The impact of smoking on mortality in the face of population ageing: the example of Germany

Background Despite weak tobacco control, smoking in Germany has steadily declined over the last 25 years. As policymakers often expect that this trend will also reflect in a declining associated public health burden, I sought to quantify trends in smoking-attributable mortality (SAM) and to explore the impact of population ageing. Methods Smoking and mortality statistics from 1992 to 2018 were obtained from the German Statistical Office, from which SAM was calculated separately for each cause of death causally associated with smoking using Levin's formula for population-attributable fractions. The impact of population ageing was explored by comparing crude and age-standardized SAM, respectively. To estimate the impact of population ageing on future SAM, a forward projection until 2040 was modelled assuming continuation of smoking trends and constant mortality rates. Results About 126.900 deaths were attributable to smoking in Germany in 2018. Since 1992, total SAM declined only slightly, while stronger decreases were seen in age-adjusted SAM. Differences between crude and age-standardized SAM seem to be particularly striking in men. The forward projection of SAM suggests that recent increases in smoking in the middle aged as well as population ageing dynamics will lead to further steady increases within the next two decades in both sexes to about 138.250. Conclusions Results indicate that past decreases in SAM due to declines in smoking were largely compensated by population ageing. In the next two decades, current smoking trends and population ageing will lead to a steady increase in SAM. Only by taking determined immediate policy action could significant inroads into reducing the smoking-associated disease burden be achieved. Also, given still significant smoking rates in middle and old age, there is tremendous potential to curb the associated public health burden by intensifying cessation programs. Key messages Contrary to common expectations among policymakers, the smoking-attributable public health burden will strongly increase in the next decades in Germany. Determined immediate policy action is required to halt or attenuate these trends.

Smoking Trends: A Cross Sectional Study in Dengkil, Sepang, Selangor, Malaysia

It is estimated that more than 27,200 of Malaysians’ deaths annually are related to smoking. Majority of the smokers start smoking at the early age, smoke more than 15 years and spend less than RM 100 for cigarettes in a month. So, this study aims to determine the trend of smoking among smokers in a residential area in Dengkil, Sepang, Selangor. A cross-sectional study was conducted among Malaysian, aged more than 18-year-old with a combination of stratified, systematic and simple random sampling. Respondents who fulfill the inclusion & exclusion criteria were interviewed using a validated questionnaire and data were analysed using SPSS. The prevalence of current smoker was 23.5% with higher among male (50.7%), single (31.0%) and self-employed (44.1%). Peer pressure plays important role in either to start or to quit from smoking. It is important to increase awareness program primarily in educational institutions such as schools and colleges. Keywords: smoking, trend, prevalence, sub-urban, Selangor, Malaysian.

Trends in Tobacco Smoking in Pregnant Women: Data From French National Perinatal Surveys

Objectives: To describe maternal smoking trends in France between 1972 and 2016, and identify whether maternal characteristics associated with smoking in the 3rd trimester of pregnancy evolved between 2010 and 2016.Methods: Using French National Perinatal Surveys, we estimated proportions of smokers and the number of cigarettes smoked both just before pregnancy and during the 3rd trimester from 1972 to 2016. We used a Poisson model with robust variance to estimate prevalence ratios for smoking during pregnancy.Results: Proportions of mothers quitting smoking were relatively stable (46.0% in 1972 and 45.8% in 2016). The number of cigarettes smoked just before pregnancy and in the 3rd trimester decreased from 1995 onward. However, proportions of smokers remained high before (30.1%) and during the 3rd trimester in 2016 (16.2%). Smoking in the 3rd trimester was associated with a lower education level and lower income in both 2010 and 2016, whereas the association with age, country of birth and parity varied according to the survey year.Conclusion: Early targeted interventions are needed for smokers who plan to have a child and must take smokers’ characteristics during pregnancy into account.

Are men who smoke at higher risk for a more severe case of COVID-19 than women who smoke? A Systematic Review

BackgroundThe novelty of the Covid-19 pandemic is reflected in the lack of literature available for the impact of smoking on the intensity of the COVID-19 clinical manifestations. Our study tries to address this gap.MethodSix cohorts from China were analysed and a crude odds ratio was manually calculated.ResultsPatients with a smoking history were approximately 2 times (95% CI= 1.036-1.883) as likely to suffer from severe clinical manifestations of COVID-19 compared to patients without a smoking history. A higher percentage of males suffer more severe symptoms of COVID-19 in comparison to females, but this could be associated with the gender specific smoking trends observed in China.ConclusionThe gender specific smoking trends could be associated with the increased severity of COVID-19 disease manifestations in the male population.

