigarette use among established smokers.
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Affiliation(s)
- Linda Johnson
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Yinjiao Ma
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Sherri L Fisher
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Alex T Ramsey
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Li-Shiun Chen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Sarah M Hartz
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Robert C Culverhouse
- Department of Medicine and Division of Biostatistics, Washington University School of Medicine, St. Louis, MO
| | - Richard A Grucza
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Nancy L Saccone
- Department of Genetics and Division of Biostatistics, Washington University School of Medicine, St. Louis, MO
| | - Timothy B Baker
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Laura J Bierut
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
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Earlier Diagnosis Not Self-Evidently Beneficial: Natural History of Subcentimeter Lung Cancers. AJR Am J Roentgenol 2019; 213:817-818. [PMID: 31120792 DOI: 10.2214/ajr.19.21159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. We estimated the natural history of subcentimeter stage I non-small cell lung cancers detected on screening CT using a computed mean 230-day tumor volume doubling time and exponential growth. CONCLUSION. We found that the majority of patients with subcentimeter, non-small cell lung cancers would survive for more than 5 years without treatment. The benefit of cancer interdiction would be offset to some extent by the combined effects of surgical mortality and materially diminished longer-term disease-free survival among the more than 40% of patients who would be overdiagnosed.
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16
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Persistence and treatment-free interval in patients being prescribed biological drugs in rheumatology practices in Germany. Eur J Clin Pharmacol 2019; 75:717-722. [DOI: 10.1007/s00228-019-02627-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 01/02/2019] [Indexed: 02/07/2023]
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Young KA, Regan EA, Han MK, Lutz SM, Ragland M, Castaldi PJ, Washko GR, Cho MH, Strand M, Curran-Everett D, Beaty TH, Bowler RP, Wan ES, Lynch DA, Make BJ, Silverman EK, Crapo JD, Hokanson JE, Kinney GL. Subtypes of COPD Have Unique Distributions and Differential Risk of Mortality. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2019; 6:400-413. [PMID: 31710795 DOI: 10.15326/jcopdf.6.5.2019.0150] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background Previous attempts to explore the heterogeneity of chronic obstructive pulmonary disease (COPD) clustered individual patients using clinical, demographic, and disease features. We developed continuous multidimensional disease axes based on radiographic and spirometric variables that split into an airway-predominant axis and an emphysema-predominant axis. Methods The COPD Genetic Epidemiology study (COPDGene®) is a cohort of current and former smokers, > 45 years, with at least 10 pack years of smoking history. Spirometry measures, blood pressure and body mass were directly measured. Mortality was assessed through continuing longitudinal follow-up and cause of death was adjudicated. Among 8157 COPDGene® participants with complete spirometry and computed tomography (CT) measures, the top 2 deciles of the airway-predominant and emphysema-predominant axes previously identified were used to categorize individuals into 3 groups having the highest risk for mortality using Cox proportional hazard ratios. These groups were also assessed for causal mortality. Biomarkers of COPD (fibrinogen, soluble receptor for advanced glycation end products [sRAGE], C-reactive protein [CRP], clara cell secretory protein [CC16], surfactant-D [SP-D]) were compared by group. Findings High-risk subtype classification was defined for 2638 COPDGene® participants who were in the highest 2 deciles of either the airway-predominant and/or emphysema-predominant axis (32% of the cohort). These high-risk participants fell into 3 groups: airway-predominant disease only (APD-only), emphysema-predominant disease only (EPD-only) and combined APD-EPD. There was 26% mortality for the APD-only group, 21% mortality for the EPD-only group, and 54% mortality for the combined APD-EPD group. The APD-only group (n=1007) was younger, had a lower forced expiratory volume in 1 second (FEV1) percent (%) predicted and a strong association with the preserved ratio-impaired spirometry (PRISm) quadrant. The EPD-only group (n=1006) showed a relatively higher FEV1 % predicted and included largely GOLD stage 0, 1 and 2 partipants. Individuals in each of the 3 high-risk groups were at greater risk for respiratory mortality, while those in the APD-only group were additionally at greater risk for cardiovascular mortality. Biomarker analysis demonstrated a significant association of the APD-only group with CRP, and sRAGE demonstrated greatest significance with both the EPD-only and the combined APD-EPD groups. Interpretation Among current and former smokers, individuals in the highest 2 deciles for mortality risk on the airway-predominant axis and the emphysema-predominant axis have unique associations to spirometric patterns, different imaging characteristics, biomarkers and causal mortality.
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Affiliation(s)
- Kendra A Young
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | | | - MeiLan K Han
- Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor
| | - Sharon M Lutz
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora
| | - Margaret Ragland
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | - Peter J Castaldi
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - George R Washko
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael H Cho
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mathew Strand
- Division of Biostatistics and Bioinformatics, Office of Academic Affairs, National Jewish Health, Denver, Colorado
| | - Douglas Curran-Everett
- Division of Biostatistics and Bioinformatics, Office of Academic Affairs, National Jewish Health, Denver, Colorado
| | - Terri H Beaty
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland
| | - Russell P Bowler
- Department of Medicine, National Jewish Health, Denver, Colorado
| | - Emily S Wan
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora.,VA Boston Healthcare System, Boston, Massachusetts
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, Colorado
| | - Barry J Make
- Department of Medicine, National Jewish Health, Denver, Colorado
| | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - James D Crapo
- Department of Medicine, National Jewish Health, Denver, Colorado
| | - John E Hokanson
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | - Gregory L Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
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Bruder C, Bulliard JL, Germann S, Konzelmann I, Bochud M, Leyvraz M, Chiolero A. Estimating lifetime and 10-year risk of lung cancer. Prev Med Rep 2018; 11:125-130. [PMID: 29942733 PMCID: PMC6010924 DOI: 10.1016/j.pmedr.2018.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 06/11/2018] [Accepted: 06/14/2018] [Indexed: 11/21/2022] Open
Abstract
Lung cancer is the commonest cancer worldwide. Mortality and incidence rates are traditionally used to assess cancer burden and as public health indicators. However, these metrics are difficult to interpret at an individual level. Providing the lifetime and 10-year risks of cancer could improve risk communication. Our aim was to estimate current lifetime and 10-year risks of lung cancer by smoking status and changes in these risks between 1995 and 2013 in a Swiss population. We used all lung cancer cases recorded between 1995 and 2013 by two population-based cancer registries in the contiguous cantons of Vaud and Valais, in Western Switzerland. We estimated sex-specific lifetime risk and 10-year risk of lung cancer using the current probability method, accounting for competing risk of death. Estimates were also provided by smoking status. Between 1995 and 2013, 9623 cases of lung cancer were recorded. During this period, the lifetime risk decreased in men from 7.1% to 6.7% and increased in women from 2.5% to 4.1%. In both sexes, the 10-year risk of lung cancer increased with age until the age of 60–70 and decreased thereafter. Difference in the cumulative risk between current, former, and never smokers were very large and reported in user-friendly charts to ease risk communication. These lifetime and 10-year risk estimates could be used systematically as public health indicators. Regularly updating risk estimations are necessary for conditions like lung cancer whose incidence has changed substantially. Providing the lifetime and cumulative 10-year risks of cancer by smoking status could improve risk communication and serve as public health indicators. These indicators can be estimated with cancer registry data and smoking data from surveys using the current probability method. In these regions of Switzerland, between 1995 and 2013, the lifetime risk of lung cancer decreased in men from 7.1% to 6.7% and increased in women from 2.5% to 4.1%. Difference in the cumulative risk between current, former, and never smokers were very large.
