Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
Value Health. 2021 May;24(5):724-732. doi: 10.1016/j.jval.2020.11.022. Epub 2021 Mar 18.
A number of studies have shown an association between smoking habit and quality of life, but these have mainly involved cross-sectional data. This study takes advantage of longitudinal panel data to estimate the effect of the transition from "smoker" to "ex-smoker" status (smoking cessation) on health-related quality of life (HRQoL), measured by SF-36, in an Australian general population sample.
Panel data from 13 waves (2001-2013) of a nationally representative longitudinal survey of Household Income and Labour Dynamics of Australia (HILDA) were used; 1858 respondents (5% of total HILDA sample) who experienced only 1 cessation event in their HILDA life were selected. HRQoL trajectories elicited by SF-36 (0-100 scale, worst to best health) were modeled before and after cessation events using a piecewise (segmented) 2-way fixed-effect linear regression, adopted to capture within-person differences. This enabled measurement of changes of regression slopes and intercept while controlling time-invariant characteristics (eg, country of birth, gender) and time-varying changes in health status.
Annual pre-post intervention improvements were estimated for the following dimensions: role physical 0.65 (95% CI 0.62-1.24), bodily pain 0.48 (95% CI 0.10-0.86), general health 0.55 (95% CI 0.2-0.9), and the physical component summary score 0.22 (95% CI 0.01-0.04). Immediate effects (discontinuity at the time of cessation) of smoking cessation existed for bodily pain -1.5 (95% CI -2.52 to -0.40) and general health 1.82 (95% CI 1.01-2.62). The effects for mental health domains were not significant.
Adjusting for all unmeasured time-invariant confounders and controlling the effect of time, this study revealed the varied effects of smoking cessation on HRQoL; it has positive effect on physical and general health but nonsignificant effect on mental aspects. Preference-based utility measures based on SF-6D capture changes that can be measured in several of the domains of the SF-36.
多项研究表明，吸烟习惯与生活质量之间存在关联，但这些研究主要涉及横断面数据。本研究利用纵向面板数据，以澳大利亚一般人群样本为对象，估计从“吸烟者”到“戒烟者”状态（戒烟）转变对健康相关生活质量（HRQoL）的影响，采用 SF-36 进行测量。
使用澳大利亚家庭收入和劳动力动态调查（HILDA）13 个波次（2001-2013 年）的面板数据；选择仅在 HILDA 生活中经历过 1 次戒烟事件的 1858 名受访者（HILDA 总样本的 5%）。使用分段（分段）双向固定效应线性回归模型在戒烟事件前后模拟 SF-36 引起的 HRQoL 轨迹（0-100 分，最差至最佳健康），该模型采用捕获个体内差异，以衡量回归斜率和截距的变化，同时控制不变特征（如出生国、性别）和健康状况的时变变化。
估计干预前后每年的以下维度的改善情况：角色身体 0.65（95%置信区间 0.62-1.24）、身体疼痛 0.48（95%置信区间 0.10-0.86）、一般健康 0.55（95%置信区间 0.2-0.9），以及身体成分综合评分 0.22（95%置信区间 0.01-0.04）。戒烟的即时效应（戒烟时的不连续性）为身体疼痛-1.5（95%置信区间-2.52 至-0.40）和一般健康 1.82（95%置信区间 1.01-2.62）。心理健康领域的影响不显著。
在调整所有未测量的不变混杂因素并控制时间影响后，本研究揭示了戒烟对 HRQoL 的不同影响；它对身体和一般健康有积极影响，但对心理方面没有显著影响。基于 SF-6D 的偏好性效用测量可以捕获 SF-36 多个领域的变化。
