From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology (N.S.P., A.C., A.E.M., S.B.M., C.I., B.B.N., H.K.), Weill Cornell Medicine, New York, NY.
Department of Population Health Sciences (I.D.), Weill Cornell Medicine, New York, NY.
Stroke. 2020 Jun;51(6):1656-1661. doi: 10.1161/STROKEAHA.120.029084. Epub 2020 May 11.
Background and Purpose- Patients who continue to smoke after a stroke face a higher risk of recurrent stroke. While several effective drugs for smoking cessation became available over the past 2 decades, whether active smoking has decreased among stroke survivors is unknown. We, therefore, evaluated trends in active smoking among stroke survivors during this period. Methods- We performed trends analyses using cross-sectional data collected every 1 to 2 years from 2 US health surveys spanning 1999 to 2018. In the National Health and Nutrition Examination Survey (NHANES) and the Behavioral Risk Factor Surveillance System (BRFSS) survey, participants were asked about prior stroke and active tobacco smoking. In NHANES, serum cotinine levels were available as a secondary measure of active smoking. We used multivariable logistic regression models for survey data to assess trends in active smoking among participants with and without prior stroke. Results- Among 49 375 participants in NHANES during 1999 to 2016 and 3 621 741 participants in BRFSS during 2011 to 2018, the prevalence of stroke was ≈3%. The overall prevalence of active smoking among stroke survivors was 24% in NHANES and 23% in BRFSS. Among individuals without prior stroke, the odds of smoking decreased over time in both NHANES (odds ratio, 0.95 per 2 years [95% CI, 0.93-0.96]) and BRFSS (odds ratio, 0.96 per year [95% CI, 0.96-0.96]). In contrast, there was no decrease in smoking among stroke survivors in NHANES (odds ratio, 1.00 [95% CI, 0.93-1.07]) or BRFSS (odds ratio, 0.99 [95% CI, 0.98-1.004]). Results were consistent in secondary analysis using biochemical ascertainment of active smoking in NHANES and in sensitivity analyses accounting for potential demographic changes in stroke epidemiology. Conclusions- In contrast to the general population, the prevalence of active smoking among stroke survivors has not decreased during the past 2 decades.
背景与目的- 中风后继续吸烟的患者面临更高的中风复发风险。尽管过去 20 年来有几种有效的戒烟药物问世，但中风幸存者的吸烟情况是否有所减少尚不清楚。因此，我们评估了在此期间中风幸存者的吸烟情况。
方法- 我们使用 1999 年至 2018 年期间进行的两项美国健康调查（国家健康和营养调查，NHANES 和行为风险因素监测系统，BRFSS）的横断面数据进行趋势分析。在 NHANES 和 BRFSS 调查中，参与者被问及先前的中风和主动吸烟情况。在 NHANES 中，可通过血清可替宁水平作为主动吸烟的次要衡量标准。我们使用多变量逻辑回归模型对调查数据进行分析，以评估有和无先前中风的参与者中主动吸烟的趋势。
结果- 在 1999 年至 2016 年期间的 NHANES 中，共有 49375 名参与者，在 2011 年至 2018 年期间的 BRFSS 中，共有 3621741 名参与者，中风的患病率约为 3%。在 NHANES 中，中风幸存者的主动吸烟总体患病率为 24%，在 BRFSS 中为 23%。在没有先前中风的个体中，NHANES（比值比，每两年降低 0.95[95%置信区间，0.93-0.96]）和 BRFSS（比值比，每年降低 0.96[95%置信区间，0.96-0.96]）中吸烟的几率随时间降低。相比之下，NHANES 中（比值比，1.00[95%置信区间，0.93-1.07]）或 BRFSS 中（比值比，0.99[95%置信区间，0.98-1.004]）中风幸存者的吸烟情况并未减少。在 NHANES 中使用生物化学方法确定主动吸烟的二次分析和考虑中风流行病学潜在人口变化的敏感性分析中，结果是一致的。
结论- 与一般人群相比，在过去的 20 年中，中风幸存者的主动吸烟率并没有下降。
