Our aim was to describe how the prevalence of subjects exposed to environmental tobacco smoke (ETS) has changed from 1992 to 2012 in Finland. We also investigated the association between ETS and ...chronic bronchitis and cause-specific and all-cause mortality.
The study population is composed of 38 494 subjects aged 25–74 years who participated in the National FINRISK Study between 1992 and 2012. Each survey included a standardized questionnaire on exposure to ETS, symptoms of chronic bronchitis, smoking habits and other risk factors, and clinical measurements at the study site. Data on mortality was obtained from the National Causes of Death Register.
In 2012, 5% of the participants were exposed to ETS compared to 25% in 1992. The adjusted odds ratio (OR) for ETS exposure in 2012 compared with that in 1992 was 0.27, p < 0.001. Exposure to ETS was more common in men than in women and among smokers than in non-smokers. Exposure to ETS was in turn associated with chronic bronchitis, OR 1.63 (95% confidence interval 1.49–1.78), – also separately both at work (OR 1.36) and at home (OR 1.69). Subjects with exposure to ETS had significantly increased all-cause (hazard ratio = HR 1.15, 1.05–1.26) and cardiovascular mortality (HR 1.26, 1.07–1.47). However, when stratified by smoking ETS was associated with all-cause mortality only in smokers (HR 1.31, 1.15–1.48).
The proportion of subjects exposed to ETS decreased substantially during the study. Additionally, ETS exposure was associated with chronic bronchitis throughout the study and increased all-cause and cardiovascular mortality.
•In 2012, 5% of the participants were exposed to ETS compared to 25% in 1992.•ETS exposure was associated with chronic bronchitis (OR 1.63) throughout the study.•ETS exposure was associated with increased all-cause and cardiovascular mortality.•Stratified by smoking, ETS increased the all-cause mortality risk only in smokers.•Chronic bronchitis strengthened the effect of ETS on all-cause mortality in men.
The present study examines how trends in the prevalence of asthma during the past three decades associate with hospitalization and mortality during the same period.
Altogether 54 320 subjects aged ...25–74 years were examined in seven independent cross-sectional population surveys repeated every five years between 1982 and 2012 in Finland. The study protocol included a standardized questionnaire on self-reported asthma, smoking habits and other risk factors, and clinical measurements at the study site. Data on hospitalizations were obtained from the Care Register for Health Care, and data on mortality from the National Causes of Death register.
During the study, the prevalence of asthma increased - especially in women. In asthmatic compared with non-asthmatic subjects, hospitalization was significantly higher for all causes, respiratory causes, cardiovascular causes and lung cancer. In addition, particularly in asthmatic subjects, mean yearly hospital days in the 5-year periods after each survey diminished. In asthmatic subjects, the decrease in yearly all-cause hospital days was from 4.45 (between 1982 and 1987) to 1.11 (between 2012 and 2015) and in subjects without asthma the corresponding decrease was from 1.77 to 0.60 (p < 0.001). Similarly between 1982 and 2015, COPD hospitalization decreased more in asthmatic than in non-asthmatic subjects. Generally in the present study, all-cause mortality decreased between 1982 and 2015, though mortality in asthmatic subjects compared with non-asthmatics was higher from all causes, respiratory causes and lung cancer.
There was an increasing trend in the prevalence of asthma and a declining trend in hospitalization, especially in asthmatic subjects.
•During the past three decades the asthma prevalence has increased, especially in women.•Simultaneously, there was a decreasing trend in hospitalization, especially in asthmatics.•However, in asthmatics hospitalization was significantly higher than in non-asthmatics.•Additionally, in asthmatics compared with non-asthmatics mortality was higher during the study.
Abstract Background The study examines the predictive value of chronic bronchitis for all cause and cause-specific hospitalizations and for mortality during the last three decades. Methods The study ...population consists of altogether 47 896 men and women aged 25–74 years who participated in the National FINRISK Study between 1982 and 2007. The study protocol included a standardized questionnaire on the symptoms of chronic bronchitis, smoking habits and other risk factors and clinical measurements at the study site. Data on hospitalizations were obtained from the National Hospital Discharge Registry, and data on the underlying causes of deaths from the National Causes of Death register. The study cohorts were followed up until the end of 2011. Results In study subjects with symptoms of chronic bronchitis the mean annual days of hospitalization were almost two-fold higher than in study subjects without chronic bronchitis. The increase was seen in all age -groups and both in 5-year periods for each cohort and during the whole 30-year follow-up. More specifically, hospitalizations were increased for respiratory diseases and cancer. Chronic bronchitis increased hospitalizations more in smokers and ex-smokers than in never smokers. Furthermore, chronic bronchitis was associated with increased all-cause mortality (hazard ratio (HR) 1.23) and mortality from respiratory causes, cardiovascular diseases and cancer. Smokers and ex-smokers with chronic bronchitis had an increased risk to die (HRs 2.89 and 1.69, respectively) compared with never-smokers without chronic bronchitis. Conclusion Symptoms of chronic bronchitis can help to identify individuals who are at risk for increased hospitalizations and mortality.
