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 D.T.
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.
N1 - Funding Information:
The authors thank the participants of the NHS for their dedicated assistance in this longitudinal study, as well as the NHS staff members at the Channing Division of Network Medicine (Department of Medicine, Brigham and Women's Hospital and Harvard Medical School). We also thank all state cancer registries who participated in this study.
Funding Information:
Supported by the NIH (grants K24-AR-052403, P60-AR-047782, L30-AR-066953, L30-AR-070514, R01-AR-049880, UM1-CA-186107, K23-AR-069688, K01-AR-064351, and T32-AR-007530). Dr. Choi’s work was supported by a Rheumatology Research Foundation Disease-Targeted Innovative Award. Dr. Sparks’ and Dr. Barbhaiya’s work was supported by Scientist Development Awards.
Publisher Copyright:
© 2017, American College of Rheumatology
PY - 2018/1
Y1 - 2018/1
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
SN - 2151-464X
VL - 70
SP - 19
EP - 29
JO - Arthritis Care and Research
JF - Arthritis Care and Research
IS - 1
ER -