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Affiliation(s)
- Christina Bruder
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Jean-Luc Bulliard
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Simon Germann
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | | | - Murielle Bochud
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Magali Leyvraz
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Arnaud Chiolero
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland.,Observatoire Valaisan de la santé (OVS), Sion, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Switzerland.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
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Kim D. Projected impacts of federal tax policy proposals on mortality burden in the United States: A microsimulation analysis. Prev Med 2018; 111:272-279. [PMID: 29066374 PMCID: PMC5911242 DOI: 10.1016/j.ypmed.2017.10.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 10/09/2017] [Accepted: 10/18/2017] [Indexed: 11/22/2022]
Abstract
The public health consequences of federal income tax policies that influence income inequality are not well understood. I aimed to project the impacts on mortality of modifying federal income tax structures based on proposals by two recent United States (U.S.) Presidential candidates: Donald Trump and Senator Bernie Sanders. I performed a microsimulation analysis using the latest U.S. Internal Revenue Service public-use tax file with state identifiers (2008 tax year), containing nationally-representative data from 139,651 tax returns. I considered five tax plan scenarios: 1) actual 2008 tax structures; proposals in 2016 by then-candidates 2) Trump and 3) Sanders; 4) a modified Sanders plan with higher top tax rates (75%); and 5) a modified Sanders plan with higher top rates plus revenue redistribution to lower-income households (<$40,000/year). I combined projected changes in income inequality with vital statistics data and past estimates of linkages between income inequality, income, and mortality. 29,689 (95% CI: 10,865-48,920) more deaths/year and 31,302 (95% CI: 11,455-51,577) fewer deaths/year from all causes are anticipated under the Trump and Sanders plans, respectively. Under the modified Sanders plan including higher top rates, 68,919 (95% CI: 25,221-113,561) fewer deaths/year are projected. Under the modified Sanders plan with redistribution, 333,504 (95% CI: 192,897-473,787) fewer deaths/year are expected. Policies that both raise federal income tax rates and redistribute tax revenue could confer large reductions in the total number of annual deaths among Americans. In this era of high income inequality and growing public support to address the rich-poor gap, policymakers should consider joint federal tax and redistributive policies as levers to reduce the burden of mortality in the United States.
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Affiliation(s)
- Daniel Kim
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, United States; EHESP School of Public Health, Sorbonne Paris Cité, Paris Descartes University, Paris, France.
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Moolgavkar SH, Chang ET, Watson HN, Lau EC. An Assessment of the Cox Proportional Hazards Regression Model for Epidemiologic Studies. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2018; 38:777-794. [PMID: 29168991 DOI: 10.1111/risa.12865] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 05/10/2017] [Accepted: 06/17/2017] [Indexed: 05/02/2023]
Abstract
The basic assumptions of the Cox proportional hazards regression model are rarely questioned. This study addresses whether hazard ratio, i.e., relative risk (RR), estimates using the Cox model are biased when these assumptions are violated. We investigated also the dependence of RR estimates on temporal exposure characteristics, and how inadequate control for a strong, time-dependent confounder affects RRs for a modest, correlated risk factor. In a realistic cohort of 500,000 adults constructed using the National Cancer Institute Smoking History Generator, we used the Cox model with increasing control of smoking to examine the impact on RRs for smoking and a correlated covariate X. The smoking-associated RR was strongly modified by age. Pack-years of smoking did not sufficiently control for its effects; simultaneous control for effect modification by age and time-dependent cumulative exposure, exposure duration, and time since cessation improved model fit. Even then, residual confounding was evident in RR estimates for covariate X, for which spurious RRs ranged from 0.980 to 1.017 per unit increase. Use of the Cox model to control for a time-dependent strong risk factor yields unreliable RR estimates unless detailed, time-varying information is incorporated in analyses. Notwithstanding, residual confounding may bias estimated RRs for a modest risk factor.
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Affiliation(s)
- Suresh H Moolgavkar
- Center for Health Sciences, Exponent, Inc., Bellevue, WA, and Menlo Park, CA, USA
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ellen T Chang
- Center for Health Sciences, Exponent, Inc., Bellevue, WA, and Menlo Park, CA, USA
- Stanford Cancer Institute, Stanford, CA, USA
| | - Heather N Watson
- Statistical & Data Sciences Practice, Exponent, Inc., Menlo Park, CA, USA
| | - Edmund C Lau
- Center for Health Sciences, Exponent, Inc., Bellevue, WA, and Menlo Park, CA, USA
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Kathuria H, Detterbeck FC, Fathi JT, Fennig K, Gould MK, Jolicoeur DG, Land SR, Massetti GM, Mazzone PJ, Silvestri GA, Slatore CG, Smith RA, Vachani A, Zeliadt SB, Wiener RS. Stakeholder Research Priorities for Smoking Cessation Interventions within Lung Cancer Screening Programs. An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2017; 196:1202-1212. [PMID: 29090963 DOI: 10.1164/rccm.201709-1858st] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
RATIONALE Smoking cessation counseling in conjunction with low-dose computed tomography (LDCT) lung cancer screening is recommended in multiple clinical practice guidelines. The best approach for integrating effective smoking cessation interventions within this setting is unknown. OBJECTIVES To summarize evidence, identify research gaps, prioritize topics for future research, and propose standardized tools for use in conducting research on smoking cessation interventions within the LDCT lung cancer screening setting. METHODS The American Thoracic Society convened a multistakeholder committee with expertise in tobacco dependence treatment and/or LDCT screening. During an in-person meeting, evidence was reviewed, research gaps were identified, and key questions were generated for each of three research domains: (1) target population to study; (2) adaptation, development, and testing of interventions; and (3) implementation of interventions with demonstrated efficacy. We also identified standardized measures for use in conducting this research. A larger stakeholder panel then ranked research questions by perceived importance in an online survey. Final prioritization was generated hierarchically on the basis of average rank assigned. RESULTS There was little consensus on which questions within the population domain were of highest priority. Within the intervention domain, research to evaluate the effectiveness in the lung cancer screening setting of evidence-based smoking cessation interventions shown to be effective in other contexts was ranked highest. In the implementation domain, stakeholders prioritized understanding strategies to identify and overcome barriers to integrating smoking cessation in lung cancer screening settings. CONCLUSIONS This statement offers an agenda to stimulate research surrounding the integration and implementation of smoking cessation interventions with LDCT lung cancer screening.
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Asay GRB, Homa DM, Abramsohn EM, Xu X, O’Connor EL, Wang G. Reducing Smoking in the US Federal Workforce: 5-Year Health and Economic Impacts From Improved Cardiovascular Disease Outcomes. Public Health Rep 2017; 132:646-653. [PMID: 29072961 PMCID: PMC5692166 DOI: 10.1177/0033354917736300] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We estimated the reduction in number of hospitalizations for acute myocardial infarction and stroke as well as the associated health care costs resulting from reducing the number of smokers in the US federal workforce during a 5-year period. METHODS We developed a 5-year spreadsheet-based cohort model with parameter values from past literature and analysis of national survey data. We obtained 2015 data on the federal workforce population from the US Office of Personnel Management and data on smoking prevalence among federal workers from the 2013-2015 National Health Interview Survey. We adjusted medical costs and productivity losses for inflation to 2015 US dollars, and we updated future productivity losses for growth. Because of uncertainty about the achievable reduction in smoking prevalence and input values (eg, relative risk for acute myocardial infarction and stroke, medical costs, and absenteeism), we performed a Monte Carlo simulation and sensitivity analysis. RESULTS We estimated smoking prevalence in the federal workforce to be 13%. A 5 percentage-point reduction in smoking prevalence could result in 1106 fewer hospitalizations for acute myocardial infarction (range, 925-1293), 799 fewer hospitalizations for stroke (range, 530-1091), and 493 fewer deaths (range, 494-598) during a 5-year period. Similarly, estimated costs averted would be $59 million (range, $49-$63 million) for medical costs, $332 million (range, $173-$490 million) for absenteeism, and $117 million (range, $93-$142 million) for productivity. CONCLUSION Reductions in the prevalence of smoking in the federal workforce could substantially reduce the number of hospitalizations for acute myocardial infarction and stroke, lower medical costs, and improve productivity.