Summary Introduction The present study examines how the trends in the prevalence of chronic bronchitis during the last three decades associate with changes in smoking habits during the same period. ...Methods Altogether 47 896 subjects aged 25–74 years were examined in six independent cross-sectional population surveys repeated every five years between 1982 and 2007 in Finland. The presence of chronic bronchitis, smoking habits and other risk factors were measured by standard questionnaires. Results During the study, the prevalence of chronic bronchitis was significantly higher in men than in women. In men aged 25–64 years, the prevalence of chronic bronchitis decreased from 19% in 1982 to 13% in 2007 ( p for trend <0.001). The corresponding decrease in women aged 25–64 years was from 13% to 11% ( p for trend 0.009). In men aged 65–74 years, the prevalence of chronic bronchitis decreased from 24% to 19% ( p for trend 0.032). Simultaneously, male smoking decreased and smoking in middle-aged women increased. However, adjusting for the changes in smoking habits did not change the declining trends in the prevalence of chronic bronchitis. The significant declining trend in chronic bronchitis was seen separately in male current smokers and in male and female never smokers aged 45–74 years and the declining trend was the greatest in male current smokers. In general, female smokers with chronic bronchitis had smoked less than their male counterparts. Conclusion There was a declining trend in the prevalence of chronic bronchitis which was probably explained by both a decrease in smoking and by other factors.
To describe the recent findings concerning the relationship between smoking, chronic bronchitis, chronic obstructive pulmonary disease and mortality.
During their lifetime, over 40% of smokers ...develop chronic bronchitis. Chronic bronchitis is associated with an accelerated decline in lung function - a risk of developing chronic obstructive pulmonary disease and mortality. Approximately one-quarter of smokers can be affected by clinically significant chronic obstructive pulmonary disease. The incidence of chronic obstructive pulmonary disease is also substantial in young adults. Smokers may reduce their risk of developing chronic obstructive pulmonary disease by physical activity and increase their survival by smoking reduction. In adults and the elderly population, severe chronic obstructive pulmonary disease is associated with the most rapid decline in lung function, which is, in turn, associated with chronic obstructive pulmonary disease-related hospitalization and mortality. Using a fixed forced expiratory volume in 1 s/force vital capacity ratio (0.7) to define obstruction in chronic obstructive pulmonary disease at old age is acceptable. In chronic obstructive pulmonary disease patients, the disease is still underreported on death certificates. Chronic mucus production and being a female are associated with chronic obstructive pulmonary disease mentioned on death certificates.
Chronic bronchitis is a marker identifying high-risk individuals. With respect to chronic obstructive pulmonary disease and mortality, interventions to promote smoking cessation are important to reduce these risks.
Polygenic risk scores (PRSs) have shown promise in predicting susceptibility to common diseases
. We estimated their added value in clinical risk prediction of five common diseases, using large-scale ...biobank data (FinnGen; n = 135,300) and the FINRISK study with clinical risk factors to test genome-wide PRSs for coronary heart disease, type 2 diabetes, atrial fibrillation, breast cancer and prostate cancer. We evaluated the lifetime risk at different PRS levels, and the impact on disease onset and on prediction together with clinical risk scores. Compared to having an average PRS, having a high PRS contributed 21% to 38% higher lifetime risk, and 4 to 9 years earlier disease onset. PRSs improved model discrimination over age and sex in type 2 diabetes, atrial fibrillation, breast cancer and prostate cancer, and over clinical risk in type 2 diabetes, breast cancer and prostate cancer. In all diseases, PRSs improved reclassification over clinical thresholds, with the largest net reclassification improvements for early-onset coronary heart disease, atrial fibrillation and prostate cancer. This study provides evidence for the additional value of PRSs in clinical disease prediction. The practical applications of polygenic risk information for stratified screening or for guiding lifestyle and medical interventions in the clinical setting remain to be defined in further studies.
To describe the 30-year cumulative incidence of chronic bronchitis and COPD in relation to smoking habits. The effect of chronic bronchitis on pulmonary function and mortality was also examined.
...Middle-aged men belonging to two rural Finnish cohorts of the Seven Countries Study (n = 1,711 in 1959) were followed up for up to 40 years until 2000. Standard questionnaires were used to measure chronic bronchitis, and repeated spirometry was used to evaluate pulmonary function during the 30 years. Forty-year mortality data were examined.
