scholarly journals An Update on Hardening: A Qualitative Review

2019 ◽  
Vol 22 (6) ◽  
pp. 867-871 ◽  
Author(s):  
John R Hughes
Keyword(s):  
General Population ◽  
Low Income ◽  
Population Based ◽  
Medical Problems ◽  
Women Smokers ◽  
Quit Attempt ◽  
Quit Attempts ◽  
Low Education ◽  
Data Points ◽  
Over Time

Abstract Introduction This review examines the evidence for the hardening hypothesis; that is, the prevalence of (1) becoming a former smoker is decreasing over time due to (2) decreased quit attempts, or (3) decreased success on a given quit attempt. Methods PubMed, EMBASE, PsychINFO, trial registries, and other databases were searched for population-based surveys that reported whether one of the aforementioned three outcomes decreased over time. Results None of the 26 studies found that conversion from current to former smoking, number of quit attempts, or success on a given quit attempt decreased over time and several found these increased over time. These results appeared to be similar across survey dates, duration of time examined, number of data points, data source, outcome definitions, and nationality. Conclusions These results convincingly indicate hardening is not occurring in the general population of smokers. On the other hand, the prevalence of smoking is declining less among older and women smokers, and smokers with low education, low income, psychological problems, alcohol or drug abuse, medical problems, and greater nicotine dependence, than among those without these characteristics, presumably due to less quitting. Why this has not lead to decreased success in stopping smoking in the general population is unclear. Implications Some have argued that a greater emphasis on harm reduction and more intensive or dependence-based treatments are needed because remaining smokers are those who are less likely to stop with current methods. This review finds no or little evidence for this assumption. Psychosocial factors, such as low education and psychiatric problems, predict less ability to quit and appear to becoming more prevalent among smokers. Why this is not leading to decreased quitting in the general population is an anomaly that may be worth trying to understand.

scholarly journals Association between socioeconomic status and self-reported, tested and diagnosed COVID-19 status during the first wave in the Northern Netherlands: a general population-based cohort from 49 474 adults

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e048020
Author(s):  
Yinjie Zhu ◽  
Ming-Jie Duan ◽  
Hermien H. Dijk ◽  
Roel D. Freriks ◽  
Louise H. Dekker ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
General Population ◽  
Low Income ◽  
Smoking Status ◽  
Sleep Time ◽  
Population Based ◽  
Lifestyle Factors ◽  
Self Report ◽  
Low Education ◽  
Tv Watching

ObjectivesStudies in clinical settings showed a potential relationship between socioeconomic status (SES) and lifestyle factors with COVID-19, but it is still unknown whether this holds in the general population. In this study, we investigated the associations of SES with self-reported, tested and diagnosed COVID-19 status in the general population.Design, setting, participants and outcome measuresParticipants were 49 474 men and women (46±12 years) residing in the Northern Netherlands from the Lifelines cohort study. SES indicators and lifestyle factors (i.e., smoking status, physical activity, alcohol intake, diet quality, sleep time and TV watching time) were assessed by questionnaire from the Lifelines Biobank. Self-reported, tested and diagnosed COVID-19 status was obtained from the Lifelines COVID-19 questionnaire.ResultsThere were 4711 participants who self-reported having had a COVID-19 infection, 2883 participants tested for COVID-19, and 123 positive cases were diagnosed in this study population. After adjustment for age, sex, lifestyle factors, body mass index and ethnicity, we found that participants with low education or low income were less likely to self-report a COVID-19 infection (OR [95% CI]: low education 0.78 [0.71 to 0.86]; low income 0.86 [0.79 to 0.93]) and be tested for COVID-19 (OR [95% CI]: low education 0.58 [0.52 to 0.66]; low income 0.86 [0.78 to 0.95]) compared with high education or high income groups, respectively.ConclusionOur findings suggest that the low SES group was the most vulnerable population to self-reported and tested COVID-19 status in the general population.

