Background
Methods
Data source and study setting
Study population
Definition of change in amount of smoking cigarettes
Covariates
Study outcomes and follow-up
Statistical analysis
Results
Baseline characteristics of study participants
Variables | Total (N = 349,137) | Smoking behavior change | |||||
---|---|---|---|---|---|---|---|
Quitter (N = 63,694) | Reducer I (N = 26,516) | Reducer II (N = 45,832) | Sustainer (N = 156,329) | Increaser (N = 56,766) | P value | ||
Age (years) | 51.6 ± 10.9 | 54.0 ± 11.1 | 52.9 ± 11.5 | 50.7 ± 10.8 | 51.1 ± 10.6 | 50.8 ± 11.0 | < 0.001 |
Sex (men) | 332,461 (95.2) | 58,025 (91.1) | 24,828 (93.6) | 44,289 (96.6) | 151,401 (96.8) | 53,918 (95.0) | < 0.001 |
Income | < 0.001 | ||||||
Q1(lowest) | 63,355 (18.2) | 11,556(18.1) | 5,567 (21.0) | 8,054 (17.6) | 27,633 (17.7) | 10,545 (18.6) | |
Q2 | 67,593 (19.4) | 12,150(19.1) | 5,472 (20.6) | 8,843 (19.3) | 29,613 (18.9) | 11,515 (20.3) | |
Q3 | 103,559 (29.7) | 17,453(27.4) | 7,493 (28.3) | 13,890 (30.3) | 47,481 (30.4) | 17,242 (30.4) | |
Q4(highest) | 114,630 (32.8) | 22,535(35.4) | 7,984 (30.1) | 15,045 (32.8) | 51,602 (33.0) | 17,464 (30.8) | |
Alcohol consumption | < 0.001 | ||||||
Non | 97,091 (27.8) | 25,781 (40.5) | 7,729 (29.2) | 11,307 (24.7) | 38,030 (24.3) | 14,244 (25.1) | |
Mild | 111,621 (32.0) | 19,429 (30.5) | 9,931 (37.5) | 15,773 (34.4) | 49,237 (31.5) | 17,251 (30.4) | |
Moderate | 77,095 (22.1) | 10,428 (16.4) | 5,352 (20.2) | 10,686 (23.3) | 37,757 (24.2) | 12,872 (22.7) | |
Heavy | 63,330 (18.1) | 8,056 (12.7) | 3,504 (13.2) | 8,066 (17.6) | 31,305 (20.0) | 12,399 (21.8) | |
Smoking status | < 0.001 | ||||||
Light, < 10 cigarettes/day | 32,551 (9.3) | 11,463 (18.0) | 1,057 (4.0) | 2,348 (5.1) | 5,561 (3.7) | 12,122 (21.4) | |
Moderate, 10–19 cigarettes/day | 127,032 (36.4) | 24,789 (38.9) | 5,276 (19.9) | 15,046 (32.8) | 50,140 (32.1) | 31,781 (56.0) | |
Heavy, ≥ 20 cigarettes/day | 189,554 (54.3) | 27,442 (43.1) | 20,183 (76.1) | 28,438 (62.1) | 100,628 (64.4) | 12,863 (22.7) | |
Duration of smoking (years) | < 0.001 | ||||||
<5 | 10,090 (2.9) | 3,575 (5.6) | 655 (2.47) | 845 (1.8) | 2,790 (1.8) | 2,225 (3.9) | |
5–9y | 13,828 (4.0) | 3,499 (5.5) | 1,101 (4.15) | 1,518 (3.3) | 4,862 (3.1) | 2,848 (5.0) | |
10–19 | 81,273 (23.3) | 14,165 (22.2) | 5,780 (21.8) | 10,864 (23.7) | 35,359 (22.6) | 15,105 (26.6) | |
20–29 | 116,486 (33.4) | 18,894 (29.7) | 8,205 (30.94) | 15,788 (34.5) | 55,080 (35.2) | 18,519 (32.6) | |
