Healthcare system factors best predict smoking cessation in RA
medwireNews: The strongest predictors of smoking cessation among people with rheumatoid arthritis (RA) are healthcare system-related rather than sociodemographic, US research suggests.
Christie Bartels (University of Wisconsin School of Medicine and Public Health, Madison) and co-investigators say their findings “highlight the role of the healthcare system in smoking cessation, pointing towards health system-level cessation efforts implemented in rheumatology clinics as a potential path for greater smoking cessation in patients with RA.”
Among 3577 patients with RA identified from one suburban and one rural healthcare system between 2005 and 2016, 507 were current smokers at baseline.
Men were more likely to be smokers than nonsmokers, as were people of Black race, those aged 40–59 years, and individuals with Medicaid. The rates of RA seropositivity were highest among current smokers, at 70.7%, followed by former smokers and never smokers, at 64.0% and 58.7%, respectively.
During a median 4.75 years of follow-up 28.8% of the baseline smokers stopped smoking.
Bartels and co-authors report in Arthritis Care & Research that contrary to expectations, none of the sociodemographic factors associated with smoking predicted smoking cessation.
Instead, they found that, after adjustment for observation time, patients who were new to rheumatology care were a significant 60% more likely to quit smoking during follow-up than those who had rheumatology appointments prior to baseline, while patients in the rural community health system were a significant 66% more likely to quit than those in the suburban system.
By contrast, seropositive patients were a significant 43% less likely to quit smoking than seronegative patients.
Based on these findings, Bartels et al believe that “the new patient period represents a window of opportunity and cessation efforts should be emphasized at this time.”
However, they add that a lack of awareness about the relationship between smoking and RA severity “has been cited as one of the primary barriers to smoking cessation and should be stressed with all patients who are current smokers or former smokers at risk of relapse.”
Bartels and team also suggest that the increased likelihood for quitting among patients from the rural healthcare setting could be “due to smoking cessation interventions that were implemented in that health system.” Indeed, approximately half of the patients in the rural cohort were covered by the system’s health insurance plan that includes such interventions.
Conversely, the researchers say that the “reduced likelihood of cessation in seropositive patients could reflect greater smoking intensity, as smoking and greater intensity of smoking are strongly correlated with seropositivity.”
They add: “While all RA patients should receive smoking cessation support, seropositive patients may need targeted smoking cessation efforts and may require greater support or more intensive interventions.”
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