scholarly journals Patterns of Survival Among Patients With Myeloproliferative Neoplasms Diagnosed in Sweden From 1973 to 2008: A Population-Based Study

2012 ◽  
Vol 30 (24) ◽  
pp. 2995-3001 ◽  
Author(s):  
Malin Hultcrantz ◽  
Sigurdur Yngvi Kristinsson ◽  
Therese M.-L. Andersson ◽  
Ola Landgren ◽  
Sandra Eloranta ◽  
...  
Keyword(s):  
General Population ◽  
Life Expectancy ◽  
Excess Mortality ◽  
Myeloproliferative Neoplasms ◽  
Treatment Options ◽  
Large Population ◽  
Relative Survival ◽  
Population Based ◽  
Population Based Study ◽  
Over Time

PurposeReported survival in patients with myeloproliferative neoplasms (MPNs) shows great variation. Patients with primary myelofibrosis (PMF) have substantially reduced life expectancy, whereas patients with polycythemia vera (PV) and essential thrombocythemia (ET) have moderately reduced survival in most, but not all, studies. We conducted a large population-based study to establish patterns of survival in more than 9,000 patients with MPNs.Patients and MethodsWe identified 9,384 patients with MPNs (from the Swedish Cancer Register) diagnosed from 1973 to 2008 (divided into four calendar periods) with follow-up to 2009. Relative survival ratios (RSRs) and excess mortality rate ratios were computed as measures of survival.ResultsPatient survival was considerably lower in all MPN subtypes compared with expected survival in the general population, reflected in 10-year RSRs of 0.64 (95% CI, 0.62 to 0.67) in patients with PV, 0.68 (95% CI, 0.64 to 0.71) in those with ET, and 0.21 (95% CI, 0.18 to 0.25) in those with PMF. Excess mortality was observed in patients with any MPN subtype during all four calendar periods (P < .001). Survival improved significantly over time (P < .001); however, the improvement was less pronounced after the year 2000 and was confined to patients with PV and ET.ConclusionWe found patients with any MPN subtype to have significantly reduced life expectancy compared with the general population. The improvement over time is most likely explained by better overall clinical management of patients with MPN. The decreased life expectancy even in the most recent calendar period emphasizes the need for new treatment options for these patients.

scholarly journals History and Correlates of Smoking Cessation Behaviors Among Smokers With Serious Mental Illness

2019 ◽  
Vol 22 (9) ◽  
pp. 1492-1499 ◽  
Author(s):  
Su Fen Lubitz ◽  
Alex Flitter ◽  
E Paul Wileyto ◽  
Douglas Ziedonis ◽  
Nathaniel Stevens ◽  
...  
Keyword(s):  
Mental Illness ◽  
Carbon Monoxide ◽  
Smoking Cessation ◽  
General Population ◽  
Serious Mental Illness ◽  
Smoking Cessation Counseling ◽  
Smoking Cessation Advice ◽  
Smoking Cessation Treatment ◽  
Quit Attempt ◽  
Quit Attempts

Abstract Introduction Individuals with serious mental illness (SMI) smoke at rates two to three times greater than the general population but are less likely to receive treatment. Increasing our understanding of correlates of smoking cessation behaviors in this group can guide intervention development. Aims and Methods Baseline data from an ongoing trial involving smokers with SMI (N = 482) were used to describe smoking cessation behaviors (ie, quit attempts, quit motivation, and smoking cessation treatment) and correlates of these behaviors (ie, demographics, attitudinal and systems-related variables). Results Forty-three percent of the sample did not report making a quit attempt in the last year, but 44% reported making one to six quit attempts; 43% and 20%, respectively, reported wanting to quit within the next 6 months or the next 30 days. Sixty-one percent used a smoking cessation medication during their quit attempt, while 13% utilized counseling. More quit attempts were associated with lower nicotine dependence and carbon monoxide and greater beliefs about the harms of smoking. Greater quit motivation was associated with lower carbon monoxide, minority race, benefits of cessation counseling, and importance of counseling within the clinic. A greater likelihood of using smoking cessation medications was associated with being female, smoking more cigarettes, and receiving smoking cessation advice. A greater likelihood of using smoking cessation counseling was associated with being male, greater academic achievement, and receiving smoking cessation advice. Conclusions Many smokers with SMI are engaged in efforts to quit smoking. Measures of smoking cessation behavior are associated with tobacco use indicators, beliefs about smoking, race and gender, and receiving cessation advice. Implications Consideration of factors related to cessation behaviors among smokers with SMI continues to be warranted, due to their high smoking rates compared to the general population. Increasing our understanding of these predictive characteristics can help promote higher engagement in evidence-based smoking cessation treatments among this subpopulation.