≥30 | 127,460 (36.5) | 23,561 (37.0) | 10,775 (40.64) | 16,817 (36.7) | 58,238 (37.3) | 18,069 (31.8) | |
Pack-years of smoking | < 0.001 | ||||||
<10 | 74,821 (21.4) | 19,913 (31.3) | 3,738 (14.1) | 6,555 (14.3) | 23,688 (15.2) | 20,927 (36.9) | |
10–20 | 97,025 (27.8) | 16,790 (26.4) | 5,925 (22.3) | 11,924 (26.0) | 42,754 (27.4) | 19,632 (34.6) | |
20–30 | 79,295 (22.7) | 12,053 (18.9) | 6,090 (23.0) | 10,169 (22.2) | 42,092 (26.9) | 8,891 (15.7) | |
≥30 | 97,996 (28.1) | 14,938 (23.5) | 10,763 (40.6) | 17,184 (37.5) | 47,795 (30.6) | 7,316 (12.9) | |
Physical activity | < 0.001 | ||||||
Non | 277,155 (79.4) | 48,323 (75.9) | 20,600 (77.7) | 36,399 (79.4) | 125,883 (80.5) | 45,950 (81.0) | |
Irregular | 53,160 (15.2) | 11,140 (17.5) | 4,307 (16.2) | 7,124 (15.5) | 22,601 (14.5) | 7,988 (14.1) | |
Regular | 18,822 (5.4) | 4231 (6.6) | 1,609 (6.1) | 2,309 (5.0) | 7,845 (5.0) | 2,828 (5.0) | |
Body mass index (kg/m2) | 24.8 ± 3.3 | 25.0 ± 3.2 | 24.7 ± 3.3 | 24.8 ± 3.4 | 24.8 ± 3.3 | 24.8 ± 3.4 | < 0.001 |
Systolic blood pressure (mmHg) | 126.8 ± 14.5 | 127.2 ± 14.5 | 127.0 ± 14.9 | 126.7 ± 14.4 | 126.7 ± 14.4 | 126.7 ± 14.7 | < 0.001 |
Diastolic blood pressure (mmHg) | 79.0 ± 9.9 | 78.8 ± 9.8 | 78.9 ± 9.9 | 79.1 ± 9.9 | 79.1 ± 9.9 | 79.0 ± 10.0 | < 0.001 |
Fasting glucose (mg/dL) | 137.8 ± 51.8 | 138.6 ± 50.8 | 137.9 ± 52.6 | 136.6 ± 50.8 | 137.4 ± 51.6 | 139.1 ± 54.0 | < 0.001 |
Total cholesterol (mg/dL) | 194.0 ± 43.3 | 192.9 ± 46.0 | 192.9 ± 47.0 | 193.9 ± 41.5 | 194.5 ± 42.6 | 194.1 ± 41.5 | < 0.001 |
Estimated glomerular filtration rate | 92.8 ± 48.6 | 90.7 ± 48.9 | 92.2 ± 46.1 | 93.3 ± 48.2 | 93.3 ± 48.7 | 93.7 ± 49.5 | < 0.001 |
Comorbidity | |||||||
Hypertension | 157,714 (45.2) | 31,276 (49.1) | 12,481 (47.1) | 20,172 (44.0) | 69,010 (44.1) | 24,775 (43.6) | < 0.001 |
Dyslipidemia | 129,888 (37.2) | 26,053 (40.9) | 9,845 (37.1) | 16,690 (36.4) | 56,738 (36.3) | 20,562 (36.2) | < 0.001 |
Chronic kidney disease | 15,585 (4.5) | 3,824 (6.0) | 1,410 (5.3) | 1,874 (4.1) | 6,145 (3.9) | 2,332 (4.1) | < 0.001 |
COPD | 87,696 (25.1) | 18,162 (28.5) | 7,116 (26.8) | 10,902 (23.8) | 37,576 (24.0) | 13,940 (24.6) | < 0.001 |
Diabetes duration | < 0.001 | ||||||
New-onset | 198,800 (56.9) | 32,857 (51.6) | 14,553 (54.9) | 27,078 (59.1) | 91,560 (58.6) | 32,752 (57.7) | |
<5 years | 79,605 (22.8) | 15,506 (24.3) | 6,254 (23.6) | 9,965 (21.7) | 34,867 (22.3) | 13,013 (22.9) | |
