Barnett Paul G, Chow Adam, Flores Nicole E, Sherman Scott E, Duffy Sonia A
VA Health Economics Resource Center, Menlo Park, California; VA Center for Innovation to Implementation, Menlo Park, California; Department of Health Research Policy, Stanford University School of Medicine, Stanford, California.
VA Health Economics Resource Center, Menlo Park, California; VA Center for Innovation to Implementation, Menlo Park, California.
Am J Prev Med. 2017 Jul;53(1):e9-e18. doi: 10.1016/j.amepre.2017.01.009. Epub 2017 Feb 10.
Electronic medical records represent a new source of longitudinal data on tobacco use.
Electronic medical records of the U.S. Department of Veterans Affairs were extracted to find patients' tobacco use status in 2009 and at another assessment 12-24 months later. Records from the year prior to the first assessment were used to determine patient demographics and comorbidities. These data were analyzed in 2015.
An annual quit rate of 12.0% was observed in 754,504 current tobacco users. Adjusted tobacco use prevalence at follow-up was 3.2% greater with alcohol use disorders at baseline, 1.9% greater with drug use disorders, 3.3% greater with schizophrenia, and lower in patients with cancer, heart disease, and other medical conditions (all differences statistically significant with p<0.05). Annual relapse rates in 412,979 former tobacco users were 29.6% in those who had quit for <1 year, 9.7% in those who had quit for 1-7 years, and 1.9% of those who had quit for >7 years. Among those who had quit for <1 year, adjusted relapse rates were 4.3% greater with alcohol use disorders and 7.2% greater with drug use disorders (statistically significant with p<0.05).
High annual cessation rates may reflect the older age and greater comorbidities of the cohort or the intensive cessation efforts of the U.S. Department of Veterans Affairs. The lower cessation and higher relapse rates in psychiatric and substance use disorders suggest that these groups will need intensive and sustained cessation efforts.
电子病历是烟草使用纵向数据的新来源。
提取美国退伍军人事务部的电子病历，以了解患者在2009年的烟草使用状况以及在12至24个月后的另一次评估中的情况。首次评估前一年的记录用于确定患者的人口统计学特征和合并症。这些数据于2015年进行分析。
在754,504名当前烟草使用者中，观察到年戒烟率为12.0%。随访时调整后的烟草使用患病率在基线时有酒精使用障碍的患者中高3.2%，有药物使用障碍的患者中高1.9%，有精神分裂症的患者中高3.3%，而在患有癌症、心脏病和其他疾病的患者中较低（所有差异均具有统计学意义，p<0.05）。在412,979名曾经吸烟的人中，戒烟<1年者的年复发率为29.6%，戒烟1 - 7年者为9.7%，戒烟>7年者为1.9%。在戒烟<1年的人群中，有酒精使用障碍者的调整后复发率高4.3%，有药物使用障碍者高7.2%（具有统计学意义，p<0.05）。
高年戒烟率可能反映了该队列的年龄较大和合并症较多，或者是美国退伍军人事务部的强化戒烟努力。精神疾病和物质使用障碍患者的戒烟率较低且复发率较高，这表明这些群体需要强化和持续的戒烟努力。