scholarly journals A Pilot Randomized Clinical Trial of Brief Interventions to Encourage Quit Attempts in Smokers From Socioeconomic Disadvantage

2020 ◽  
Vol 22 (9) ◽  
pp. 1500-1508 ◽  
Author(s):  
Marc L Steinberg ◽  
Rachel L Rosen ◽  
Mark V Versella ◽  
Allison Borges ◽  
Teresa M Leyro
Keyword(s):  
Motivational Interviewing ◽  
Low Socioeconomic Status ◽  
Low Income ◽  
Local Community ◽  
Socioeconomic Disadvantage ◽  
Brief Interventions ◽  
Financial Strain ◽  
Quit Attempt ◽  
Quit Attempts

Abstract Introduction Cigarette smoking disproportionately affects communities of low socioeconomic status where greater smoking prevalence and poorer cessation rates have been observed. Utilizing brief evidence-based interventions to increase cessation attempts may be an effective and easily disseminable means by which to mitigate undue burden in this population. Aims and Methods The current intervention randomized daily smokers (N = 57) recruited from a local community soup kitchen to receive either Brief (eg, 30 m) Motivational Interviewing, Nicotine Replacement Therapy (NRT) sampling, or a Referral-Only intervention. Approximately half of participants (50.9%) reported not completing high school and many reported either just (41.4%) or not (40.4%) meeting basic expenses. Follow-up was completed approximately 1-month postintervention. Results Nonsignificant group differences indicated that participants randomized to the NRT sampling condition were more likely to make a quit attempt (moderate effect size). Approximately 40% of the sample reported making a serious quit attempt at follow-up. Significant differences in cigarettes per day at follow-up, controlling for baseline, were observed, with participants in the Motivational Interviewing condition, only, reporting significant reductions. Participants randomized to the NRT condition were significantly more likely to report using NRT patch and lozenge at follow-up (large effect). There were no differences between groups with respect to seeking behavioral support. Finally, we found that subjective financial strain moderated the effect of condition on change in cigarette consumption where NRT sampling was more effective for participants reporting less financial strain. Conclusions Findings provide initial evidence for personalizing brief interventions to promote quit attempts in low-income smokers. Implications While most clinical research on tobacco use and dependence focuses on successful sustained abstinence, the current study is novel because it examined three brief interventions designed to increase the number of quit attempts made by a nontreatment-seeking group suffering from health disparities (ie, smokers from socioeconomic disadvantage). These data suggest that nontreatment-seeking smokers from socioeconomic disadvantage can be influenced by Brief MIs and these interventions should be used to motivate smokers from socioeconomic disadvantage to make a quit attempt. Future studies should examine combined MIs including pharmacological and behavioral interventions.

