Lynn Josephs, David Culliford, Matthew Johnson, Mike Thomas

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Presentation transcript:

Lynn Josephs, David Culliford, Matthew Johnson, Mike Thomas Current smoking status and its relationship to COPD outcomes: an observational cohort study using routine data in the Hampshire Health Record. Lynn Josephs, David Culliford, Matthew Johnson, Mike Thomas Department of Primary Care and Population Sciences and NIHR CLAHRC Wessex Methodological Hub, University of Southampton, UK. Contact: L.Josephs@Soton.ac.uk

Study Background Smoking accelerates decline in FEV1 in COPD Smoking cessation reduces this accelerated decline, especially early in the disease Less is known of relationship to clinical outcomes

Study Aims Quantify current smoking status Relationship smoking status to outcomes over 3y All-cause mortality Respiratory-cause hospital admissions (ICD-10 codes) Respiratory-cause emergency department (ED) attendances

The data - HHRA Retrospective observational study Individual patient-anonymised data held in the Hampshire Health Record Analytical database (HHRA) Routine 1⁰ and 2⁰ care data >140 practices >1.4 million patients

Methods: Patients Identified a prevalent cohort with a practice diagnosis of COPD as at 31/12/10 (Read Codes) Quantified current smoking status: Active smokers Ex-smokers Never smokers Age, sex, socio-economic deprivation (IMD), BMI, FEV1 %predicted, FEV1/FVC %, comorbidities Described age, sex, socio-economic deprivation (IMD), BMI, FEV1 %predicted, FEV1/FVC, comorbidities (18 diseases)

COPD cohort 16,479 patients (male 53.7%), mean (SD) age 70.1 (11.1) years Smoking status: available for 97.4% of cohort (missing in 434 patients) Active smokers: 6,138 (37.2%) Ex-smokers: 9,515 (57.7%) Never smokers: 392 (2.4%)

Patient characteristics and smoking Total cohort Active smokers Ex-smokers Never smokers Sex (male), n (%) 8847 (53.7) 3162 (51.5) 5319 (55.9) 135 (34.4) Age years, mean (SD) 70.1 (11.1) 65.6 (10.9) 72.8 (10.1) 75.2 (12.9) IMD rank decile, median (IQR) 6 (3-9) 6 (3-8) 6 (2-9) FEV1 %predicted, mean (SD) 60.7 (20.1) 60.4 (19.3) 60.7 (20.6) 65.7 (23.9) FEV1/FVC %, mean (SD) 59.6 (14.9) 59.1 (14.5) 59.7 (15.1) 64.5 (16.1) BMI Kg/m², mean (SD) 27.2 (6.0) 26.3 (6.2) 27.7 (5.8) 26.5 (5.5) Nº comorbidities, mean (SD) 2.6 (1.7) 2.3 (2.8) 2.8 (1.8) 2.8 (1.7)

Comorbidities 90.7% patients had one or more pre-existing comorbidity anxiety and/or depression bronchiectasis cerebrovascular disease chronic kidney disease connective tissue disease diabetes mellitus gastro oesophageal reflux heart failure hyperlipidaemia hypertension ischaemic heart disease lung cancer obstructive sleep apnoea osteoporosis peripheral vascular disease rhino-sinusitis asthma dementia ≥1 pre-existing comorbidities in 90.7% cohort: ;;;;;;;;;;;;;;;; e;

Outcomes and smoking (total cohort) Active smokers Ex-smokers Never smokers Deaths n (%) 2101 (12.7) 663 (10.8) 1342 (14.1) 63 (16.1) Number (%) ≥1 hospitalisations 2909 (17.7) 1086 (17.7) 1705 (17.9) 64 (16.3) Number (%) ≥1 ED attendances 1581 (9.6) 670 (10.9) 851 (8.9) 26 (6.6)

Number (%) with ≥1 admission Odds ratios (95% CI) for each outcome in each smoking category adjusted for all measured variables (n=13,220) Outcomes Number (%) of deaths Number (%) with ≥1 admission Number (%) with ≥1 ED attendance Univariate Adjusted Current Smokers (n=5015) 1.00 (reference) Ex-smokers (n=7947) 1.36* (1.23-1.50) 0.88* (0.77-0.99) 1.02 (0.94-1.10) 0.81* (0.73-0.89) 0.80* (0.72-0.89) (0.71-0.91) Never smokers (n=258) 1.58* (1.19-2.10) 0.88 (0.59-1.31) 0.91 (0.69-1.19) 0.66* (0.46-0.95) 0.58* (0.39-0.87) 0.71 (0.44-1.16)

Conclusions After adjusting for confounders, current ex-smokers had significantly lower odds of all 3 adverse outcomes compared with active smokers This highlights the importance of effective smoking cessation support The small numbers of never smokers also appear to have a more benign prognosis (likely to be a heterogeneous group). …

Acknowledgements The research team would like to thank NHS South, Central and West Commissioning Support Unit and the Hampshire Health Record Information Governance Group for their support, and for the provision of access to HHRA data.