Wang Yang, Salamanca Ludwing F, Sanchez Carmen S, Fang Hai
School of Public Health, Peking University, Beijing, China.
China Center for Health Development Studies, Peking University, Beijing, China.
Tob Induc Dis. 2023 Sep 27;21:119. doi: 10.18332/tid/169975. eCollection 2023.
In China's aging population, hypertension, aggravated by smoking, constitutes a substantial health concern. However, the effectiveness of the national public health interventions for smoking cessation under the Essential Public Health Services remains unverified. Our aim was to examine smoking prevalence, the proportion of individuals receiving smoking cessation advice, its impact on successful cessation among Chinese hypertensive patients aged ≥45 years, and to discern disparities in the coverage and efficacy of smoking cessation interventions between primary care facilities and hospitals.
Employing a longitudinal cohort approach, we examined four waves (2011-2018) of the China Health and Retirement Longitudinal Study (CHARLS). We surveyed a nationally representative cohort of hypertensive individuals, accounting for smoking status, cessation advice, healthcare preferences, and 11 pertinent covariates.
Among the 4269 hypertensive patients, smokers were predominantly male, aged <65 years, with lower education and lower wealth. Smoking prevalence decreased from 25.2% in 2011 to 21.1% in 2018. The incidence of physician-provided smoking cessation advice reached a peak of 60.3% in 2015, decreasing to 54.8% in 2018. Visitors to primary care facilities reported the highest rate of advice reception. While patients receiving advice exhibited a higher smoking prevalence, instrumental variable regression and subgroup analyses found no significant correlation between advice receipt and successful cessation.
We observed a substantial smoking prevalence among older hypertensive Chinese individuals and limited effectiveness of existing cessation programs. This underscores the necessity for augmenting primary care and devising a comprehensive health policy for more successful smoking cessation interventions, particularly considering China's rapidly aging population.
在中国老龄化人口中，吸烟加剧了高血压问题，这构成了一个重大的健康问题。然而，基本公共卫生服务下国家戒烟公共卫生干预措施的有效性尚未得到验证。我们的目的是研究吸烟率、接受戒烟建议的个体比例、其对≥45岁中国高血压患者成功戒烟的影响，并识别基层医疗设施和医院在戒烟干预措施的覆盖范围和效果方面的差异。
我们采用纵向队列研究方法，分析了中国健康与养老追踪调查（CHARLS）的四个调查周期（2011 - 2018年）的数据。我们对全国具有代表性的高血压患者队列进行了调查，记录了吸烟状况、戒烟建议、医疗保健偏好以及11个相关协变量。
在4269名高血压患者中，吸烟者主要为男性，年龄<65岁，教育程度较低且财富水平较低。吸烟率从2011年的25.2%降至2018年的21.1%。医生提供戒烟建议的比例在2015年达到峰值60.3%，2018年降至54.8%。基层医疗设施的就诊者接受建议的比例最高。虽然接受建议的患者吸烟率较高，但工具变量回归和亚组分析发现接受建议与成功戒烟之间无显著相关性。
我们观察到中国老年高血压患者中吸烟率较高，现有戒烟项目效果有限。这凸显了加强基层医疗服务以及制定更成功的戒烟干预综合卫生政策的必要性，特别是考虑到中国迅速老龄化的人口状况。
