Secular trends in smoking in relation to prevalent and incident smoking-related disease: A prospective population-based study
More details
Hide details
Department of Sleep Medicine, Glostrup University Hospital, Copenhagen, Denmark
The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
Philip Tonnesen   

Department of Sleep Medicine, Glostrup University Hospital, Valdemar Hansens Vej 1-23, 2600 Glostrup, Copenhagen, Denmark
Publish date: 2019-10-07
Tob. Induc. Dis. 2019;17(October):72
We examined changes in smoking habits in the general population according to prevalence and incidence of chronic diseases affected by smoking.

We included 12283 individuals enrolled from 2003 in the Copenhagen General Population Study and re-examined from 2014. Participants were classified as either healthy or suffering from chronic obstructive pulmonary disease (COPD), asthma, diabetes mellitus, heart disease or stroke.

At entry, smoking prevalence was 15.4% in healthy participants, 29.8% with COPD, 15.8% with asthma, 21.7 % with diabetes mellitus, 17.2 % with ischemic heart disease/heart failure and 18.6% in participants with previous stroke. Smoking prevalence declined during the 10 years of observation. Among healthy subjects who developed one of the above mentioned diseases during follow-up, those who developed COPD had the highest initial smoking prevalence (51.5%). Quit rates were highest in those who developed asthma resulting in smoking prevalence of 8.2% versus 27.7% in COPD. After adjustment for age, smoking severity and genotype previously associated with heavy smoking (CHRNA3 rs1051730 AA), significant predictors of quitting were new diagnosis of ischemic heart disease/heart failure (OR=2.33, 95 % CI: 1.61–3.42), new diagnosis of asthma (OR=1.84, 95% CI: 1.18–2.90) and low number of pack-years.

Individuals with prevalent smoking related diseases continued to smoke more than healthy individuals. Incident heart disease and asthma, but not incident COPD, stroke or diabetes were associated with a higher chance of quitting. Special focus on smokers with COPD, asthma, diabetes, stroke and ischemic heart disease/heart failure is warranted to decrease smoking prevalence in these groups. Smokers with a new diagnosis of diabetes, stroke and COPD need special smoking cessation support.

The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
There was no source of funding for this research.
Not commissioned; externally peer reviewed.
Jha P, Peto R. Global effects of smoking, of quitting, and of taxing tobacco. N Engl J Med. 2014;370:60-68. doi:10.1056/nejmra1308383.
Chalmers GW, Macleod KJ, Little SA, Thomson LJ, McSharry CP, Thomson NC. Influence of cigarette smoking on inhaled corticosteroid treatment in mild asthma. Thorax. 2002;57:226-230. doi:10.1136/thorax.57.3.226.
Anthonisen NR, Skeans MA, Wise RA, et al. The effects of a smoking cessation intervention on 14.5-year mortality: a randomized clinical trial. Ann Intern Med. 2005;142:233-239. doi:10.7326/0003-4819-142-4-200502150-00005.
Engelmann J, Manuwald U, Rubach C, et al. Determinants of mortality in patients with type 2 diabetes: a review. Rev Endocr Metab Disord. 2016;17:129-137. doi:10.1007/s11154-016-9349-0.
Cea Soriano L, Johansson S, Stefansson B, Rodríguez LA. Cardiovascular events and all-cause mortality in a cohort of 57,946 patients with type 2 diabetes: associations with renal function and cardiovascular risk factors. Cardiovasc Diabetol. 2015;14:38. doi:10.1186/s12933-015-0204-5.
Kwak MJ, Kim J, Bhise V, Chung TH, Petitto GS. National Trends in Smoking Cessation Medication Prescriptions for Smokers With Chronic Obstructive Pulmonary Disease in the United States, 2007-2012. J Prev Med Public Health. 2018;51(5):257-262. doi:10.3961/jpmph.18.119.
Tøttenborg SS, Clark AJ, Thomsen RW, Johnsen SP, Lange P. Socioeconomic inequality in the use of prescription medications for smoking cessation among patients with COPD: a nationwide study. Int J Chron Obstruct Pulmon Dis. 2018;13:1775-1781. doi:10.2147/copd.s158954.
Stegberg M, Hasselgren M, Montgomery S, et al. Changes in smoking prevalence and cessation support, and factors associated with success of smoking cessation in Swedish patients with asthma and COPD. Eur Clin Respir J. 2018;5(1):1421389. doi:10.1080/20018525.2017.1421389.
Holm M, Schiöler L, Andersson E, et al. Predictors of smoking cessation: A longitudinal study in a large cohort of smokers. Respir Med. 2017;132:164-169. doi:10.1016/j.rmed.2017.10.013.
Lange P, Marott JL, Vestbo J, et al. Prediction of the clinical course of chronic obstructive pulmonary disease, using the new GOLD classification: a study of the general population. Am J Respir Crit Care Med. 2012;186(10):975-981. doi:10.1164/rccm.201207-1299oc.
Çolak Y, Afzal S, Nordestgaard BG, Vestbo J, Lange P. Prognosis of asymptomatic and symptomatic, undiagnosed COPD in the general population in Denmark: a prospective cohort study. Lancet Respir Med. 2017;5:426-434. doi:10.1016/s2213-2600(17)30119-4.
Thorgeirsson TE, Geller F, Sulem P, et al. A variant associated with nicotine dependence, lung cancer and peripheral arterial disease. Nature. 2008;452:638-642. doi:10.1038/nature06846.
Thorgeirsson TE, Gudbjartsson DF, Surakka I, et al. Sequence variants at CHRNB3-CHRNA6 and CYP2A6 affect smoking behavior. Nat Genet. 2010;42:448-453. doi:10.1038/ng.573.
Kaur-Knudsen D, Nordestgaard BG, Bojesen SE. CHRNA3 genotype, nicotine dependence, lung function and disease in the general population. Eur Respir J. 2012;40:1538-1544. doi:10.1183/09031936.00176811.
World Health Organization. ICD-10 online versions. Accessed June 26, 2019.
Tashkin DP, Rennard S, Hays JT, Ma W, Lawrence D, Lee TC. Effects of varenicline on smoking cessation in patients with mild to moderate COPD: a randomized controlled trial. Chest. 2011;139(3):591-599. doi:10.1378/chest.10-0865.
Stegberg M, Hasselgren M, Montgomery S, et al. Changes in smoking prevalence and cessation support, and factors associated with successful smoking cessation in Swedish patients with asthma and COPD. Eur Clin Respir J. 2018;5(1):1421389. doi:10.1080/20018525.2017.1421389.
Danielsen SE, Lochen ML, Medbo A, Linea M, Vold, Melbye H. A new diagnosis of asthma or COPD is linked to smoking cessation – the Tromso study. Int J Chron Obstruct Pulmon Dis. 2016;11:1453-1458. doi:10.2147/copd.s108046.
Newsom JT, Huguet N, McCarthy MJ, et al. Health behavior change following chronic illness in middle and later life. J Gerontol B Psychol Sci Soc Sci. 2012;67:279-288. doi:10.1093/geronb/gbr103.
Dawood N, Vaccarino V, Reid KJ, et al. Predictors of smoking cessation after a myocardial infarction: the role of institutional smoking cessation programs in improving success. Arch Intern Med. 2008;168:1961-1967. doi:10.1001/archinte.168.18.1961.