Patterns of Survival and Causes of Death In 9,384 Patients with Myeloproliferative Neoplasms Diagnosed In Sweden Between 1973 and 2008

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3071-3071
Author(s):  
Malin Hultcrantz ◽  
Sigurdur Y. Kristinsson ◽  
Therese M-L Andersson ◽  
Sandra Eloranta ◽  
Åsa Rangert Derolf ◽  
...  
Keyword(s):  
General Population ◽  
Cardiac Disease ◽  
Causes Of Death ◽  
Myeloproliferative Neoplasms ◽  
Relative Survival ◽  
Relative Number ◽  
Population Based ◽  
Calendar Period ◽  
Population Based Study ◽  
Over Time

Abstract Abstract 3071 Background: Available data on survival patterns among patients diagnosed with myeloproliferative neoplasms (MPN) show a great diversity. For instance, in essential thrombocythemia (ET) there are reports stating that survival is not affected by the disease while other investigators consider ET to be a serious disease that significantly reduces life expectancy. Patients with primary myelofibrosis (PMF) are consistently reported to have a shortened life span while polycythemia vera (PV) is associated with a reduced survival in many, but not all, studies. We conducted a comprehensive, population-based study to assess survival and to define causes of death MPN patients, and to compare patterns to the general population. Patients and Methods: The nationwide Swedish Cancer Registry was used to identify all cases of MPN between 1973 and 2008 with follow-up to 2009. Relative survival ratios (RSRs) and excess mortality rate ratios (EMRRs) were computed as measures of survival. The Cause of Death Registry was used to obtain information on causes of death both in the patient and the general population. Results: A total of 9,384 MPN patients were identified (PV n=4,389, ET n=2,559, PMF n=1,048 and MPN not otherwise specified (MPN NOS) n=1,288); 47% were males and the median age at diagnosis was 71. The reporting rate to the Cancer Registry increased over time being well above 95% during the most recent calendar period. There was a significant overall excess mortality in all subtypes of MPN, reflected in 5-year and 10-year RSRs of 0.83 (95% CI 0.81–0.84) and 0.64 (0.62-0.67) for PV, 0.80 (0.78-0.82) and 0.68 (0.64-0.71) for ET and 0.39 (0.35-0.43) and 0.21 (0.18-0.25) for PMF, respectively. Higher age at MPN diagnosis was associated with a poorer survival. For example, the 10-year RSR for patients <50 years was 0.86 (0.83-0.88) as compared to 0.35 (0.29-0.43; p<0.001) in those >80 years. Females had a superior survival, EMRR 0.72 (0.66-0.78), compared to males (reference 1.00). Survival of patients with MPN improved significantly over time with an EMRR of 0.60 (0.53-0.67) in 1983–1992, 0.29 (0.25-0.34) in 1993–2000 and 0.23 (0.19-0.27) 2001–2008 using the calendar period 1973–1982 as a reference (1.00). However, MPN patients of all subtypes including PV and ET had an inferior survival compared to the general population during all calendar periods indicating that these patients continue to experience higher mortality. The 10-year RSRs for patients diagnosed 1993–2008 were 0.72 (0.67-0.76) for PV and 0.83 (0.79-0.88) for ET (Figure). The most common causes of death in MPN patients were, in order, hematological malignancy 27.2%, cardiac disease 27.1%, solid tumors 12.4% and vascular events including thromboembolism and bleeding, 9.2%. Four per cent of patients in this cohort were reported to have died due to acute myeloid leukemia. Over time, the proportion of deaths due to cardiac disease and thromboembolic events has decreased. On the other hand, we observed an increasing relative number of deaths due to hematological malignancies during the more recent calendar periods. The relative risks of dying from these causes in relation to the general population will be presented. Summary/conclusion: In this large population based study including over 9,000 MPN patients, we found all MPN subtypes to have a significantly lower life expectancy compared to the general population. Survival improved over time, however patients of all subtypes including ET had an inferior relative survival even in the most recent calendar period. Especially during earlier years, a certain misclassification and under reporting of ET may have contributed to a reduction in survival rates in the ET group. The relative number of deaths due to cardiac disease and thromboembolic events decreased during more recent calendar periods. This, and the improvement in survival might reflect the introduction of better treatment strategies for both the disease itself and for the prevention and treatment of thromboembolic complications of MPNs. Disclosures: No relevant conflicts of interest to declare.