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Affiliation(s)
- Garrett R. Beeler Asay
- Office of the Associate Director for Policy, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - David M. Homa
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Erin M. Abramsohn
- Office of the Associate Director for Policy, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Xin Xu
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Erin L. O’Connor
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Guijing Wang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Shi Z, Wang AL, Aronowitz CA, Romer D, Langleben DD. Individual differences in the processing of smoking-cessation video messages: An imaging genetics study. Biol Psychol 2017; 128:125-131. [PMID: 28757070 PMCID: PMC5731475 DOI: 10.1016/j.biopsycho.2017.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 07/21/2017] [Accepted: 07/24/2017] [Indexed: 11/25/2022]
Abstract
Studies testing the benefits of enriching smoking-cessation video ads with attention-grabbing sensory features have yielded variable results. Dopamine transporter gene (DAT1) has been implicated in attention deficits. We hypothesized that DAT1 polymorphism is partially responsible for this variability. Using functional magnetic resonance imaging, we examined brain responses to videos high or low in attention-grabbing features, indexed by "message sensation value" (MSV), in 53 smokers genotyped for DAT1. Compared to other smokers, 10/10 homozygotes showed greater neural response to High- vs. Low-MSV smoking-cessation videos in two a priori regions of interest: the right temporoparietal junction and the right ventrolateral prefrontal cortex. These regions are known to underlie stimulus-driven attentional processing. Exploratory analysis showed that the right temporoparietal response positively predicted follow-up smoking behavior indexed by urine cotinine. Our findings suggest that responses to attention-grabbing features in smoking-cessation messages is affected by the DAT1 genotype.
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Affiliation(s)
- Zhenhao Shi
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States; Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - An-Li Wang
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Catherine A Aronowitz
- Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Daniel Romer
- Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Daniel D Langleben
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States; Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA 19104, United States; Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA 19104, United States.
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The Relationship of Pregnancy Intentions to Breastfeeding Duration: A New Evaluation. ACTA ACUST UNITED AC 2017. [DOI: 10.1108/s0275-495920170000035002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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25
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Kõks G, Fischer K, Kõks S. Smoking-related general and cause-specific mortality in Estonia. BMC Public Health 2017; 18:34. [PMID: 28724413 PMCID: PMC5517793 DOI: 10.1186/s12889-017-4590-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 07/12/2017] [Indexed: 12/20/2022] Open
Abstract
Background Tobacco smoking is known to be the single largest cause of premature death worldwide. The aim of present study was to analyse the effect of smoking on general and cause-specific mortality in the Estonian population. Methods The data from 51,756 adults in the Estonian Genome Center of the University of Tartu was used. Information on dates and causes of death was retrieved from the National Causes of Death Registry. Smoking status, general survival, general mortality and cause-specific mortality were analysed using Kaplan-Meier estimator and Cox proportional hazards models. Results The study found that smoking reduces median survival in men by 11.4 years and in women by 5.8 years. Tobacco smoking produces a very specific pattern in the cause of deaths, significantly increasing the risks for different cancers and cardiovascular diseases as causes of death for men and women. This study also identified that external causes, such as alcohol intoxication and intentional self-harm, are more prevalent causes of death among smokers than non-smokers. Additionally, smoking cessation was found to reverse the increased risks for premature mortality. Conclusions Tobacco smoking remains the major cause for losses of life inducing cancers and cardiovascular diseases. In addition to the common diseases, external causes also reduce substantially the years of life. External causes of death indicate that smoking has a long-term influence on the behaviour of smokers, provoking self-destructive behaviour. Our study supports the idea, that tobacco smoking generates complex harm to our health increasing mortality from both somatic and mental disorders.
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Affiliation(s)
- Gea Kõks
- Department of Pathophysiology, University of Tartu, 19 Ravila Street, 50411, Tartu, Estonia
| | - Krista Fischer
- Estonian Genome Center, University of Tartu, 23b Riia Street, 51010, Tartu, Estonia
| | - Sulev Kõks
- Department of Pathophysiology, University of Tartu, 19 Ravila Street, 50411, Tartu, Estonia. .,Department of Reproductive Biology, Estonian University of Life Sciences, 62 Kreutzwaldi Street, 51006, Tartu, Estonia.
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Howlader N, Mariotto AB, Besson C, Suneja G, Robien K, Younes N, Engels EA. Cancer-specific mortality, cure fraction, and noncancer causes of death among diffuse large B-cell lymphoma patients in the immunochemotherapy era. Cancer 2017; 123:3326-3334. [DOI: 10.1002/cncr.30739] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/20/2017] [Accepted: 02/08/2017] [Indexed: 01/24/2023]
Affiliation(s)
- Nadia Howlader
- Surveillance Research Program, Division of Cancer Control and Population Sciences; National Cancer Institute; Bethesda Maryland
- Department of Epidemiology and Biostatistics; George Washington University Milken Institute School of Public Health; Washington DC
| | - Angela B. Mariotto
- Surveillance Research Program, Division of Cancer Control and Population Sciences; National Cancer Institute; Bethesda Maryland
| | - Caroline Besson
- Faculty of Medicine; University of Paris Sud; Le Kremlin-Bicêtre France
| | - Gita Suneja
- Department of Radiation Oncology; University of Utah; Salt Lake City Utah
| | - Kim Robien
- Department of Epidemiology and Biostatistics; George Washington University Milken Institute School of Public Health; Washington DC
| | - Naji Younes
- Department of Epidemiology and Biostatistics; George Washington University Milken Institute School of Public Health; Washington DC
| | - Eric A. Engels
- Division of Cancer Epidemiology and Genetics; National Cancer Institute; Bethesda Maryland
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Jung M. Breast, prostate, and thyroid cancer screening tests and overdiagnosis. Curr Probl Cancer 2017; 41:71-79. [DOI: 10.1016/j.currproblcancer.2016.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 11/15/2016] [Accepted: 11/29/2016] [Indexed: 12/20/2022]
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Buckles K, Hagemann A, Malamud O, Morrill M, Wozniak A. The effect of college education on mortality. JOURNAL OF HEALTH ECONOMICS 2016; 50:99-114. [PMID: 27723470 DOI: 10.1016/j.jhealeco.2016.08.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 07/02/2016] [Accepted: 08/16/2016] [Indexed: 06/06/2023]
Abstract
We exploit exogenous variation in years of completed college induced by draft-avoidance behavior during the Vietnam War to examine the impact of college on adult mortality. Our estimates imply that increasing college attainment from the level of the state at the 25th percentile of the education distribution to that of the state at the 75th percentile would decrease cumulative mortality for cohorts in our sample by 8 to 10 percent relative to the mean. Most of the reduction in mortality is from deaths due to cancer and heart disease. We also explore potential mechanisms, including differential earnings and health insurance.
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Affiliation(s)
- Kasey Buckles
- University of Notre Dame, Notre Dame, IN, USA; National Bureau of Economic Research, Cambridge, MA, USA; Institute for the Study of Labor (IZA), Bonn, Germany
| | | | - Ofer Malamud
- National Bureau of Economic Research, Cambridge, MA, USA; University of Chicago, Chicago, IL, USA
| | | | - Abigail Wozniak
- University of Notre Dame, Notre Dame, IN, USA; National Bureau of Economic Research, Cambridge, MA, USA; Institute for the Study of Labor (IZA), Bonn, Germany.
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Criscitelli K, Avena NM. The neurobiological and behavioral overlaps of nicotine and food addiction. Prev Med 2016; 92:82-89. [PMID: 27509870 DOI: 10.1016/j.ypmed.2016.08.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 08/01/2016] [Accepted: 08/06/2016] [Indexed: 12/19/2022]
Abstract
Both cigarette smoking and obesity are significant public health concerns and are associated with increased risk of early mortality. It is well established that the mesolimbic dopamine pathway is an important component of the reward system within the brain and is implicated in the development of addiction. Indeed, nicotine and highly palatable foods are capable of altering dopamine release within this system, engendering addictive like responses in susceptible individuals. Although additional research is warranted, findings from animal and human literature have elucidated many of neuroadaptions that occur from exposure to nicotine and highly palatable foods, leading to a greater understanding of the underlying mechanisms contributing to these aberrant behaviors. In this review we present the findings taken from preclinical and clinical literature of the known effects of exposure to nicotine and highly palatable foods on the reward related circuitry within the brain. Further, we compare the neurobiological and behavioral overlaps between nicotine, highly palatable foods and obesity. Lastly, we examine the stigma associated with smoking, obesity and food addiction, and the consequences stigma has on the overall health and wellbeing of an individual.