≥5 years | 70,732 (20.3) | 15,331 (24.1) | 5,709 (21.5) | 8,789 (19.2) | 29,902 (19.1) | 11,001 (19.4) | |
Number of antidiabetic agents used | < 0.001 | ||||||
0 | 172,956 (49.5) | 27,042 (42.5) | 12,671 (47.8) | 23,830 (52.0) | 80,418 (51.4) | 28,995 (51.1) | |
1–2 | 124,456 (35.7) | 25,584 (40.2) | 9,693 (36.6) | 15,646 (34.1) | 53,989 (34.5) | 19,544 (34.4) | |
≥3 | 51,725 (14.8) | 11,068 (17.4) | 4,152 (15.7) | 6,356 (13.9) | 21,922 (14.0) | 8,227 (14.5) | |
Use of insulin | 17,474 (5.0) | 4,227 (6.6) | 1,436 (5.4) | 2,105 (4.6) | 6,960 (4.5) | 2,746 (4.8) | < 0.001 |
The risk of CVD and death according to smoking behavior change among individuals with T2DM
Smoking behavior change | Event (n) | Duration (person-years) | IR | Hazard ratio (95% confidence interval) | 5-year absolute risk (%) (95% CI) | Risk difference (95% CI) | No. Needed to Treat | ||
---|---|---|---|---|---|---|---|---|---|
Model 1 | Model 2 | Model 3 | |||||||
Cardiovascular disease events | |||||||||
Myocardial infarction | |||||||||
Quitter | 1,171 | 314,614.7 | 3.7 | 1.00 (0.93–1.07) |
0.81 (0.76–0.87)
|
0.80 (0.75–0.86)
| 1.54 (1.45, 1.63) |
-0.38 (-0.49, -0.27)
| 2.6 |
Reducer I | 573 | 129,894.0 | 4.4 |
1.19 (1.08–1.30)
| 1.04 (0.95–1.14) | 1.03 (0.94–1.13) | 1.98 (1.81, 2.14) | 0.06 (-0.12, 0.24) | 16.7 |
Reducer II | 823 | 226,066.8 | 3.6 | 0.98 (0.91–1.06) | 0.99 (0.92–1.07) | 0.99 (0.92–1.07) | 1.90 (1.77, 2.03) | -0.02 (-0.16, 0.12) | 50 |
Sustainer | 2,856 | 768,275.4 | 3.7 | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1.92 (1.84, 1.99) | Ref. | Ref. |
Increaser | 1,091 | 277,276.4 | 3.9 | 1.06 (0.99–1.14) | 1.06 (0.99–1.14) | 1.05 (0.98–1.13) | 2.02 (1.90, 2.14) | 0.10 (-0.03, 0.23) | 10 |
P value | 0.001 | < 0.001 | < 0.001 | ||||||
Ischemic stroke | |||||||||
Quitter | 1,420 | 313,782.0 | 4.5 | 1.00 (0.94–1.06) |
0.82 (0.77–0.87)
|
0.80 (0.75–0.85)
| 1.90 (1.80, 2.00) |
-0.46 (-0.59, -0.33)
| 2.2 |
Reducer I | 699 | 129,406.0 | 5.4 |
1.19 (1.10–1.30)
| 1.01 (0.93–1.09) | 1.00 (0.92–1.08) | 2.35 (2.18, 2.52) | -0.01 (-0.20, 0.18) | 100 |
Reducer II | 948 | 225,652.8 | 4.2 | 0.93 (0.86–1.00) | 0.95 (0.89–1.02) | 0.95 (0.89–1.02) | 2.25 (2.11, 2.39) | -0.11 (-0.27, 0.05) | 9.1 |
Sustainer | 3,466 | 766,293.8 | 4.5 | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 2.36 (2.28, 2.44) | Ref. | Ref. |
Increaser | 1,304 | 276,608.2 | 4.7 | 1.04 (0.98–1.11) | 1.05 (0.98–1.11) | 1.04 (0.97–1.10) | 2.44 (2.31, 2.57) | 0.08 (-0.07, 0.23) | 12.5 |