scholarly journals SAT0252 INCREASED MORTALITY FOR INDIVIDUALS WITH GIANT CELL ARTERITIS: A POPULATION-BASED STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1069.1-1069
Author(s):  
L. Barra ◽  
J. Pope ◽  
P. Pequeno ◽  
J. Gatley ◽  
J. Widdifield
Keyword(s):  
General Population ◽  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Age Groups ◽  
Mortality Rates ◽  
Population Based ◽  
Population Based Study ◽  
Risk Of Mortality ◽  
Younger Age ◽  
Over Time

Background:Individuals with giant cell arteritis (GCA) are at increased risk of serious morbidity including cardiovascular disease and stroke. Yet the risk of mortality among individuals with GCA have produced conflicting reports1.Objectives:Our aim was to evaluate excess all-cause mortality among individuals with GCA relative to the general population over time.Methods:We performed a population-based study in Ontario, Canada, using health administrative data among all individuals 50 years and older. Individuals with GCA were identified using a validated case definition (81% PPV, 100% specificity). All Ontario residents aged 50 and above who do not have GCA served as the General Population comparators. Deaths occurring in each cohort each year were ascertained from vital statistics. Annual crude and age/sex standardized all-cause mortality rates were determined for individuals with and without GCA between 2000 and 2018. Standardized mortality ratios (SMRs) were calculated to measure relative excess mortality over time. Differences in mortality between sexes and ages were also evaluated.Results:Population denominators among individuals 50 years and older with GCA and the General Population increased over time with 12,792 GCA patients and 5,456,966 comparators by 2018. Annual standardized mortality rates among the comparators steadily declined over time and were significantly lower than GCA morality rates (Figure). Annual GCA mortality rates fluctuated between 42-61 deaths per 1000 population (with overlapping confidence intervals) during the same time period. SMRs for GCA ranged from 1.28 (95% CI 1.08,1.47) at the lowest in 2002 to 1.96 (95% CI 1.84, 2.07) at the highest in 2018. GCA mortality rates and SMRs were highest among males and younger age groups.Conclusion:Over a 19-year period, mortality has remained increased among GCA patients relative to the general population. GCA mortality rates were higher among males and more premature deaths were occurring at younger age groups. In our study, improvements to the relative excess mortality for GCA patients over time (mortality gap) did not occur. Understanding cause-specific mortality and other factors are necessary to inform contributors to premature mortality among GCA patients.References:[1]Hill CL, et al. Risk of mortality in patients with giant cell arteritis: a systematic review and meta-analysis. Semin Arthritis Rheum. 2017;46(4):513-9.Figure.Acknowledgments: :This study was supported by a CIORA grantDisclosure of Interests:Lillian Barra: None declared, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB, Priscila Pequeno: None declared, Jodi Gatley: None declared, Jessica Widdifield: None declared

Ten-year risk of cerebrovascular accidents in incident rheumatoid arthritis: a population-based study of trends over time

Rheumatology ◽  
2020 ◽  
Author(s):  
Kiana Yazdani ◽  
Hui Xie ◽  
J Antonio Avina-Zubieta ◽  
Yufei Zheng ◽  
Michal Abrahamowicz ◽  
...  
Keyword(s):  
General Population ◽  
Cox Model ◽  
Population Based ◽  
Case Definition ◽  
P Value ◽  
Linear Quadratic ◽  
Cox Models ◽  
Cerebrovascular Accidents ◽  
Interaction Term ◽  
Over Time