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Affiliation(s)
- Kristen Criscitelli
- Department of Pharmacology and Systems Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Nicole M Avena
- Department of Pharmacology and Systems Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
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Gigerenzer G, Gaissmaier W, Kurz-Milcke E, Schwartz LM, Woloshin S. Helping Doctors and Patients Make Sense of Health Statistics. Psychol Sci Public Interest 2016; 8:53-96. [DOI: 10.1111/j.1539-6053.2008.00033.x] [Citation(s) in RCA: 718] [Impact Index Per Article: 89.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Many doctors, patients, journalists, and politicians alike do not understand what health statistics mean or draw wrong conclusions without noticing. Collective statistical illiteracy refers to the widespread inability to understand the meaning of numbers. For instance, many citizens are unaware that higher survival rates with cancer screening do not imply longer life, or that the statement that mammography screening reduces the risk of dying from breast cancer by 25% in fact means that 1 less woman out of 1,000 will die of the disease. We provide evidence that statistical illiteracy (a) is common to patients, journalists, and physicians; (b) is created by nontransparent framing of information that is sometimes an unintentional result of lack of understanding but can also be a result of intentional efforts to manipulate or persuade people; and (c) can have serious consequences for health. The causes of statistical illiteracy should not be attributed to cognitive biases alone, but to the emotional nature of the doctor–patient relationship and conflicts of interest in the healthcare system. The classic doctor–patient relation is based on (the physician's) paternalism and (the patient's) trust in authority, which make statistical literacy seem unnecessary; so does the traditional combination of determinism (physicians who seek causes, not chances) and the illusion of certainty (patients who seek certainty when there is none). We show that information pamphlets, Web sites, leaflets distributed to doctors by the pharmaceutical industry, and even medical journals often report evidence in nontransparent forms that suggest big benefits of featured interventions and small harms. Without understanding the numbers involved, the public is susceptible to political and commercial manipulation of their anxieties and hopes, which undermines the goals of informed consent and shared decision making. What can be done? We discuss the importance of teaching statistical thinking and transparent representations in primary and secondary education as well as in medical school. Yet this requires familiarizing children early on with the concept of probability and teaching statistical literacy as the art of solving real-world problems rather than applying formulas to toy problems about coins and dice. A major precondition for statistical literacy is transparent risk communication. We recommend using frequency statements instead of single-event probabilities, absolute risks instead of relative risks, mortality rates instead of survival rates, and natural frequencies instead of conditional probabilities. Psychological research on transparent visual and numerical forms of risk communication, as well as training of physicians in their use, is called for. Statistical literacy is a necessary precondition for an educated citizenship in a technological democracy. Understanding risks and asking critical questions can also shape the emotional climate in a society so that hopes and anxieties are no longer as easily manipulated from outside and citizens can develop a better-informed and more relaxed attitude toward their health.
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Affiliation(s)
- Gerd Gigerenzer
- Max Planck Institute for Human Development, Berlin
- Harding Center for Risk Literacy, Berlin
| | - Wolfgang Gaissmaier
- Max Planck Institute for Human Development, Berlin
- Harding Center for Risk Literacy, Berlin
| | - Elke Kurz-Milcke
- Max Planck Institute for Human Development, Berlin
- Harding Center for Risk Literacy, Berlin
| | - Lisa M. Schwartz
- The Dartmouth Institute for Health Policy and Clinical Practice's Center for Medicine and the Media, Dartmouth Medical School
| | - Steven Woloshin
- The Dartmouth Institute for Health Policy and Clinical Practice's Center for Medicine and the Media, Dartmouth Medical School
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Schulte DM, Duster M, Warrack S, Valentine S, Jorenby D, Shirley D, Sosman J, Catz S, Safdar N. Feasibility and patient satisfaction with smoking cessation interventions for prevention of healthcare-associated infections in inpatients. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2016; 11:15. [PMID: 27113448 PMCID: PMC4845502 DOI: 10.1186/s13011-016-0059-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 04/17/2016] [Indexed: 01/25/2023]
Abstract
Background Smoking increases hospitalization and healthcare-associated infection. Our primary aim of this pilot, randomized-controlled trial was to examine the feasibility and acceptability of a tobacco cessation intervention compared with usual care in inpatients. S. aureus carriage, healthcare-associated infections and infections post discharge were exploratory outcomes. Methods Current inpatient smokers from a university hospital facility were randomized to usual care or a face to face tobacco cessation counseling session where patients’ tobacco use and strategies for quitting were discussed. Patient engagement, satisfaction and withdrawal symptoms were measured at 1 week and 12 weeks post discharge. Nasal swabs were collected at enrollment and discharge and assessed for S. aureus colonization. P-values were calculated using Fisher’s exact and t-tests were used to compare groups. Results For the study’s primary outcome, participants reported the intervention as being generally acceptable and reported high overall levels of satisfaction, with a Likert scale score of at least 4/5 for all measures of satisfaction. No subjects utilized free tobacco cessation services after discharge. 83 % of the intervention group and 93 % of the control group smoked at least one cigarette after discharge. Secondary outcomes with regard to infections showed that, at discharge, 12 % of the intervention group (n = 17) and 18 % of the control group (n = 22) tested positive for S. aureus. After 3 months, 9 % of the intervention group developed infection, 41 % visited an emergency room, and 24 % were readmitted within 3 months post-discharge, compared to 27, 32 and 36 % of the control group respectively. Conclusions With regards to the primary aim of this study, there were overall high levels of satisfaction with the intervention, indicating good feasibility and acceptance among patients. However, more intensive interventions in hospitalized patients and impact on healthcare-associated infections and post-discharge infections should be explored.
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Affiliation(s)
- Danielle M Schulte
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.,Department of Population Health Sciences, University of Wisconsin - Madison School of Medicine and Public Health, Madison, WI, USA
| | - Megan Duster
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Simone Warrack
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Susan Valentine
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Douglas Jorenby
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.,Center for Tobacco Research and Intervention, University of Wisconsin-Madison, Madison, WI, USA
| | - Daniel Shirley
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - James Sosman
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Sheryl Catz
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, CA, USA
| | - Nasia Safdar
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA. .,University of Wisconsin Hospitals and Clinics, Madison, WI, USA. .,William S. Middleton Memorial Veterans Affairs Medical Center, 5221 MFCB, 1685 Highland Avenue, Madison, WI, 53705, USA.
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Keen JD, Jørgensen KJ. Four Principles to Consider Before Advising Women on Screening Mammography. J Womens Health (Larchmt) 2015; 24:867-74. [PMID: 26496048 PMCID: PMC4649764 DOI: 10.1089/jwh.2015.5220] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
This article reviews four important screening principles applicable to screening mammography in order to facilitate informed choice. The first principle is that screening may help, hurt, or have no effect. In order to reduce mortality and mastectomy rates, screening must reduce the rate of advanced disease, which likely has not happened. Through overdiagnosis, screening produces substantial harm by increasing both lumpectomy and mastectomy rates, which offsets the often-promised benefit of less invasive therapy. Next, all-cause mortality is the most reliable way to measure the efficacy of a screening intervention. Disease-specific mortality is biased due to difficulties in attribution of cause of death and to increased mortality due to overdiagnosis and the resulting overtreatment with radiotherapy and chemotherapy. To enhance participation, the benefit from screening is often presented in relative instead of absolute terms. Third, some screening statistics must be interpreted with caution. Increased survival time and the percentage of early-stage tumors at detection sound plausible, but are affected by lead-time and length biases. In addition, analyses that only include women who attend screening cannot reliably correct for selection bias. The final principle is that accounting for tumor biology is important for accurate estimates of lead time, and the potential benefit from screening. Since “early detection” is actually late in a tumor's lifetime, the time window when screen detection might extend a woman's life is narrow, as many tumors that can form metastases will already have done so. Instead of encouraging screening mammography, physicians should help women make an informed decision as with any medical intervention.
