Nicotine Dependence Services, Centre for Addiction and Mental Health, Toronto, Canada.
Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
Can J Psychiatry. 2023 May;68(5):359-369. doi: 10.1177/07067437231155693. Epub 2023 Feb 9.
People with schizophrenia are much more likely than others to smoke tobacco, raising risks of disease and premature mortality. These individuals are also less likely to quit successfully after treatment, but the few existing clinical and observational studies have been limited by small sample sizes, and have generally considered specialized treatment approaches. In this analysis, we examine outcomes, service use, and potential explanatory variables in a large sample of people with schizophrenia treated in a general-population cessation program.
Our sample comprised 3,011 people with schizophrenia and 77,790 controls receiving free nicotine replacement therapy through 400 clinics and health centres. We analysed self-reported 7-day abstinence or reduction at 6-month follow-up, as well as the number of visits attended and self-reported difficulties in quitting. We adjusted for demographic, socioeconomic, and health variables, and used multiple imputation to address missing data.
Abstinence was achieved by 16.2% (95% confidence interval [CI], 14.5% to 17.8%) of people with schizophrenia and 26.4% (95% CI, 26.0% to 26.7%) of others (absolute difference = 10.2%; 95% CI, 8.5% to 11.9%; < 0.001). After adjustment, this difference was reduced to 7.3% (95% CI, 5.4% to 9.3%; < 0.001). Reduction in use was reported by 11.8% (95% CI, 10.3% to 13.3%) and 12.5% (95% CI, 12.2% to 12.8%), respectively; this difference was nonsignificant after adjustment. People with schizophrenia attended more clinic visits (incidence rate ratio [IRR] = 1.15, 95% CI = 1.12% to 1.18%, < 0.001) and reported more difficulties related to "being around other smokers" (odds ratio [OR] = 1.28; 95% CI, 1.11% to 1.47%; = 0.001).
There is abundant demand for tobacco cessation treatment in this population. Outcomes were substantially poorer for people with schizophrenia, and this difference was not explained by covariates. Cessation remained much better than for unaided quit attempts, however, and engagement was high, demonstrating that people with schizophrenia benefit from nonspecialized pharmacological treatment programs.
精神分裂症患者比其他人更有可能吸烟，这增加了患病和早逝的风险。这些人在治疗后也不太可能成功戒烟，但为数不多的现有临床和观察性研究受到样本量小的限制，并且通常考虑了专门的治疗方法。在这项分析中，我们在一个接受一般人群戒烟计划治疗的大量精神分裂症患者中检查了结果、服务使用情况和潜在的解释变量。
我们的样本包括 3011 名精神分裂症患者和 77790 名接受免费尼古丁替代疗法的对照者，他们在 400 家诊所和卫生中心接受治疗。我们分析了在 6 个月随访时自我报告的 7 天戒烟或减少情况，以及就诊次数和自我报告的戒烟困难程度。我们调整了人口统计学、社会经济和健康变量，并使用多重插补来解决缺失数据。
精神分裂症患者的戒烟率为 16.2%（95%置信区间[CI]，14.5%至 17.8%），而对照组为 26.4%（95%CI，26.0%至 26.7%）（绝对差异=10.2%；95%CI，8.5%至 11.9%； <0.001）。调整后，这一差异缩小至 7.3%（95%CI，5.4%至 9.3%； <0.001）。分别有 11.8%（95%CI，10.3%至 13.3%）和 12.5%（95%CI，12.2%至 12.8%）的人报告了使用量减少，调整后这一差异无统计学意义。精神分裂症患者就诊次数更多（发病率比[IRR] = 1.15，95%CI = 1.12%至 1.18%， <0.001），并且报告与“周围有其他吸烟者”相关的困难更多（比值比[OR] = 1.28；95%CI，1.11%至 1.47%； = 0.001）。
该人群对烟草戒断治疗有很大的需求。精神分裂症患者的结果明显较差，而且这种差异不能用协变量来解释。然而，戒烟的效果仍然远优于未经辅助的戒烟尝试，并且参与度很高，这表明精神分裂症患者从非专门的药物治疗方案中受益。
