Smoking-attributable morbidity: acute care hospital diagnoses and days of treatment in Canada, 2002

<p>Abstract</p> <p>Background</p> <p>Smoking is one of the most important risk factors for burden of disease. Our objective was to estimate the number of hospital diagnoses and days of treatment attributable to smoking for Canada, 2002.</p> <p>Methods</p> <p>Distribution of exposure was taken from a major national survey of Canada, the Canadian Community Health Survey. For chronic diseases, risk relations were taken from the published literature and combined with exposure to calculate age- and sex-specific smoking-attributable fractions (SAFs). For fire deaths, SAFs were taken directly from available statistics. Information on morbidity, with cause of illness coded according to the International Classification of Diseases version 10, was obtained from the Canadian Institute for Health Information.</p> <p>Results</p> <p>For Canada in 2002, 339,179 of all hospital diagnoses were estimated to be attributable to smoking and 2,210,155 acute care hospital days. Ischaemic heart disease was the largest single category in terms of hospital days accounting for 21 percent, followed by lung cancer at 9 percent. Smoking-attributable acute care hospital days cost over $2.5 billion in Canada in 2002.</p> <p>Conclusion</p> <p>Since the last major project produced estimates of this type, the rate of hospital days per 100,000 population has decreased by 33.8 percent. Several possible factors may have contributed to the decline in the rate of smoking-attributable hospital days: a drop in smoking prevalence, a decline in overall hospital days, and a shift in distribution of disease categories. Smoking remains a significant health, social, and economic burden in Canada.</p

Alcohol as a Risk Factor for Type 2 Diabetes: A systematic review and meta-analysis

OBJECTIVE - To clarify the dose-response relationship between alcohol consumption and type 2 diabetes.RESEARCH DESIGN AND METHODS - A systematic computer-assisted and hand search was conducted to identify relevant articles with longitudinal design and quantitative measurement of alcohol consumption. Adjustment was made for the sick-quitter effect. We used fractional polynomials in a meta-regression to determine the dose-response relationships by sex and end point using lifetime abstainers as the reference group.RESULTS - The search revealed 20 cohort studies that met our inclusion criteria. A U-shaped relationship was found for both sexes. Compared with lifetime abstainers, the relative risk (RR) for type 2 diabetes among men was most protective when consuming 22 g/day alcohol (RR 0.87 [95% CI 0.76-1.00]) and became deleterious at just over 60 g/day alcohol (1.01 [0.71-1.44]). Among women, consumption of 24 g/day alcohol was most protective (0.60 [0.52-0.69]) and became deleterious at about 50 g/day alcohol (1.02 [0.83-1.26]).CONCLUSIONS - Our analysis confirms previous research findings that moderate alcohol consumption is protective for type 2 diabetes in men and women

The costs of alcohol, illegal drugs, and tobacco in Canada, 2002

Objective: The aim of this study was to estimate costs attributable to substance use and misuse in Canada in 2002. Method: Based on information about prevalence of exposure and risk relations for more than 80 disease categories, deaths, years of life lost, and hospitalizations attributable to substance use and misuse were estimated. In addition, substance-attributable fractions for criminal justice expenditures were derived. Indirect costs were estimated using a modified human capital approach. Results: Costs of substance use and misuse totaled almost Can. $40 billion in 2002. The total cost per capita for substance use and misuse was about Can.$1,267: Can. $463 for alcohol, Can.$262 for illegal drugs, and Can. $541 for tobacco. Legal substances accounted for the vast majority of these costs (tobacco: almost 43% of total costs; alcohol: 37%). Indirect costs or productivity losses were the largest cost category (61%), followed by health care (22%) and law enforcement costs (14%). More than 40,000 people died in Canada in 2002 because of substance use and misuse: 37,209 deaths were attributable to tobacco, 4,258 were attributable to alcohol, and 1,695 were attributable to illegal drugs. A total of about 3.8 million hospital days were attributable to substance use and misuse, again mainly to tobacco. Conclusions: Substance use and misuse imposes a considerable economic toll on Canadian society and requires more preventive efforts

Primary care- based smoking cessation treatment and subsequent healthcare service utilisation : a matched cohort study of smokers using linked administrative healthcare data