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Affiliation(s)
- John D Keen
- 1 Department of Radiology, John H. Stroger Jr. Hospital of Cook County , Chicago, Illinois
| | - Karsten J Jørgensen
- 2 The Nordic Cochrane Centre, Rigshospitalet Department, Copenhagen , Denmark
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Hunter N, Muirhead CR, Bochicchio F, Haylock RGE. Calculation of lifetime lung cancer risks associated with radon exposure, based on various models and exposure scenarios. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2015; 35:539-55. [PMID: 26083042 DOI: 10.1088/0952-4746/35/3/539] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The risk of lung cancer mortality up to 75 years of age due to radon exposure has been estimated for both male and female continuing, ex- and never-smokers, based on various radon risk models and exposure scenarios. We used risk models derived from (i) the BEIR VI analysis of cohorts of radon-exposed miners, (ii) cohort and nested case-control analyses of a European cohort of uranium miners and (iii) the joint analysis of European residential radon case-control studies. Estimates of the lifetime lung cancer risk due to radon varied between these models by just over a factor of 2 and risk estimates based on models from analyses of European uranium miners exposed at comparatively low rates and of people exposed to radon in homes were broadly compatible. For a given smoking category, there was not much difference in lifetime lung cancer risk between males and females. The estimated lifetime risk of radon-induced lung cancer for exposure to a concentration of 200 Bq m(-3) was in the range 2.98-6.55% for male continuing smokers and 0.19-0.42% for male never-smokers, depending on the model used and assuming a multiplicative relationship for the joint effect of radon and smoking. Stopping smoking at age 50 years decreases the lifetime risk due to radon by around a half relative to continuing smoking, but the risk for ex-smokers remains about a factor of 5-7 higher than that for never-smokers. Under a sub-multiplicative model for the joint effect of radon and smoking, the lifetime risk of radon-induced lung cancer was still estimated to be substantially higher for continuing smokers than for never smokers. Radon mitigation-used to reduce radon concentrations at homes-can also have a substantial impact on lung cancer risk, even for persons in their 50 s; for each of continuing smokers, ex-smokers and never-smokers, radon mitigation at age 50 would lower the lifetime risk of radon-induced lung cancer by about one-third. To maximise risk reductions, smokers in high-radon homes should both stop smoking and remediate their homes.
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Affiliation(s)
- Nezahat Hunter
- Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot, Oxon OX11 0RQ, UK
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Maciosek MV, Xu X, Butani AL, Pechacek TF. Smoking-attributable medical expenditures by age, sex, and smoking status estimated using a relative risk approach. Prev Med 2015; 77:162-7. [PMID: 26051203 PMCID: PMC4597893 DOI: 10.1016/j.ypmed.2015.05.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 05/28/2015] [Accepted: 05/30/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To accurately assess the benefits of tobacco control interventions and to better inform decision makers, knowledge of medical expenditures by age, gender, and smoking status is essential. METHOD We propose an approach to distribute smoking-attributable expenditures by age, gender, and cigarette smoking status to reflect the known risks of smoking. We distribute hospitalization days for smoking-attributable diseases according to relative risks of smoking-attributable mortality, and use the method to determine national estimates of smoking-attributable expenditures by age, sex, and cigarette smoking status. Sensitivity analyses explored assumptions of the method. RESULTS Both current and former smokers ages 75 and over have about 12 times the smoking-attributable expenditures of their current and former smoker counterparts 35-54years of age. Within each age group, the expenditures of formers smokers are about 70% lower than current smokers. In sensitivity analysis, these results were not robust to large changes to the relative risks of smoking-attributable mortality which were used in the calculations. CONCLUSION Sex- and age-group-specific smoking expenditures reflect observed disease risk differences between current and former cigarette smokers and indicate that about 70% of current smokers' excess medical care costs is preventable by quitting.
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Affiliation(s)
- Michael V Maciosek
- HealthPartners Institute for Education and Research, Minneapolis, MN, USA.
| | - Xin Xu
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amy L Butani
- HealthPartners Institute for Education and Research, Minneapolis, MN, USA
| | - Terry F Pechacek
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Reduction of risk of dying from tobacco-related diseases after quitting smoking in Italy. TUMORI JOURNAL 2015; 101:657-63. [PMID: 26108248 DOI: 10.5301/tj.5000307] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2015] [Indexed: 11/20/2022]
Abstract
AIMS AND BACKGROUND The aims of this paper are to compute the risks of dying of ischemic heart disease (IHD), lung cancer (LC), stroke, and chronic obstructive pulmonary disease (COPD) for Italian smokers by gender, age and daily number of cigarettes smoked, and to estimate the benefit of stopping smoking in terms of risk reduction. METHODS Life tables by sex and smoking status were computed for each smoking-related disease based on Italian smoking data, and risk charts with 10-year probabilities of death were computed for never, current and former smokers. RESULTS Men aged 45-49 years, current smokers, have a 8, 10, 3 and 1 in 1,000 chance of dying of IHD, LC, stroke and COPD, respectively, whereas women with the same characteristics have a 2, 6, 3 and 1 in 1,000 chance, respectively, for all smokers combined, i.e., independent of the smoking intensity. The risk reduction rates from quitting smoking are remarkable: a man who quits smoking at 45-49 years can reduce the risk of dying of IHD, LC, stroke and COPD in the next 10 years by 43%, 53%, 57% and 55%, respectively; a woman by 49%, 49%, 59% and 57%, respectively. CONCLUSIONS Estimates of risk reduction by quitting smoking are useful to provide a sounder scientific basis for public health messages and clinical advice.
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Landsman V, Lou WYW, Graubard BI. Estimating survival probabilities by exposure levels: utilizing vital statistics and complex survey data with mortality follow-up. Stat Med 2015; 34:1864-75. [PMID: 25656596 DOI: 10.1002/sim.6455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 10/26/2014] [Accepted: 01/22/2015] [Indexed: 11/08/2022]
Abstract
We present a two-step approach for estimating hazard rates and, consequently, survival probabilities, by levels of general categorical exposure. The resulting estimator utilizes three sources of data: vital statistics data and census data are used at the first step to estimate the overall hazard rate for a given combination of gender and age group, and cohort data constructed from a nationally representative complex survey with linked mortality records, are used at the second step to divide the overall hazard rate by exposure levels. We present an explicit expression for the resulting estimator and consider two methods for variance estimation that account for complex multistage sample design: (1) the leaving-one-out jackknife method, and (2) the Taylor linearization method, which provides an analytic formula for the variance estimator. The methods are illustrated with smoking and all-cause mortality data from the US National Health Interview Survey Linked Mortality Files, and the proposed estimator is compared with a previously studied crude hazard rate estimator that uses survey data only. The advantages of a two-step approach and possible extensions of the proposed estimator are discussed.
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Affiliation(s)
- V Landsman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, M5T 3M7, Canada
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Xu X, Alexander RL, Simpson SA, Goates S, Nonnemaker JM, Davis KC, McAfee T. A cost-effectiveness analysis of the first federally funded antismoking campaign. Am J Prev Med 2015; 48:318-25. [PMID: 25498550 PMCID: PMC4603744 DOI: 10.1016/j.amepre.2014.10.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 10/01/2014] [Accepted: 10/17/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND In 2012, CDC launched the first federally funded national mass media antismoking campaign. The Tips From Former Smokers (Tips) campaign resulted in a 12% relative increase in population-level quit attempts. PURPOSE Cost-effectiveness analysis was conducted in 2013 to evaluate Tips from a funding agency's perspective. METHODS Estimates of sustained cessations; premature deaths averted; undiscounted life years (LYs) saved; and quality-adjusted life years (QALYs) gained by Tips were estimated. RESULTS Tips saved about 179,099 QALYs and prevented 17,109 premature deaths in the U.S. With the campaign cost of roughly $48 million, Tips spent approximately $480 per quitter, $2,819 per premature death averted, $393 per LY saved, and $268 per QALY gained. CONCLUSIONS Tips was not only successful at reducing smoking-attributable morbidity and mortality but also was a highly cost-effective mass media intervention.
