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Smoking and Cancer, Cardiovascular and Total Mortality Among Older Adults: the Inrf Isk Study Noel C

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Smoking and Cancer, Cardiovascular and Total Mortality Among Older Adults: the Inrf Isk Study Noel C Florida International University FIU Digital Commons HWCOM Faculty Publications Herbert Wertheim College of Medicine 4-24-2019 Smoking and cancer, cardiovascular and total mortality among older adults: The inrF isk Study Noel C. Barengo Herbert Wertheim College of Medicine, Florida International University, [email protected] Riitta Antikainen University of Oulu Kennet Harald National Institute for Health and Welfare (THL) Pekka Jousilahti National Institute for Health and Welfare (THL) This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License. Follow this and additional works at: https://digitalcommons.fiu.edu/com_facpub Part of the Medicine and Health Sciences Commons Recommended Citation Barengo, Noel C.; Antikainen, Riitta; Harald, Kennet; and Jousilahti, Pekka, "Smoking and cancer, cardiovascular and total mortality among older adults: The inrF isk Study" (2019). HWCOM Faculty Publications. 145. https://digitalcommons.fiu.edu/com_facpub/145 This work is brought to you for free and open access by the Herbert Wertheim College of Medicine at FIU Digital Commons. It has been accepted for inclusion in HWCOM Faculty Publications by an authorized administrator of FIU Digital Commons. For more information, please contact [email protected]. Preventive Medicine Reports 14 (2019) 100875 Contents lists available at ScienceDirect Preventive Medicine Reports journal homepage: www.elsevier.com/locate/pmedr Smoking and cancer, cardiovascular and total mortality among older adults: The Finrisk Study ⁎ Noël C. Barengoa,b, , Riitta Antikainenc,d,e, Kennet Haraldf, Pekka Jousilahtif a Department of Medical and Population Health Sciences Research, Herbert Wertheim College of Medicine, Florida International University, Miami 33199, USA b Department of Public Health, University of Helsinki, Helsinki, Finland c Center for Life Course Health Research/Geriatrics, Faculty of Medicine, University of Oulu, Oulu, Finland d Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland e Oulu City Hospital, Oulu, Finland f Public Health Solutions Department, National Institute for Health and Welfare (THL) ARTICLE INFO ABSTRACT Keywords: Little information is available about the deleterious effect of smoking in older adults The objective of this study Cessation was to assess the relationship of smoking habits with cancer, CVD and all-cause mortality in late middle-age Survival (45–64 years) and older (65–74) people. This cohort study of 6516 men and 6514 women studied the re- Elderly lationship of smoking habits with cancer, cardiovascular disease (CVD) and all-cause mortality among middle- Non-communicable diseases aged and older Finnish men and women during 1997–2013. The study cohort was followed up until the end of Hazard 2013 (median follow-up time was 11.8 years). Mortality data were obtained from the National Causes of Death Register and data on incident stroke events from the National Hospital Discharge Register. Adjusted Hazard ratios (HR) for total mortality were 2.61 (95% Confidence interval 2.15–3.18) among 45–64 years-old men and 2.59 (2.03–3.29) in 65–74 years-old men. The corresponding HRs for women 45–64 years-of-age were 3.21 (2.47–4.19) and 3.12 (2.09–4.68) for those 65–74 years-old, respectively. Adjusted HRs for CVD mortality in the 45–64 years-old and 65–74 years-old groups were 2.67 (1.92–2.67) and 1.95 (1.33–2.86) in men, and 4.28 (2.29–7.99) and 2.67 (1.28–5.58) in women, respectively. Among men, the risk difference between never and current smokers was 108/100.000 in the age-group 45–64 years, and 324/100.000 in the age group 65–74 years. Among women the differences were 52/100.000 and 196/100.000, respectively. In conclusion, absolute risk difference between never and current smokers are larger among the older age group. Smoking cessation counseling should routinely target also older adults in primary health-care. 1. Introduction advances, and cessation delays, the risk of all-cause, CVD and cancer death (Ordóñez-Mena et al., 2016; Mons et al., 2015; Müezzinler et al., Tobacco smoking causes many chronic diseases, such as many 2015). However, scientific evidence in regard the risk estimates of CVD, cancers, cardiovascular disease (CVD) and chronic obstructive pul- cancer and all-cause mortality between middle-aged and older adults in monary disease (COPD), and increases markedly all-cause mortality the same population cohort is scarce. (Mitchell et al., 2010; Doll et al., 2004). Even though the age-standar- As the number of older adults is globally increasing, it must be of dized smoking prevalence has decreased worldwide during the past great public health interest to get estimates of the association between three decades, the absolute number of smokers has increased