Smoking Cessation in Stroke Survivors in the United States: A Nationwide Analysis

Abstract

Background and Purpose: Continued smoking after stroke is associated with a high risk of stroke recurrence and other cardiovascular disease. We sought to comprehensively understand the epidemiology of smoking cessation in stroke survivors in the United States. Furthermore, we compared smoking cessation in stroke and cancer survivors because cancer is another smoking-related condition in which smoking cessation is prioritized. Methods: We performed a cross-sectional analysis of data from the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System, an annual, nationally representative health survey. Using pooled data from 2013 to 2019, we identified stroke and cancer survivors with a history of smoking. We used survey procedures to estimate frequencies and summarize quit ratios with attention to demographic and geographic (state-wise and rural-urban) factors for stroke survivors. The quit ratio is conventionally defined as the proportion of ever smokers who have quit. Then, we used multivariable logistic regression to compare quit ratios in stroke and cancer survivors while adjusting for demographics and smoking-related comorbidities. Results: Among 4 434 604 Americans with a history of stroke and smoking, the median age was 68 years (interquartile range, 59–76), and 45.4% were women. The overall quit ratio was 60.8% (95% CI, 60.1%–61.6%). Quit ratios varied by age group, sex, race and ethnicity, and several geographic factors. There was marked geographic variation in quit ratios, ranging from 48.3% in Kentucky to 71.5% in California. Furthermore, compared with cancer survivors, stroke survivors were less likely to have quit smoking (odds ratio, 0.72 [95% CI, 0.67–0.79]) after accounting for differences in demographics and smoking-related comorbidities. Conclusions: There were considerable demographic and geographic disparities in smoking quit ratios in stroke survivors, who were less likely to have quit smoking than cancer survivors. A targeted initiative is needed to improve smoking cessation for stroke survivors.

Risk Factors Associated with Disability among Elderly with Stroke in Indonesia: A Secondary Data Analysis of 2018 National Basic Health Research

“…28 In addition, stroke survivors who smoke also have a greater increased risk of death than death from cancer. 29 The results of this study indicate that had smoking history is a protective factor of disability among the elderly with stroke may be due to the effects of passive smoking which were not examined in this study. 30 After controlling for other variables, there was a significant relationship between joint disease status with disability among elderly with stroke The adjusted prevalence ratio (aPR) result was 0.546 (CI 95%= 0.311-0.958), shows that had joint disease was the protective factor of disability among elderly with stroke.…”

Cost-Effectiveness of Smoking Cessation Interventions in Patients With Ischemic Stroke and Transient Ischemic Attack

“…1,3,[7][8][9]11,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] We used a quit rate of 35% with brief counseling alone, the usual care strategy that each intervention is compared with, based on population-based estimates from the United States and meta-analyses of cohort studies. 3,6 Quit rates associated with each of the 3 comparator interventions, used in addition to brief counseling, were based on meta-analyses and randomized trials that examined the effect of each of the 3 interventions on smoking cessation. [7][8][9]20,24,26 Key parameters for the Markov model were recurrent event rates that differed by smoking status.…”

“…4 Based on several estimates, only ≈40% of people quit smoking after stroke, and there are emerging data that smoking cessation strategies are underutilized after TIA and ischemic stroke. 3,5,6 An array of evidence-based smoking cessation interventions are available. In addition to counseling and behavioral interventions, several pharmacotherapies have been shown to increase the likelihood of successful smoking cessation, including nicotine replacement therapy, varenicline, and bupropion.…”

Electronic Cigarette Vape Exposure Exacerbates Post-Ischemic Outcomes in Female but Not in Male Rats

“…Therefore, a logical question arises: Will EC-attributed nicotine exposure have similar effects on brain energy metabolism, and will it worsen stroke outcomes? Since continuing smoking after an ischemic stroke increases the risk of recurrent and more disabling strokes, [12][13][14] cessation of smoking is recommended to lower the risk of recurrence. [14][15][16] Therefore, the current study evaluates the effects of EC vaping before induction of transient middle cerebral artery occlusion (tMCAO) on stroke outcomes in rats.…”