Abstract Objective To evaluate secular trends in 10-year risk of incident cerebrovascular accidents (CVA), in incident RA relative to the general population. Methods We conducted a retrospective study of a population-based incident cohort with RA onset from 1997 to 2004 in British Columbia, Canada, with matched general population controls (2:1), using administrative health data. RA and general population cohorts were divided according to year of RA onset, defined according to the first RA visit of the case definition. Incident CVA was defined as the first CVA occurring within 10 years from the first RA visit. Secular trend was assessed using delayed-entry Cox models with a two-way interaction term between the year of RA onset and indicator of RA vs general population. Linear, quadratic and spline functions of year of RA onset were compared with assess non-linear effects. The model with the lowest Akaike Information Criterion was selected. Results Overall, 23 545 RA and 47 090 general population experienced 658 and 1220 incident CVAs, respectively. A spline Cox model with a knot at year of onset 1999 was selected. A significant decline in risk of CVA was observed in individuals with RA onset after 1999 [0.90 (0.86, 0.95); P = 0.0001]. The change in CVA risk over time differed significantly in RA with onset from 1999 onwards compared with the general population (P-value of interaction term = 0.03), but not before 1999 (P = 0.06). Conclusion Our findings suggest that people with RA onset from 1999 onwards, had a significantly greater decline in 10-year risk of CVA compared with the general population.

scholarly journals P767 Prevalence and incidence rates of inflammatory bowel disease among First Nations: Population-based evidence from Saskatchewan, Canada

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S608-S609
Author(s):  
J N Peña-Sánchez ◽  
D Jennings ◽  
J A Osei ◽  
M Andkhoie ◽  
C Brass ◽  
...  
Keyword(s):  
Health Care ◽  
Inflammatory Bowel Disease ◽  
General Population ◽  
First Nations ◽  
Negative Binomial ◽  
Population Based ◽  
Incidence Rates ◽  
Annual Prevalence ◽  
Inflammatory Bowel ◽  
Over Time

Abstract Background Worldwide, the epidemiology of inflammatory bowel disease (IBD) has been widely studied in the general population; however, there is limited-to-no evidence about IBD among Indigenous peoples, specifically among First Nations (FNs). Saskatchewan (SK) is a province in western Canada with a population of 1.1 million, 11% of whom are FNs. We aimed to estimate the prevalence, incidence, and trends of IBD among FNs in SK since 1999. Methods As part of a patient-oriented research project, we conducted a retrospective population-based study between 1999 and 2016 fiscal years using administrative data for the province of SK. A previously validated algorithm that required multiple health care contacts was applied to identify IBD cases (Crohn’s disease [CD] and ulcerative colitis [UC]). The ‘self-declared FN status’ variable in the Person Health Registration System was used to determine FNs meeting the IBD case definition and the population at risk. Generalised linear models (GLMs) with generalised estimated equations and a negative binomial distribution were used to estimate the annual prevalence of IBD, CD, and UC. Incidence rates and their corresponding 95% confidence intervals (95%CI) were estimated using GLMs with a negative binomial distribution. The GLMs were used to test trends overtime. Results The annual prevalence of IBD among FNs in SK increased from 64 (95%CI 62–66) per 100,000 people in 1999 to 142 (95%CI 140–144) per 100,000 population in 2016. Also, the prevalence of CD and UC increased during the study period, with 53/100,000 (95%CI 52–55) for CD and 87/100,000 (95%CI 86–89) for UC in 2016. The average increase in the prevalence of IBD was 4.2% (95%CI 3.2–5.2) per year, with similar trends observed in CD (4.1% [95%CI 3.3–4.9]) and UC (3.4% [95%CI 2.3–4.6]). The incidence rates of IBD among FNs were 11 (95%CI 5–25) per 100,000 people in 1999 and 3 (95%CI 1–11) per 100,000 population in 2016. No statistically significant changes were observed in the incidence rates over time (p = 0.09). Conclusion This study is the first epidemiological work providing detailed evidence of IBD among FNs. We identified that FNs have increasing trends in the prevalence of IBD, which has also been described in the Canadian general population. In contrast to the general population of Canada and other developed countries that have shown decreasing trends, the incidence rates of IBD among FNs appear to be stable over time. Also, among FNs, UC appears to be more prevalent than CD; this pattern has been observed in the general populations of developing countries. These results illuminate the need to advocate for better health care and wellness for FNs living with IBD.