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Affiliation(s)
- Xin Xu
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion.
| | - Robert L Alexander
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion
| | - Sean A Simpson
- RTI International, Research Triangle Park, North Carolina
| | - Scott Goates
- Office of the Associate Director for Policy , Office of the Director, CDC, Atlanta, Georgia
| | | | - Kevin C Davis
- RTI International, Research Triangle Park, North Carolina
| | - Tim McAfee
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion
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Brinkman M, Kim H, Chuang JC, Kroeger RR, Deojay D, Clark PI, Gordon SM. Comparison of True and Smoothed Puff Profile Replication on Smoking Behavior and Mainstream Smoke Emissions. Chem Res Toxicol 2015; 28:182-90. [PMID: 25536227 PMCID: PMC4332039 DOI: 10.1021/tx500318h] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Indexed: 11/29/2022]
Abstract
To estimate exposures to smokers from cigarettes, smoking topography is typically measured and programmed into a smoking machine to mimic human smoking, and the resulting smoke emissions are tested for relative levels of harmful constituents. However, using only the summary puff data--with a fixed puff frequency, volume, and duration--may underestimate or overestimate actual exposure to smoke toxins. In this laboratory study, we used a topography-driven smoking machine that faithfully reproduces a human smoking session and individual human topography data (n = 24) collected during previous clinical research to investigate if replicating the true puff profile (TP) versus the mathematically derived smoothed puff profile (SM) resulted in differences in particle size distributions and selected toxic/carcinogenic organic compounds from mainstream smoke emissions. Particle size distributions were measured using an electrical low pressure impactor, the masses of the size-fractionated fine and ultrafine particles were determined gravimetrically, and the collected particulate was analyzed for selected particle-bound, semivolatile compounds. Volatile compounds were measured in real time using a proton transfer reaction-mass spectrometer. By and large, TP levels for the fine and ultrafine particulate masses as well as particle-bound organic compounds were slightly lower than the SM concentrations. The volatile compounds, by contrast, showed no clear trend. Differences in emissions due to the use of the TP and SM profiles are generally not large enough to warrant abandoning the procedures used to generate the simpler smoothed profile in favor of the true profile.
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Affiliation(s)
- Marielle
C. Brinkman
- Tobacco
Exposure Research Laboratory, Battelle Memorial
Institute, 505 King Avenue, Columbus, Ohio 43201, United States
| | - Hyoshin Kim
- Tobacco
Exposure Research Laboratory, Battelle Memorial
Institute, 505 King Avenue, Columbus, Ohio 43201, United States
| | - Jane C. Chuang
- Tobacco
Exposure Research Laboratory, Battelle Memorial
Institute, 505 King Avenue, Columbus, Ohio 43201, United States
| | - Robyn R. Kroeger
- Tobacco
Exposure Research Laboratory, Battelle Memorial
Institute, 505 King Avenue, Columbus, Ohio 43201, United States
| | - Dawn Deojay
- Tobacco
Exposure Research Laboratory, Battelle Memorial
Institute, 505 King Avenue, Columbus, Ohio 43201, United States
| | - Pamela I. Clark
- University
of Maryland, College Park, Maryland 20742, United States
| | - Sydney M. Gordon
- Tobacco
Exposure Research Laboratory, Battelle Memorial
Institute, 505 King Avenue, Columbus, Ohio 43201, United States
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Clamon G. Chemoprevention and Screening for Lung Cancer: Changing Our Focus to Former Smokers. Clin Lung Cancer 2015; 16:1-5. [DOI: 10.1016/j.cllc.2014.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 09/25/2014] [Accepted: 09/25/2014] [Indexed: 12/26/2022]
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Abstract
Past epidemiological observations and recent molecular studies suggest that chronic obstructive pulmonary disease (COPD) and lung cancer are closely related diseases, resulting from overlapping genetic susceptibility and exposure to aero-pollutants, primarily cigarette smoke. Statistics from the American Lung Association and American Cancer Society reveal that mortality from COPD and lung cancer are lowest in Hispanic subjects and generally highest in African American subjects, with mortality in non-Hispanic white subjects and Asian subjects in between. This observation, described as the “Hispanic paradox”, persists after adjusting for confounding variables, notably smoking exposure and sociodemographic factors. While differences in genetic predisposition might underlie this observation, differences in diet remain a possible explanation. Such a hypothesis is supported by the observation that a diet high in fruit and vegetables has been shown to confer a protective effect on both COPD and lung cancer. In this article, we hypothesise that a diet rich in legumes may explain, in part, the Hispanic paradox, given the traditionally high consumption of legumes (beans and lentils) by Hispanic subjects. Legumes are very high in fibre and have recently been shown to attenuate systemic inflammation significantly, which has previously been linked to susceptibility to COPD and lung cancer in large prospective studies. A similar protective effect could be attributed to the consumption of soy products (from soybeans) in Asian subjects, for whom a lower incidence of COPD and lung cancer has also been reported. This hypothesis requires confirmation in cohort studies and randomised control trials, where the effects of diet on outcomes can be carefully examined in a prospective study design.
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Affiliation(s)
- Robert P Young
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. School of Biological Sciences, University of Auckland, Auckland, New Zealand Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | - Raewyn J Hopkins
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. School of Biological Sciences, University of Auckland, Auckland, New Zealand
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Rudel RA, Ackerman JM, Attfield KR, Brody JG. New exposure biomarkers as tools for breast cancer epidemiology, biomonitoring, and prevention: a systematic approach based on animal evidence. ENVIRONMENTAL HEALTH PERSPECTIVES 2014; 122:881-95. [PMID: 24818537 PMCID: PMC4154213 DOI: 10.1289/ehp.1307455] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 04/29/2014] [Indexed: 05/19/2023]
Abstract
BACKGROUND Exposure to chemicals that cause rodent mammary gland tumors is common, but few studies have evaluated potential breast cancer risks of these chemicals in humans. OBJECTIVE The goal of this review was to identify and bring together the needed tools to facilitate the measurement of biomarkers of exposure to potential breast carcinogens in breast cancer studies and biomonitoring. METHODS We conducted a structured literature search to identify measurement methods for exposure biomarkers for 102 chemicals that cause rodent mammary tumors. To evaluate concordance, we compared human and animal evidence for agents identified as plausibly linked to breast cancer in major reviews. To facilitate future application of exposure biomarkers, we compiled information about relevant cohort studies. RESULTS Exposure biomarkers have been developed for nearly three-quarters of these rodent mammary carcinogens. Analytical methods have been published for 73 of the chemicals. Some of the remaining chemicals could be measured using modified versions of existing methods for related chemicals. In humans, biomarkers of exposure have been measured for 62 chemicals, and for 45 in a nonoccupationally exposed population. The Centers for Disease Control and Prevention has measured 23 in the U.S. population. Seventy-five of the rodent mammary carcinogens fall into 17 groups, based on exposure potential, carcinogenicity, and structural similarity. Carcinogenicity in humans and rodents is generally consistent, although comparisons are limited because few agents have been studied in humans. We identified 44 cohort studies, with a total of > 3.5 million women enrolled, that have recorded breast cancer incidence and stored biological samples. CONCLUSIONS Exposure measurement methods and cohort study resources are available to expand biomonitoring and epidemiology related to breast cancer etiology and prevention.