with al- smoking, morbidity and mortality in the older adult population. most one billion daily smokers worldwide in 2012 (Ng et al., 2014). The objective of this study was to assess the relationship of smoking Even though a number of the studies have shown the deleterious habits with cancer, CVD and all-cause mortality and to compare whe- effect of smoking in the middle-aged population, less information is ther the smoking related health risk differs between late middle-age available in older adults (Kelly et al., 2008; Myint et al., 2008; Parish (45–64 years) and older (65–74) people. et al., 1995; Thun et al., 2013a; Gellert et al., 2012a). A recent meta- analysis revealed that smoking, even among older adults, considerably ⁎ Corresponding author at: Department of Medical and Population Health Sciences Research, Herbert Wertheim College of Medicine, Florida International University, Miami, USA. E-mail address: nbarengo@fiu.edu (N.C. Barengo). https://doi.org/10.1016/j.pmedr.2019.100875 Received 30 August 2018; Received in revised form 17 April 2019; Accepted 22 April 2019 Available online 24 April 2019 2211-3355/ © 2019 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/BY-NC-ND/4.0/). N.C. Barengo, et al. Preventive Medicine Reports 14 (2019) 100875 2. Methods systolic blood pressure, education and marital status. All analysis was done separately for men and women, and by age-group, 45–64 years 2.1. Study participants and 65–74 years. Smoking status was treated as ordinal variable in the model, and the statistical significance of the different smoking cate- The National FINRISK Study has been conducted every five years gories was tested in the same models, with the category never smoking since 1972 in order to monitor cardiovascular and other non-commu- as reference group. The proportional hazards assumption in the Cox nicable disease risk factors and other health related factors among the model was tested graphically using Kaplan-Meier curves. The p-value Finnish adult population (Borodulin et al., 2015). An independent for statistical significance was set as 0.05. Finally, the incidence rates random sample has been drawn from the national population register were calculated dividing the number of new cases by the follow-up time for each survey. The samples were stratified by sex and 10-year age of the people for each smoking category separately for sex and the two categories according to the World Health Organization Multinational age-groups. In addition, the corresponding 95% confidence intervals for Monitoring (WHO MONICA) of trends and determinants of CVD pro- each incidence rate was calculated. tocol (Vartiainen et al., 2010). The current study cohort consists of – participants who were aged 45 74 years sampled in 1997, 2002, and 2.5. Ethical issues 2007 in five study areas (provinces of North Karelia and North Savo in Eastern Finland, Turku-Loimaa area in Southwestern Finland, cities of The study was conducted according to the Helsinki Declaration of Helsinki and Vantaa in Southern Finland and Oulu province in Northern the World Medical Association. The study protocol was approved by the Finland). People who participated more than once in the surveys are ethics committee as defined by the Finnish law during each study year. fi included in their rst study cohort, and those with missing information All participants gave an informed consent. The study report is written on any of the variables needed for the analysis or those with an acute by following the STROBE guidelines for prospective cohort studies (Von CHD, stroke event prevalent heart failure or cancer before the baseline Elm et al., 2007). survey, were excluded from the analysis. The final sample size of the follow-up cohort consisted of 6516 men and 6514 women. 3. Results 2.2. Baseline assessment of cardiovascular risk factors Table 1 shows the characteristics of the study population according to sex and age-group at baseline. The prevalence of current smoking A self-administered questionnaire was mailed to the participants in was 30% in men 45–64 years-of-age and 15% in men 65–74 years-of- advance. The questionnaire included standardized questions on health age. The corresponding prevalence in women were as 18% and 7%, behavior, including smoking habits, and other health related and so- respectively. ciodemographic factors. Smoking habits were classified to three cate- Multifactorial adjusted (age, area, study year, BMI, systolic blood gories: never smokers, ex-smokers (stopped more than six months ago) pressure, serum cholesterol, education and marital status) hazard ratios and current smokers (currently smoking or stopped smoking within the (HR) for current smoking, compared to never smoking were 2.61 (95% last 6 months). Education level, measured as the total number of school CI 2.15–3.18) among 45–64 years-old men and 2.59 (95% CI years, was divided into birth cohort-specific thirds. Marital status was 2.03–3.29) in 65–74 years-old men (Table 2).
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