Background No research has assessed the individual- level impact of smoking cessation treatment delivered within a general primary care patient population on multiple forms of subsequent healthcare service use. Objective We aimed to compare the rate of outpatient visits, emergency department (ED) visits and hospitalisations during a 5- year follow- up period among smokers who had and had not accessed a smoking cessation treatment programme. Methods The study was a retrospective matched cohort study using linked demographic and administrative healthcare databases in Ontario, Canada. 9951 patients who accessed smoking cessation services between July 2011 and December 2012 were matched to a smoker who did not access services, obtained from the Canadian Community Health Survey, using a combination of hard matching and propensity score matching. Outcomes were rates of healthcare service use from index date (programme enrolment or survey response) to March 2017. Results After controlling for potential confounders, patients in the overall treatment cohort had modestly greater rates of the outcomes: outpatient visits (rate ratio (RR) 1.10, 95% CI: 1.06 to 1.14), ED visits (RR 1.08, 95% CI: 1.03 to 1.13) and hospitalisations (RR 1.09, 95% CI: 1.02 to 1.18). Effect modification of the association between smoking cessation treatment and healthcare service use by prevalent comorbidity was found for outpatient visits (p=0.006), and hospitalisations (p=0.050), but not ED visits. Conclusions Patients who enrolled in smoking cessation treatment offered through primary care clinics in Ontario displayed a modest but significantly greater rate of outpatient visits, ED visits and hospitalisations over a 5- year follow- up period

The effectiveness of generic emails versus a remote knowledge broker to integrate mood management into a smoking cessation program in team based primary care : A cluster randomized trial

Background: Knowledge brokering is a knowledge translation approach that has been gaining popularity in Canada although the effectiveness is unknown. This study evaluated the effectiveness of generalised, exclusively email-based prompts versus a personalised remote knowledge broker for delivering evidence-based mood management interventions within an existing smoking cessation programme in primary care settings. Methods: The study design is a cluster randomised controlled trial of 123 Ontario Family Health Teams participating in the Smoking Treatment for Ontario Patients programme. They were randomly allocated 1:1 for healthcare providers to receive either: a remote knowledge broker offering tailored support via phone and email (group A), or a generalised monthly email focused on tobacco and depression treatment (group B), to encourage the implementation of an evidence-based mood management intervention to smokers presenting depressive symptoms. The primary outcome was participants’ acceptance of a self-help mood management resource. The secondary outcome was smoking abstinence at 6-month follow-up, measured by self-report of smoking abstinence for at least 7 previous days. The tertiary outcome was the costs of delivering each intervention arm, which, together with the effectiveness outcomes, were used to undertake a cost minimisation analysis

Alcohol consumption and the risk of morbidity and mortality for different stroke types - a systematic review and meta-analysis

<p>Abstract</p> <p>Background</p> <p>Observational studies have suggested a complex relationship between alcohol consumption and stroke, dependent on sex, type of stroke and outcome (morbidity vs. mortality). We undertook a systematic review and a meta-analysis of studies assessing the association between levels of average alcohol consumption and relative risks of ischemic and hemorrhagic strokes separately by sex and outcome. This meta-analysis is the first to explicitly separate morbidity and mortality of alcohol-attributable stroke and thus has implications for public health and prevention.</p> <p>Methods</p> <p>Using Medical Subject Headings (alcohol drinking, ethanol, cerebrovascular accident, cerebrovascular disorders, and intracranial embolism and thrombosis and the key word stroke), a literature search of MEDLINE, EMBASE, CINAHL, CABS, WHOlist, SIGLE, ETOH, and Web of Science databases between 1980 to June 2009 was performed followed by manual searches of bibliographies of key retrieved articles. From twenty-six observational studies (cohort or case-control) with ischemic or hemorrhagic strokes the relative risk or odds ratios or hazard ratios of stroke associated with alcohol consumption were reported; alcohol consumption was quantified; and life time abstention (manually estimated where data for current abstainers were given) was used as the reference group. Two reviewers independently extracted the information on study design, participant characteristics, level of alcohol consumption, stroke outcome, control for potential confounding factors, risk estimates and key criteria of study quality using a standardized protocol.</p> <p>Results</p> <p>The dose-response relationship for hemorrhagic stroke had monotonically increasing risk for increasing consumption, whereas ischemic stroke showed a curvilinear relationship, with a protective effect of alcohol for low to moderate consumption, and increased risk for higher exposure. For more than 3 drinks on average/day, in general women had higher risks than men, and the risks for mortality were higher compared to the risks for morbidity.</p> <p>Conclusions</p> <p>These results indicate that heavy alcohol consumption increases the relative risk of any stroke while light or moderate alcohol consumption may be protective against ischemic stroke. Preventive measures that should be initiated are discussed.</p