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Wattson DA, Hunink MGM, DiPiro PJ, Das P, Hodgson DC, Mauch PM, Ng AK. Low-dose chest computed tomography for lung cancer screening among Hodgkin lymphoma survivors: a cost-effectiveness analysis. Int J Radiat Oncol Biol Phys 2014; 90:344-53. [PMID: 25104066 DOI: 10.1016/j.ijrobp.2014.06.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 05/29/2014] [Accepted: 06/03/2014] [Indexed: 01/02/2023]
Abstract
PURPOSE Hodgkin lymphoma (HL) survivors face an increased risk of treatment-related lung cancer. Screening with low-dose computed tomography (LDCT) may allow detection of early stage, resectable cancers. We developed a Markov decision-analytic and cost-effectiveness model to estimate the merits of annual LDCT screening among HL survivors. METHODS AND MATERIALS Population databases and HL-specific literature informed key model parameters, including lung cancer rates and stage distribution, cause-specific survival estimates, and utilities. Relative risks accounted for radiation therapy (RT) technique, smoking status (>10 pack-years or current smokers vs not), age at HL diagnosis, time from HL treatment, and excess radiation from LDCTs. LDCT assumptions, including expected stage-shift, false-positive rates, and likely additional workup were derived from the National Lung Screening Trial and preliminary results from an internal phase 2 protocol that performed annual LDCTs in 53 HL survivors. We assumed a 3% discount rate and a willingness-to-pay (WTP) threshold of $50,000 per quality-adjusted life year (QALY). RESULTS Annual LDCT screening was cost effective for all smokers. A male smoker treated with mantle RT at age 25 achieved maximum QALYs by initiating screening 12 years post-HL, with a life expectancy benefit of 2.1 months and an incremental cost of $34,841/QALY. Among nonsmokers, annual screening produced a QALY benefit in some cases, but the incremental cost was not below the WTP threshold for any patient subsets. As age at HL diagnosis increased, earlier initiation of screening improved outcomes. Sensitivity analyses revealed that the model was most sensitive to the lung cancer incidence and mortality rates and expected stage-shift from screening. CONCLUSIONS HL survivors are an important high-risk population that may benefit from screening, especially those treated in the past with large radiation fields including mantle or involved-field RT. Screening may be cost effective for all smokers but possibly not for nonsmokers despite a small life expectancy benefit.
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Affiliation(s)
| | - M G Myriam Hunink
- Departments of Radiology and Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands and Center for Health Decision Science, Harvard School of Public Health, Boston, Massachusetts
| | - Pamela J DiPiro
- Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Prajnan Das
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David C Hodgson
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Peter M Mauch
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Andrea K Ng
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts
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Olchanski N, Winn A, Cohen JT, Neumann PJ. Abdominal aortic aneurysm screening: how many life years lost from underuse of the medicare screening benefit? J Gen Intern Med 2014; 29:1155-61. [PMID: 24715406 PMCID: PMC4099445 DOI: 10.1007/s11606-014-2831-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 11/25/2013] [Accepted: 03/02/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Since 2007, Medicare has provided one-time abdominal aortic aneurysm (AAA) screening for men with smoking history, and men and women with a family history of AAA as part of its Welcome to Medicare visit. OBJECTIVE We examined utilization of the new AAA screening benefit and estimated how increased utilization could influence population health as measured by life years gained. Additionally, we explored the impact of expanding screening to women with smoking history. DESIGN Analysis of Medicare claims and a simulation model to estimate the effects of screening, using published data for parameter estimates. SETTING AAA screening in the primary care setting. PATIENTS Newly-enrolled Medicare beneficiaries aged 65 years, with smoking history or family history of AAA. MAIN MEASURES Life expectancy, 10-year survival rates. KEY RESULTS Medicare data revealed low utilization of AAA screening, under 1% among those eligible. We estimate that screening could increase life expectancy per individual invited to screening for men with smoking history (0.11 years), with family history of AAA (0.17 years), and women with family history (0.08 years), and smoking history (0.09 years). Average gains of 131 life years per 1,000 persons screened for AAA compare favorably with the grade B United States Preventive Services Task Force (USPSTF) recommendation for breast cancer screening, which yields 95-128 life years per 1,000 women screened. These findings were robust over a range of scenarios. LIMITATIONS The simulation results reflect assumptions regarding AAA prevalence, treatment, and outcomes in specific populations based on published research and US survey data. Published data on women were limited. CONCLUSIONS The Welcome to Medicare and AAA screening benefits have been underutilized. Increasing utilization of AAA screening would yield substantial gains in life expectancy. Expanding screening to women with smoking history also has the potential for substantial health benefits.
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Affiliation(s)
- N Olchanski
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA,
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Ellis L, Coleman MP, Rachet B. The impact of life tables adjusted for smoking on the socio-economic difference in net survival for laryngeal and lung cancer. Br J Cancer 2014; 111:195-202. [PMID: 24853177 PMCID: PMC4090723 DOI: 10.1038/bjc.2014.217] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 04/01/2014] [Accepted: 04/04/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Net survival is a key measure in cancer control, but estimates for cancers that are strongly associated with smoking may be biased. General population life tables represent background mortality in net survival, but may not adequately reflect the higher mortality experienced by smokers. METHODS Life tables adjusted for smoking were developed, and their impact on net survival and inequalities in net survival for laryngeal and lung cancers was examined. RESULTS The 5-year net survival estimated with smoking-adjusted life tables was consistently higher than the survival estimated with unadjusted life tables: 7% higher for laryngeal cancer and 1.5% higher for lung cancer. The impact of using smoking-adjusted life tables was more pronounced in affluent patients; the deprivation gap in 5-year net survival for laryngeal cancer widened by 3%, from 11% to 14%. CONCLUSIONS Using smoking-adjusted life tables to estimate net survival has only a small impact on the deprivation gap in survival, even when inequalities are substantial. Adjusting for the higher, smoking-related background mortality did increase the estimates of net survival for all deprivation groups, and may be more important when measuring the public health impact of differences or changes in survival, such as avoidable deaths or crude probabilities of death.
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Affiliation(s)
- L Ellis
- Cancer Research UK Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - M P Coleman
- Cancer Research UK Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - B Rachet
- Cancer Research UK Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Abstract
Lung cancer is the leading cause of cancer death. Although smoking prevention and cessation programs have decreased lung cancer mortality, there remains a large at-risk population. Dismal long-term survival rates persist despite improvements in diagnosis, staging, and treatment. Early efforts to identify an effective screening test have been unsuccessful. Recent advances in multidetector computed tomography have allowed screening studies using low-dose computed tomography (LDCT) to be performed. This set the stage for the National Lung Screening Trial that found that annual LDCT screening benefits individuals at high risk for lung cancer. An understanding of the harmful effects of lung cancer screening is required to help maximize the benefits and decrease the risks of a lung cancer screening program. Although many questions remain regarding LDCT screening, a comprehensive lung cancer screening program of high-risk individuals will increase detection of preclinical and potentially curable disease, creating a new model of lung cancer surveillance and management.
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Affiliation(s)
- Antonio Gutierrez
- Department of Radiological Sciences, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA Medical Center, Los Angeles, California
| | - Robert Suh
- Department of Radiological Sciences, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA Medical Center, Los Angeles, California
| | - Fereidoun Abtin
- Department of Radiological Sciences, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA Medical Center, Los Angeles, California
| | - Scott Genshaft
- Department of Radiological Sciences, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA Medical Center, Los Angeles, California
| | - Kathleen Brown
- Department of Radiological Sciences, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA Medical Center, Los Angeles, California
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Richards TB, White MC, Caraballo RS. Lung cancer screening with low-dose computed tomography for primary care providers. Prim Care 2014; 41:307-30. [PMID: 24830610 DOI: 10.1016/j.pop.2014.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This review provides an update on lung cancer screening with low-dose computed tomography (LDCT) and its implications for primary care providers. One of the unique features of lung cancer screening is the potential complexity in patient management if an LDCT scan reveals a small pulmonary nodule. Additional tests, consultation with multiple specialists, and follow-up evaluations may be needed to evaluate whether lung cancer is present. Primary care providers should know the resources available in their communities for lung cancer screening with LDCT and smoking cessation, and the key points to be addressed in informed and shared decision-making discussions with patients.