Tobacco retail availability and risk of relapse among smokers who make a quit attempt: a population-based cohort study

2017 ◽  
Vol 27 (2) ◽  
pp. 163-169 ◽  
Author(s):  
Michael O Chaiton ◽  
Graham Mecredy ◽  
Joanna Cohen
Keyword(s):  
Population Based ◽  
Smoking Behaviour ◽  
Individual Characteristics ◽  
Walking Distance ◽  
Distance Threshold ◽  
Location Data ◽  
Quit Attempt ◽  
Increased Risk ◽  
Quit Attempts ◽  
Risk Of Relapse

IntroductionThe availability of tobacco is thought to influence smoking behaviour, but there are few longitudinal studies examining if the location and number of tobacco outlets has a prospective impact on smoking cessation.MethodsThe Ontario Tobacco Survey, a population-representative sample of Ontario adult smokers who were followed every 6 months for up to 3 years, was linked with tobacco outlet location data from the Ontario Ministry of Health. Proximity (distance), threshold (at least one outlet within 500 m) and density (number of outlets within 500 m) with respect to a smokers’ home were calculated among urban and suburban current smokers (n=2414). Quit attempts and risk of relapse were assessed using logistic regression and survival analysis, adjusted for neighbourhood effects and individual characteristics.ResultsIncreased density of tobacco outlets was associated with decreased odds of making a quit attempt (OR: 0.54; 95% CI 0.35 to 0.85) in high-income neighbourhoods, but not in lower income ones. There was an increased risk of relapse among those who had at least one store within 500 m (HR: 1.41 (95% CI 1.06 to 1.88). Otherwise, there was no association of proximity with quit attempts or relapse.ConclusionsThe existence of a tobacco retail outlet within walking distance from home was associated with difficulty in succeeding in a quit attempt, while the increased density of stores was associated with decreased attempts in higher income neighbourhoods. The availability of tobacco may influence tobacco use through multiple mechanisms.

scholarly journals Improvement in 5-year mortality in incident rheumatoid arthritis compared with the general population—closing the mortality gap

2016 ◽  
Vol 76 (6) ◽  
pp. 1057-1063 ◽  
Author(s):  
Diane Lacaille ◽  
J Antonio Avina-Zubieta ◽  
Eric C Sayre ◽  
Michal Abrahamowicz
Keyword(s):  
Rheumatoid Arthritis ◽  
General Population ◽  
Population Based ◽  
Vital Statistics ◽  
Mortality Trends ◽  
Physician Visits ◽  
Rate Ratios ◽  
Population Controls ◽  
Over Time

ObjectiveExcess mortality in rheumatoid arthritis (RA) is expected to have improved over time, due to improved treatment. Our objective was to evaluate secular 5-year mortality trends in RA relative to general population controls in incident RA cohorts diagnosed in 1996–2000 vs 2001–2006.MethodsWe conducted a population-based cohort study, using administrative health data, of all incident RA cases in British Columbia who first met RA criteria between January 1996 and December 2006, with general population controls matched 1:1 on gender, birth and index years. Cohorts were divided into earlier (RA onset 1996–2000) and later (2001–2006) cohorts. Physician visits and vital statistics data were obtained until December 2010. Follow-up was censored at 5 years to ensure equal follow-up in both cohorts. Mortality rates, mortality rate ratios and HRs for mortality (RA vs controls) using proportional hazard models adjusting for age, were calculated. Differences in mortality in RA versus controls between earlier and later incident cohorts were tested via interaction between RA status (case/control) and cohort (earlier/later).Results24 914 RA cases and controls experienced 2747 and 2332 deaths, respectively. Mortality risk in RA versus controls differed across incident cohorts for all-cause, cardiovascular diseases (CVD) and cancer mortality (interactions p<0.01). A significant increase in mortality in RA versus controls was observed in earlier, but not later, cohorts (all-cause mortality adjusted HR (95% CI): 1.40 (1.30 to 1.51) and 0.97 (0.89 to 1.05), respectively).ConclusionsIn our population-based incident RA cohort, mortality compared with the general population improved over time. Increased mortality in the first 5 years was observed in people with RA onset before, but not after, 2000.

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