Smoking Behavior Changes in the Early Rheumatoid Arthritis Period and Risk of Mortality During Thirty-Six Years of Prospective Followup

Jeffrey A. Sparks, Shun Chiao Chang, Uyen-sa Duc tran Nguyen, Medha Barbhaiya, Sara K. Tedeschi, Bing Lu, Karen H. Costenbader, Yuqing Zhang, Hyon K. Choi, Elizabeth W. Karlson

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective: To investigate whether rheumatoid arthritis (RA) diagnosis influences smoking behavior changes and whether these changes were associated with mortality. Methods: We identified an incident RA cohort in the Nurses' Health Study (NHS; 1976–2012). Behavioral data were collected through biennial questionnaires. We created a comparison cohort, matching RA cases to women without RA by age and calendar year at the index date of RA diagnosis. To investigate smoking behavior changes in the early RA period, sustained cessation was defined as permanently quitting within 4 years of the RA/index date. We used Cox regression to obtain hazard ratios (HRs) for mortality, comparing sustained smoking cessation to continued smoking. Results: Among 121,700 women in the NHS, we identified 938 with incident RA matched to 8,951 non-RA comparators. Among current smokers, 40.0% with RA permanently quit smoking in the early RA period, compared to 36.1% of comparators (odds ratio for sustained cessation 1.18 [95% confidence interval (95% CI) 0.88, 1.58]). There were 313 deaths (33.4%) in the RA cohort and 2,042 (22.8%) among comparators. Compared to continued smoking, sustained cessation was associated with similarly decreased mortality in both the RA (HR 0.58 [95% CI 0.33, 1.01]) and comparison (HR 0.47 [95% CI 0.39, 0.58]) cohorts. Women with RA had higher mortality for >5 post-RA pack-years (HR 3.67 [95% CI 2.80, 4.81]) than comparators with >5 post-index pack-years (HR 1.88 [95% CI 1.62, 2.17]; P < 0.001 for interaction; reference: ever-smoker non-RA women with 0 post-index pack-years). Conclusion: Sustained smoking cessation within 4 years of RA diagnosis reduced mortality risk, with a similar effect observed among non-RA comparators. Smoking >5 pack-years after RA diagnosis significantly increased mortality beyond the risk of non-RA comparators.

Original languageEnglish
Pages (from-to)19-29
Number of pages11
JournalArthritis Care and Research
Volume70
Issue number1
DOIs
StatePublished - 1 Jan 2018

Fingerprint

Rheumatoid Arthritis
Smoking
Mortality
Confidence Intervals
Smoking Cessation
Arthritis
Odds Ratio
Nurses

Cite this

Sparks, Jeffrey A. ; Chang, Shun Chiao ; Nguyen, Uyen-sa Duc tran ; Barbhaiya, Medha ; Tedeschi, Sara K. ; Lu, Bing ; Costenbader, Karen H. ; Zhang, Yuqing ; Choi, Hyon K. ; Karlson, Elizabeth W. / Smoking Behavior Changes in the Early Rheumatoid Arthritis Period and Risk of Mortality During Thirty-Six Years of Prospective Followup. In: Arthritis Care and Research. 2018 ; Vol. 70, No. 1. pp. 19-29.
@article{f8a764dbf5734cd3a80a10a841b54d9a,
title = "Smoking Behavior Changes in the Early Rheumatoid Arthritis Period and Risk of Mortality During Thirty-Six Years of Prospective Followup",
abstract = "Objective: To investigate whether rheumatoid arthritis (RA) diagnosis influences smoking behavior changes and whether these changes were associated with mortality. Methods: We identified an incident RA cohort in the Nurses' Health Study (NHS; 1976–2012). Behavioral data were collected through biennial questionnaires. We created a comparison cohort, matching RA cases to women without RA by age and calendar year at the index date of RA diagnosis. To investigate smoking behavior changes in the early RA period, sustained cessation was defined as permanently quitting within 4 years of the RA/index date. We used Cox regression to obtain hazard ratios (HRs) for mortality, comparing sustained smoking cessation to continued smoking. Results: Among 121,700 women in the NHS, we identified 938 with incident RA matched to 8,951 non-RA comparators. Among current smokers, 40.0{\%} with RA permanently quit smoking in the early RA period, compared to 36.1{\%} of comparators (odds ratio for sustained cessation 1.18 [95{\%} confidence interval (95{\%} CI) 0.88, 1.58]). There were 313 deaths (33.4{\%}) in the RA cohort and 2,042 (22.8{\%}) among comparators. Compared to continued smoking, sustained cessation was associated with similarly decreased mortality in both the RA (HR 0.58 [95{\%} CI 0.33, 1.01]) and comparison (HR 0.47 [95{\%} CI 0.39, 0.58]) cohorts. Women with RA had higher mortality for >5 post-RA pack-years (HR 3.67 [95{\%} CI 2.80, 4.81]) than comparators with >5 post-index pack-years (HR 1.88 [95{\%} CI 1.62, 2.17]; P < 0.001 for interaction; reference: ever-smoker non-RA women with 0 post-index pack-years). Conclusion: Sustained smoking cessation within 4 years of RA diagnosis reduced mortality risk, with a similar effect observed among non-RA comparators. Smoking >5 pack-years after RA diagnosis significantly increased mortality beyond the risk of non-RA comparators.",
author = "Sparks, {Jeffrey A.} and Chang, {Shun Chiao} and Nguyen, {Uyen-sa Duc tran} and Medha Barbhaiya and Tedeschi, {Sara K.} and Bing Lu and Costenbader, {Karen H.} and Yuqing Zhang and Choi, {Hyon K.} and Karlson, {Elizabeth W.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1002/acr.23269",
language = "English",
volume = "70",
pages = "19--29",
journal = "Arthritis Care and Research",
issn = "2151-464X",
publisher = "John Wiley and Sons Inc.",
number = "1",