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Affiliation(s)
- Thomas B Richards
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Building 107, F-76, 4770 Buford Highway Northeast, Atlanta, GA 30341-3717, USA.
| | - Mary C White
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Building 107, F-76, 4770 Buford Highway Northeast, Atlanta, GA 30341-3717, USA
| | - Ralph S Caraballo
- Office of Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Building 107, F-79, 4770 Buford Highway Northeast, Atlanta, GA 30341-3717, USA
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Carrozzi L, Falcone F, Carreras G, Pistelli F, Gorini G, Martini A, Viegi G. Life gain in Italian smokers who quit. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:2395-406. [PMID: 24577282 PMCID: PMC3986982 DOI: 10.3390/ijerph110302395] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 02/13/2014] [Accepted: 02/13/2014] [Indexed: 12/03/2022]
Abstract
This study aims to estimate the number of life years gained with quitting smoking in Italian smokers of both sexes, by number of cigarettes smoked per day (cig/day) and age at cessation. All-cause mortality tables by age, sex and smoking status were computed, based on Italian smoking data, and the survival curves of former and current smokers were compared. The more cig/day a man/woman smokes, and the younger his/her age of quitting smoking, the more years of life he/she gains with cessation. In fact, cessation at age 30, 40, 50, or 60 years gained, respectively, about 7, 7, 6, or 5, and 5, 5, 4, or 3 years of life, respectively, for men and women that smoked 10–19 cig/day. The gain in life years was higher for heavy smokers (9 years for >20 cig/day) and lower for light smokers (4 years for 1–9 cig/day). Consistently with prospective studies conducted worldwide, quitting smoking increases life expectancy regardless of age, gender and number of cig/day. The estimates of the number of years of life that could be gained by quitting smoking, when computed specifically for a single smoker, could be used by physicians and health professionals to promote a quit attempt.
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Affiliation(s)
- Laura Carrozzi
- Pulmonary Unit, CardioThoracic and Vascular Department, University Hospital of Pisa, via Paradisa 2, Cisanello, Pisa 56124, Italy.
| | - Franco Falcone
- Italian Association of Hospital Pulmonologists (AIPO) Research,Via Antonio Da Recanate, 2, Milan 20124, Italy.
| | - Giulia Carreras
- Unit of Environmental and Occupational Epidemiology, Cancer Prevention and Research Institute (ISPO), via delle Oblate 2, Florence 50139, Italy.
| | - Francesco Pistelli
- Pulmonary Unit, CardioThoracic and Vascular Department, University Hospital of Pisa, via Paradisa 2, Cisanello, Pisa 56124, Italy.
| | - Giuseppe Gorini
- Unit of Environmental and Occupational Epidemiology, Cancer Prevention and Research Institute (ISPO), via delle Oblate 2, Florence 50139, Italy.
| | - Andrea Martini
- Unit of Environmental and Occupational Epidemiology, Cancer Prevention and Research Institute (ISPO), via delle Oblate 2, Florence 50139, Italy.
| | - Giovanni Viegi
- Unit of Pulmonary Environmental Epidemiology, Institute of Clinical Physiology, Italian National Research Council (IFC-CNR), via Trieste 41, Pisa 56126, Italy.
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Barnett PG, Wong W, Jeffers A, Munoz R, Humfleet G, Hall S. Cost-effectiveness of extended cessation treatment for older smokers. Addiction 2014; 109:314-22. [PMID: 24329972 PMCID: PMC4020783 DOI: 10.1111/add.12404] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 12/21/2012] [Accepted: 10/24/2013] [Indexed: 11/30/2022]
Abstract
AIMS We examined the cost-effectiveness of extended smoking cessation treatment in older smokers. DESIGN Participants who completed a 12-week smoking cessation program were factorial randomized to extended cognitive behavioral treatment and extended nicotine replacement therapy. SETTING A free-standing smoking cessation clinic. PARTICIPANTS A total of 402 smokers aged 50 years and older were recruited from the community. MEASUREMENTS The trial measured biochemically verified abstinence from cigarettes after 2 years and the quantity of smoking cessation services utilized. Trial findings were combined with literature on changes in smoking status and the age- and gender-adjusted effect of smoking on health-care cost, mortality and quality of life over the long term in a Markov model of cost-effectiveness over a lifetime horizon. FINDINGS The addition of extended cognitive behavioral therapy added $83 in smoking cessation services cost [P = 0.012, confidence interval (CI) = $22-212]. At the end of follow-up, cigarette abstinence rates were 50.0% with extended cognitive behavioral therapy and 37.2% without this therapy (P < 0.05, odds ratio 1.69, CI 1.18-2.54). The model-based incremental cost-effectiveness ratio was $6324 per quality-adjusted life year (QALY). Probabilistic sensitivity analysis found that the additional $947 in lifetime cost of the intervention had a 95% confidence interval of -$331 to 2081; the 0.15 additional QALYs had a confidence interval of 0.035-0.280, and that the intervention was cost-effective against a $50 000/QALY acceptance criterion in 99.6% of the replicates. Extended nicotine replacement therapy was not cost-effective. CONCLUSIONS Adding extended cognitive behavior therapy to standard cessation treatment was cost-effective. Further intensification of treatment may be warranted.
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Affiliation(s)
- Paul G. Barnett
- Department of Psychiatry, University of California, San Francisco
,Veterans Affairs Health Economics Resource Center and Stanford University
| | - Wynnie Wong
- Department of Psychiatry, University of California, San Francisco
| | - Abra Jeffers
- Veterans Affairs Health Economics Resource Center and Stanford University
| | - Ricardo Munoz
- Department of Psychiatry, University of California, San Francisco
,Palo Alto University
| | - Gary Humfleet
- Department of Psychiatry, University of California, San Francisco
| | - Sharon Hall
- Department of Psychiatry, University of California, San Francisco
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Ozanne EM, Howe R, Omer Z, Esserman LJ. Development of a personalized decision aid for breast cancer risk reduction and management. BMC Med Inform Decis Mak 2014; 14:4. [PMID: 24422989 PMCID: PMC3899602 DOI: 10.1186/1472-6947-14-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 01/02/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Breast cancer risk reduction has the potential to decrease the incidence of the disease, yet remains underused. We report on the development a web-based tool that provides automated risk assessment and personalized decision support designed for collaborative use between patients and clinicians. METHODS Under Institutional Review Board approval, we evaluated the decision tool through a patient focus group, usability testing, and provider interviews (including breast specialists, primary care physicians, genetic counselors). This included demonstrations and data collection at two scientific conferences (2009 International Shared Decision Making Conference, 2009 San Antonio Breast Cancer Symposium). RESULTS Overall, the evaluations were favorable. The patient focus group evaluations and usability testing (N = 34) provided qualitative feedback about format and design; 88% of these participants found the tool useful and 94% found it easy to use. 91% of the providers (N = 23) indicated that they would use the tool in their clinical setting. CONCLUSION BreastHealthDecisions.org represents a new approach to breast cancer prevention care and a framework for high quality preventive healthcare. The ability to integrate risk assessment and decision support in real time will allow for informed, value-driven, and patient-centered breast cancer prevention decisions. The tool is being further evaluated in the clinical setting.
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Affiliation(s)
- Elissa M Ozanne
- Department of Surgery, Institute for Health Policy Studies, University of California at San Francisco, San Francisco, CA, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, 35 Centerra Parkway, Lebanon, NH 03766, USA
| | - Rebecca Howe
- Department of Surgery, University of California at San Francisco, San Francisco, CA, USA
| | - Zehra Omer
- University of Massachusetts, Worcester, USA
| | - Laura J Esserman
- Department of Surgery, University of California at San Francisco, San Francisco, CA, USA
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