Joseph Rebecca M, Movahedi Mohammad, Dixon William G, Symmons Deborah Pm
NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
RMD Open. 2017 Sep 26;3(2):e000506. doi: 10.1136/rmdopen-2017-000506. eCollection 2017.
To investigate the associations between smoking status, smoking cessation and hospitalisations for cardiovascular events (CVE) and respiratory tract infections (RTI) in an inception cohort of patients with rheumatoid arthritis (RA).
The study was set within UK primary care electronic health records (the Clinical Practice Research Datalink) linked to hospital inpatient data (Hospital Episode Statistics). Patients with RA were followed from diagnosis to hospitalisation with a record of CVE or RTI, leaving their general practice, death, or 10 January 2012, whichever was earliest. Smoking status (never, current, former) was defined using primary care data and could vary over time. Survival analysis was performed using Cox regression (first event) and conditional risk set models (multiple RTIs).
5677 patients were included in the cohort: 68% female, median age 61 years. The age-adjusted and sex-adjusted risks of hospitalisation for CVE or RTI were more than twice as high in current vs never smokers (CVE HR (95% CI) 2.19 (1.44 to 3.31); RTI 2.18 (1.71 to 2.78)). The risks for both outcomes were significantly higher in current compared with former smokers (CVE 1.51 (1.04 to 2.19), RTI 1.29 (1.04 to 1.61)). For each additional year of smoking cessation, the risk of first CVE and RTI hospitalisation fell significantly, approximately 25% and 15% respectively in the adjusted models.
Patients with RA who smoke have an increased risk of hospitalisation with CVE or RTI compared with never and former smokers. The risk decreases for each additional year of smoking cessation. Patients with RA who smoke should be advised to stop smoking.
在类风湿关节炎（RA）患者起始队列中，研究吸烟状况、戒烟与心血管事件（CVE）和呼吸道感染（RTI）住院治疗之间的关联。
该研究基于与医院住院患者数据（医院事件统计）相链接的英国初级医疗电子健康记录（临床实践研究数据链）开展。对RA患者从诊断开始进行随访，直至出现CVE或RTI住院记录、离开全科医疗、死亡或2012年1月10日（以最早者为准）。吸烟状况（从不吸烟、当前吸烟、既往吸烟）根据初级医疗数据定义，且可能随时间变化。使用Cox回归（首次事件）和条件风险集模型（多次RTI）进行生存分析。
该队列纳入了5677例患者，其中68%为女性，中位年龄61岁。当前吸烟者与从不吸烟者相比，经年龄和性别调整后的CVE或RTI住院风险高出两倍多（CVE风险比（95%置信区间）2.19（1.44至3.31）；RTI为2.18（1.71至2.78））。与既往吸烟者相比，当前吸烟者这两种结局的风险均显著更高（CVE为1.51（1.04至2.19），RTI为1.29（1.04至1.61））。每多戒烟一年，则首次CVE和RTI住院风险显著降低，在调整模型中分别约降低25%和15%。
与从不吸烟和既往吸烟者相比，吸烟的RA患者发生CVE或RTI住院的风险增加。每多戒烟一年，风险降低。应建议吸烟的RA患者戒烟。