The cumulative incidence of chronic bronchitis and COPD was 42% and 32%, respectively, in continuous smokers, compared to 26% and 14% in ex-smokers and 22% and 12% in never-smokers. During the follow-up, subjects with chronic bronchitis had on average 252 mL (95% confidence interval, 211 to 293 mL) lower forced expiratory volume than those without it. The decrease in forced expiratory volume attributable to chronic bronchitis was most pronounced in those with persistent symptoms and in smokers. In subjects with chronic bronchitis, all-cause mortality was increased by a hazard ratio of 1.30 (95% confidence interval, 1.02 to 1.65). Smokers with chronic bronchitis who decreased their daily cigarette consumption increased their median life span by 2.4 years.
The lifetime risk of chronic bronchitis among smokers is approximately two in five, and almost one half of smokers who have chronic bronchitis also acquire COPD. Chronic bronchitis is related to earlier death, also in never-smokers, probably partly through a rapid decline in pulmonary function.
To describe the 30-year cumulative incidence of chronic bronchitis and COPD in relation to smoking habits. The effect of chronic bronchitis on pulmonary function and mortality was also examined.
...Middle-aged men belonging to two rural Finnish cohorts of the Seven Countries Study (n = 1,711 in 1959) were followed up for up to 40 years until 2000. Standard questionnaires were used to measure chronic bronchitis, and repeated spirometry was used to evaluate pulmonary function during the 30 years. Forty-year mortality data were examined.
The cumulative incidence of chronic bronchitis and COPD was 42% and 32%, respectively, in continuous smokers, compared to 26% and 14% in ex-smokers and 22% and 12% in never-smokers. During the follow-up, subjects with chronic bronchitis had on average 252 mL (95% confidence interval, 211 to 293 mL) lower forced expiratory volume than those without it. The decrease in forced expiratory volume attributable to chronic bronchitis was most pronounced in those with persistent symptoms and in smokers. In subjects with chronic bronchitis, all-cause mortality was increased by a hazard ratio of 1.30 (95% confidence interval, 1.02 to 1.65). Smokers with chronic bronchitis who decreased their daily cigarette consumption increased their median life span by 2.4 years.
The lifetime risk of chronic bronchitis among smokers is approximately two in five, and almost one half of smokers who have chronic bronchitis also acquire COPD. Chronic bronchitis is related to earlier death, also in never-smokers, probably partly through a rapid decline in pulmonary function.
The importance of physical activity for health is well recognized, but little is known about the influence of physical activity on pulmonary function. We have examined whether physical activity could ...slow down the decline in pulmonary function among the southwestern rural Finnish cohort of the Seven Countries Study. Physical activity was estimated by kilometers walked, cycled, and skied daily. We had complete data for 429 men for 10 years, 275 men for 20 years, and 186 men for 25 years. During the first 10 years, the decline in FEV was 9.8 ml/year less among men in the highest tertile of baseline physical activity than in men in the lowest tertile. According to the mean physical activity over either 20 or 25 years, men in the highest tertile also lost less pulmonary function (p = 0.009 and p = 0.043, respectively). A similar beneficial effect was observed in all smoking categories. In mortality analysis, continued high physical activity and an increase in activity to high level were associated with lower mortality. In conclusion, results indicated that physical activity is associated with a slower decline in pulmonary function and with lower mortality, and thus, middle-aged and older people should be encouraged to enjoy exercise.
BACKGROUND Although it is well known that impaired pulmonary function is a strong predictor of mortality and that smoking decreases pulmonary function, little is known about the long term effect of ...smoking cessation on mortality at different levels of pulmonary function. We have studied the impact of smoking cessation on mortality over the entire range of baseline pulmonary function. METHODS The study subjects consisted of men aged 40–59 at entry who were the Finnish participants in the Seven Countries Study during 1959–89. RESULTS In all the participants (n = 1582) impaired forced expiratory volume in 0.75 seconds (FEV0.75) was significantly associated with increased all cause mortality. When those who gave up smoking during the follow up period were compared with continuous smokers (n = 860) all cause mortality was found to be decreased among those who quit. The relative adjusted hazard (HR) was 0.71 (95% confidence interval 0.50 to 1.00). The median survival time in those who stopped smoking compared with those who continued to smoke from 1969 onwards was 7.65, 7.59, and 6.30 years longer in the lowest, middle and highest tertiles of adjusted FEV0.75 distribution, respectively. In those who gave up smoking, mortality from cardiovascular causes was significantly lower (HR 0.60 (95% CI 0.37 to 0.98)). CONCLUSIONS These findings suggest that smokers across the entire range of pulmonary function may increase their expectation of lifespan by giving up smoking.
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