}

Sparks, JA, Chang, SC, Nguyen, UDT, Barbhaiya, M, Tedeschi, SK, Lu, B, Costenbader, KH, Zhang, Y, Choi, HK & Karlson, EW 2018, 'Smoking Behavior Changes in the Early Rheumatoid Arthritis Period and Risk of Mortality During Thirty-Six Years of Prospective Followup', Arthritis Care and Research, vol. 70, no. 1, pp. 19-29. https://doi.org/10.1002/acr.23269

Smoking Behavior Changes in the Early Rheumatoid Arthritis Period and Risk of Mortality During Thirty-Six Years of Prospective Followup. / Sparks, Jeffrey A.; Chang, Shun Chiao; Nguyen, Uyen-sa Duc tran; Barbhaiya, Medha; Tedeschi, Sara K.; Lu, Bing; Costenbader, Karen H.; Zhang, Yuqing; Choi, Hyon K.; Karlson, Elizabeth W.

In: Arthritis Care and Research, Vol. 70, No. 1, 01.01.2018, p. 19-29.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Smoking Behavior Changes in the Early Rheumatoid Arthritis Period and Risk of Mortality During Thirty-Six Years of Prospective Followup

AU - Sparks, Jeffrey A.

AU - Chang, Shun Chiao

AU - Nguyen, Uyen-sa Duc tran

AU - Barbhaiya, Medha

AU - Tedeschi, Sara K.

AU - Lu, Bing

AU - Costenbader, Karen H.

AU - Zhang, Yuqing

AU - Choi, Hyon K.

AU - Karlson, Elizabeth W.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective: To investigate whether rheumatoid arthritis (RA) diagnosis influences smoking behavior changes and whether these changes were associated with mortality. Methods: We identified an incident RA cohort in the Nurses' Health Study (NHS; 1976–2012). Behavioral data were collected through biennial questionnaires. We created a comparison cohort, matching RA cases to women without RA by age and calendar year at the index date of RA diagnosis. To investigate smoking behavior changes in the early RA period, sustained cessation was defined as permanently quitting within 4 years of the RA/index date. We used Cox regression to obtain hazard ratios (HRs) for mortality, comparing sustained smoking cessation to continued smoking. Results: Among 121,700 women in the NHS, we identified 938 with incident RA matched to 8,951 non-RA comparators. Among current smokers, 40.0% with RA permanently quit smoking in the early RA period, compared to 36.1% of comparators (odds ratio for sustained cessation 1.18 [95% confidence interval (95% CI) 0.88, 1.58]). There were 313 deaths (33.4%) in the RA cohort and 2,042 (22.8%) among comparators. Compared to continued smoking, sustained cessation was associated with similarly decreased mortality in both the RA (HR 0.58 [95% CI 0.33, 1.01]) and comparison (HR 0.47 [95% CI 0.39, 0.58]) cohorts. Women with RA had higher mortality for >5 post-RA pack-years (HR 3.67 [95% CI 2.80, 4.81]) than comparators with >5 post-index pack-years (HR 1.88 [95% CI 1.62, 2.17]; P < 0.001 for interaction; reference: ever-smoker non-RA women with 0 post-index pack-years). Conclusion: Sustained smoking cessation within 4 years of RA diagnosis reduced mortality risk, with a similar effect observed among non-RA comparators. Smoking >5 pack-years after RA diagnosis significantly increased mortality beyond the risk of non-RA comparators.

AB - Objective: To investigate whether rheumatoid arthritis (RA) diagnosis influences smoking behavior changes and whether these changes were associated with mortality. Methods: We identified an incident RA cohort in the Nurses' Health Study (NHS; 1976–2012). Behavioral data were collected through biennial questionnaires. We created a comparison cohort, matching RA cases to women without RA by age and calendar year at the index date of RA diagnosis. To investigate smoking behavior changes in the early RA period, sustained cessation was defined as permanently quitting within 4 years of the RA/index date. We used Cox regression to obtain hazard ratios (HRs) for mortality, comparing sustained smoking cessation to continued smoking. Results: Among 121,700 women in the NHS, we identified 938 with incident RA matched to 8,951 non-RA comparators. Among current smokers, 40.0% with RA permanently quit smoking in the early RA period, compared to 36.1% of comparators (odds ratio for sustained cessation 1.18 [95% confidence interval (95% CI) 0.88, 1.58]). There were 313 deaths (33.4%) in the RA cohort and 2,042 (22.8%) among comparators. Compared to continued smoking, sustained cessation was associated with similarly decreased mortality in both the RA (HR 0.58 [95% CI 0.33, 1.01]) and comparison (HR 0.47 [95% CI 0.39, 0.58]) cohorts. Women with RA had higher mortality for >5 post-RA pack-years (HR 3.67 [95% CI 2.80, 4.81]) than comparators with >5 post-index pack-years (HR 1.88 [95% CI 1.62, 2.17]; P < 0.001 for interaction; reference: ever-smoker non-RA women with 0 post-index pack-years). Conclusion: Sustained smoking cessation within 4 years of RA diagnosis reduced mortality risk, with a similar effect observed among non-RA comparators. Smoking >5 pack-years after RA diagnosis significantly increased mortality beyond the risk of non-RA comparators.

UR - http://www.scopus.com/inward/record.url?scp=85031686537&partnerID=8YFLogxK

U2 - 10.1002/acr.23269

DO - 10.1002/acr.23269

M3 - Article

C2 - 28464477

AN - SCOPUS:85031686537

VL - 70

SP - 19

EP - 29

JO - Arthritis Care and Research

JF - Arthritis Care and Research

SN - 2151-464X

IS - 1

ER -