Diabetes

This chapter reviews evidence on the link between alcohol consumption and the risk for type 2 diabetes. The results of individual studies vary. Some studies have found a linear inverse relationship association between alcohol consumption and incidence of type 2 diabetes. In the Nurses’ Health Study, alcohol consumption was associated with a lower risk of type 2 diabetes compared to abstention. The Health Professionals Follow-Up Study in males found a similar inverse association between alcohol consumption and type 2 diabetes. The Physician’s Health Study corroborates that consumption of alcohol in men has an inverse linear association with type 2 diabetes. In contrast, Holbrook et al. found a positive association between alcohol consumption and incidence of type 2 diabetes in men. A study in middle-aged men who consumed a substantial amount of alcohol (greater than 21 drinks per week) found a 50% increase in relative risk of type 2 diabetes compared with their counterparts who drank up to one drink per week

Alcohol consumption and risk of incident human immunodeficiency virus infection: a meta-analysis

To analyze the relationship between alcohol consumption and incident HIV infection.Articles were identified via electronic and hand searches. Inclusion criteria were: incident HIV infection, preceding alcohol consumption, and association relating the two. The DerSimonian and Laird random effects model was used. For studies with more than one estimate of a given type, estimates were combined using the inverse variance weighted method. Publication bias was assessed using Begg's and Egger's tests. Heterogeneity was assessed using Q and I (2) statistics.Ten studies were included. Overall alcohol consumption (any of the three types identified) increased the risk of HIV (RR 1.98, 95% CI 1.59-2.47). Alcohol consumers were at 77% higher risk (RR 1.77, 95% CI 1.43-2.19). Those consuming alcohol prior to, or at the time of, sexual relations were at an 87% increased risk (RR 1.87, 95% CI 1.39-2.50). For binge drinkers, the risk was double that of non-binge drinkers (RR 2.20, 95% CI 1.29-3.74).Alcohol consumption is associated with an increased risk of incident HIV infection. Additional research is required to further investigate a possible causal role

Does tailoring reduce attrition in web-based smoking cessation interventions? Systematic review and meta-analysis (Preprint)

Background: The growing number of internet users presents an opportunity to deliver health interventions to large populations. Despite their potential, many web-based interventions, including those for smoking cessation, face high rates of attrition. Further consideration of how intervention features impact attrition is needed. Objective: The objective of this systematic review is to identify whether tailored web-based smoking cessation interventions for smokers is associated with reduced attrition when compared to active or passive untailored web-based interventions. The outcomes of interest were loss to follow-up attrition at 1-, 3-, 6- and 12-months follow-up. Methods: Literature searches were conducted in May 2018 on MEDLINE, PsycINFO, CINAHL, PubMed and the Cochrane Tobacco Addiction Group Specialized Register with the following search terms: smoking cessation, tailored, web or internet-based. Included studies were published in English before or in 2018 using a randomized control trial (RCT) design. Studies were restricted to those with web-based delivery, a tailored intervention group, an untailored control group and a reported outcome of smoking cessation. Studies were assessed for methodological quality using the Cochrane Risk of Bias tool. Two reviewers independently extracted study characteristics and the number of participants lost to follow-up for each treatment group. Results: 14 studies were included in the systematic review, 12 of which were included in the meta-analysis. Tailoring had no statistically significant effect on loss to follow-up attrition at 1-month (RR= 1.02, 95% CI 0.95–1.09, P=.58), 3-months (RR=0.99, 95% CI 0.95-1.04, P=.80), 6-months (RR=1.00, 95% CI 0.95-1.05, P=.92) or 12-months (RR=0.97, 95% CI 0.92-1.02, P=.26) follow-up. Subgroup analyses suggested that there is a statistically significant effect of tailoring between the active and passive subgroups at 1-month (P=.03), 3-months (