P value | < 0.001 | < 0.001 | < 0.001 | ||||||
Mortality
| |||||||||
All-cause mortality | |||||||||
Quitter | 2,881 | 316,956.8 | 9.1 |
1.11 (1.07–1.16)
|
0.92 (0.88–0.96)
|
0.90 (0.86–0.94)
| 3.63 (3.50, 3.77) |
-0.40 (-0.56, -0.24)
| 2.5 |
Reducer I | 1,520 | 131,023.4 | 11.6 |
1.43 (1.35–1.51)
|
1.15 (1.09–1.22)
|
1.14 (1.08–1.21)
| 4.55 (4.34, 4.77) | 0.52 (0.29, 0.75) | 2.0 |
Reducer II | 1,832 | 227,806.9 | 8.0 | 0.99 (0.94–1.04) | 1.02 (0.97–1.07) | 1.02 (0.97–1.07) | 4.10 (3.93, 4.28) | 0.07 (-0.13, 0.27) | 14.3 |
Sustainer | 6,294 | 774,303.1 | 8.1 | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 4.03 (3.94, 4.13) | Ref. | Ref. |
Increaser | 2,405 | 279,628.3 | 8.6 |
1.06 (1.01–1.11)
|
1.07 (1.02–1.12)
|
1.06 (1.01–1.11)
| 4.24 (4.08, 4.40) | 0.21 (0.02, 0.40) | 4.8 |
P value | < 0.001 | < 0.001 | < 0.001 | ||||||
Myocardial infarction mortality | |||||||||
Quitter | 122 | 316,956.8 | 0.4 | 1.08 (0.87–1.33) | 0.81 (0.65–1.00) |
0.79 (0.64–0.98)
| 0.15 (0.12, 0.18) |
-0.04 (-0.08, 0.00)
| 25 |
Reducer I | 69 | 131,023.4 | 0.5 |
1.48 (1.13–1.92)
| 1.18 (0.90–1.54) | 1.16 (0.89–1.51) | 0.22 (0.17, 0.27) | 0.03 (-0.03, 0.09) | 33.3 |
Reducer II | 76 | 227,806.9 | 0.3 | 0.94 (0.73–1.21) | 0.94 (0.73–1.21) | 0.94 (0.73–1.21) | 0.18 (0.14, 0.22) | -0.01 (-0.06, 0.04) | 100 |
Sustainer | 276 | 774,303.1 | 0.4 | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 0.19 (0.17, 0.21) | Ref. | Ref. |
Increaser | 104 | 279,628.3 | 0.4 | 1.05 (0.83–1.31) | 1.06 (0.84–1.33) | 1.05 (0.84–1.32) | 0.20 (0.16, 0.24) | 0.01 (-0.04, 0.06) | 100 |
P value | 0.046 | 0.099 | 0.084 | ||||||
Ischemic stroke mortality | |||||||||
Quitter | 46 | 316,956.8 | 0.1 | 1.04 (0.73–1.46) |
0.69 (0.48–0.98)
|
0.67 (0.47–0.95)
| 0.05 (0.04, 0.07) |
-0.03 (-0.05, -0.01)
| 33.3 |
Reducer I | 25 | 131,023.4 | 0.2 | 1.37 (0.88–2.11) | 0.91 (0.59–1.41) | 0.89 (0.58–1.39) | 0.07 (0.04, 0.10) | -0.01 (-0.04, 0.02) | 100 |
Reducer II | 31 | 227,806.9 | 0.1 | 0.97 (0.65–1.45) | 0.98 (0.65–1.46) | 0.98 (0.66–1.46) | 0.08 (0.05, 0.11) | 0.00 (-0.03, 0.03) | NA |
Sustainer | 108 | 774,303.1 | 0.1 | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 0.08 (0.06, 0.10) | Ref. | Ref. |
Increaser | 43 | 279,628.3 | 0.2 | 1.11 (0.78–1.57) | 1.02 (0.71–1.45) | 1.01 (0.71–1.44) | 0.08 (0.06, 0.10) | 0.00 (-0.03, 0.03) | NA |
P value | 0.684 | 0.291 | 0.222 |