Smoking trends in Mexico, 2002–2016: before and after the ratification of the WHO’s Framework Convention on Tobacco Control

IntroductionMexico was the first Latin American country to ratify the Framework Convention on Tobacco Control (FCTC) in 2004, after which it implemented some key FCTC policies (e.g., taxes, smoke-free, pictorial warnings and ad bans). This study assessed trends in the prevalence of current, daily and non-daily smoking in Mexico before and after the implementation of key FCTC policies.MethodsData were analysed from two comparable, nationally representative surveys (i.e., the National Survey on Addictions 2002, 2011 and 2016, and the Global Adult Tobacco Survey 2009 and 2015). The pooled sample comprised 100 302 persons aged 15–65 years. Changes in the prevalence of current, daily and non-daily smoking were assessed.ResultsFrom 2002 to 2016, the prevalence of current smoking fell 11% in relative terms (from 21.5% to 19.0%). The decrease was registered between 2002 and 2009, and after that, a slight increase was observed (from 16.5% in 2009 to 19% in 2016). The prevalence of daily smoking decreased by about 50% between 2002 and 2016 (from 13.5% to 7.0%) with most of the decrease occurring by 2009. Conversely, the prevalence of non-daily smoking increased by 35% between 2009 and 2016 (from 8.8% to 11.9%).ConclusionsFull implementation of the FCTC is necessary to further reduce smoking. Specific interventions may be needed to target non-daily smokers, who now comprise more than half of current smokers in Mexico.

Incidence Rates for Surgery in Crohn’s Disease Have Decreased: A Population-based Time-trend Analysis

Background Many Crohn’s disease (CD) patients will undergo surgery over the course of their life. It is thought that with the introduction of disease-modifying agents like anti-TNF therapy, there would be a population-level decrease in the need for surgery. This time-trend study aimed to assess the changes in surgical rates following the induction of anti-TNF therapy. Methods Adult CD patients who underwent abdominal surgery (identified by administrative coding) between January of 1996 and December of 2013 at 1 of the 4 Edmonton-area hospitals were included. Patient charts were manually reviewed to confirm diagnosis and gather demographic and disease-related data. Population-adjusted annual incidence rates for IBD surgery were calculated by dividing the number of surgeries by estimates for total population of CD patients in Edmonton. Time-trend analysis was conducted to identify change points, calculate annual percent change (APC), and associated 95% confidence intervals (CIs). Results A total of 1410 patients with Crohn’s disease underwent surgery for their disease. The surgical rate decreased by 8.4% each year (95% CI, −9.6% to −7.3%). There was a 36.2% increase in the use of anti-TNF therapy per year (95% CI, 31.3% to 41.5%). Changes in modifiable risk factors for surgery were also seen, including the proportion of active smokers decreasing by 2.2% per year (95% CI, −3.7% to −0.6%). Conclusions Although anti-TNF therapy seems to play a role, the decrease in surgical trends is likely multifactorial, owing to a decline in smoking trends, earlier diagnosis, earlier treatment, improved patient education, and changes in clinical practice.

Tobacco smoking in pregnant women: fifty years of evolution in France

Background Smoking during pregnancy is a major modifiable risk factor for maternal and foetal morbidity. We aimed to describe 1/smoking trends in France between 1972 and 2016, 2/ the factors associated with smoking cessation and reduction during pregnancy in 2016. Methods French National Perinatal Surveys are routine surveys based on a representative sample of births (N = 11,733 in 2016). Data were collected in face-to-face interviews in postnatal wards and from the mother’s medical record. Smoking rates before pregnancy and during 3rd trimester were estimated for each study year and characteristics associated with smoking reduction (relative percent change in number of cigarettes smoked before and during pregnancy <50% or ≥ 50%) compared with smoking cessation were analysed using multinomial logistic regression. Results After significantly decreasing from 1995 onwards, smoking prevalence stagnates since 2010 both before pregnancy and in the 3rd trimester (30.1% and 16.2%, respectively in 2016). In 2016, 45.8% ceased smoking during pregnancy, 37.2% reduced by ≥ 50% their consumption and 16.9% reduced by < 50% or did not reduce at all. The more cigarettes women smoked before pregnancy, the greater this reduction was (p < 0,001). Moderate reduction (<50%) vs stopping was more frequent in multiparae compared to nulliparae (aOR=2,47 [IC95%:1,93-3,15]) and in women with low education (aOR(<High school vs university graduates)=7,20 [4,78-10,82]) and low income (aOR(<1500€per month/>3000€)=2,30 [1,51-3,50]). Conclusions Smoking rates were high before and during pregnancy in France in 2016. Socio-demographic factors should be considered when targeting women most at risk of continuing smoking during pregnancy. Key messages After significantly decreasing from 1995 onwards, smoking prevalence stagnates since 2010 both before pregnancy and in the 3rd trimester in France. Supporting female smokers of childbearing age in their attempts to quit and remain non-smokers even after pregnancy is crucial, especially in multiparae and women in poor social condition.