Cigarette Smoking Among Adults With Selected Chronic Diseases

Abstract and Introduction

Abstract

Introduction: People who smoke cigarettes are at greater risk of developing chronic diseases and related complications. Our study provides recent estimates and trends in cigarette smoking among people with respiratory and cardiovascular diseases, cancers, and diabetes.

Methods; Using data from the 2019 National Health Interview Survey, we calculated the prevalence of current and former cigarette smoking among adults aged 18 to 44 years, 45 to 64 years, and 65 years or older with chronic diseases. Those diseases were cancers associated with smoking, chronic obstructive pulmonary disease, diabetes, coronary heart disease, and/or stroke (N = 3,741). Using data from the 2010–2019 National Health Interview Surveys, we assessed trends in current cigarette smoking by chronic disease by using the National Cancer Institute's Joinpoint Regression Program.

Results: In 2019, current cigarette smoking prevalence among adults with chronic diseases associated with smoking ranged from 6.0% among adults aged 65 or older with diabetes to 51.9% among adults aged 18 to 44 years with 2 or more chronic diseases. During 2010 through 2019, a significant decrease occurred in current cigarette smoking among adults aged 45 to 64 years with diabetes.

Conclusion: Overall, smoking prevalence remains high and relatively unchanged among people with chronic diseases associated with smoking, even as the overall prevalence of cigarette smoking in the US continues to decrease. The lack of progress in smoking cessation among adults with chronic diseases associated with smoking suggests that access, promotion, and integration of cessation treatment across the continuum of health care (ie, oncology, pulmonology, and cardiology settings) may be important in the success of smoking cessation in this population.

Introduction

Chronic diseases associated with cigarette smoking include respiratory and cardiovascular diseases, cancers, and diabetes.^[1] An estimated 16 million US adults live with a smoking-related disease.^[1] Cigarette smoking can increase the risk of chronic disease and subsequent complications and can lead to overall reduced quality of life.^[1] As of 2019, 34.1 million adults (14.0%) in the US currently smoke cigarettes.^[2]

Cigarette smoking is the predominant cause of lung cancer and chronic obstructive pulmonary disease (COPD). Furthermore, smoking increases one's risk of cardiovascular disease, several types of cancer, diabetes, and other chronic conditions.^[1,3–6] Although many studies have evaluated the effect of smoking on chronic disease development, few studies have assessed the prevalence of current cigarette smoking among adults with chronic diseases. The most recent published estimates of cigarette smoking among adults with asthma, diabetes, heart disease, hypertension, hepatitis, HIV, lung cancer, or stroke were reported using data from the 2013 National Survey on Drug Use and Health.^[7]

The objectives of our study were to 1) provide the most recent (2019) estimates of current and former cigarette smoking among adults aged 18 years or older with chronic diseases that can be associated with smoking (hereinafter, chronic disease) and 2) report temporal changes in current cigarette smoking among adults with chronic disease during 2010 through 2019.

Table 1. Prevalence of Cigarette Smoking by Chronic Disease Associated With Smoking Among Adults Aged ≥18 Years, National Health Interview Survey, US, 2019
Chronic disease, by age group	Current cigarette smoking,^a % (95% CI)	Former cigarette smoking, % (95% CI)
Aged 18–44 y
Any chronic disease^b	27.8 (23.3–32.3)	13.6 (10.6–16.6)
Chronic obstructive pulmonary disease	34.5 (25.5–43.4)	18.8 (11.5–26.2)
Coronary heart disease	34.4 (22.2–46.7	NR
Stroke	35.0 (23.1–46.8)	NR
Diabetes	22.6 (16.4–28.8)	14.5 (10.1–19.0)
Cancer associated with smoking^c	45.3 (31.8–58.8)	NR
≥2 Chronic diseases	51.9 (37.4–66.5)	20.0 (9.0–31.0)
Aged 45–64 y
Any chronic disease^b	26.0 (23.9–28.1)	28.2 (25.9–30.5)
Chronic obstructive pulmonary disease	49.1 (44.2–53.9)	32.5 (28.2–36.9)
Coronary heart disease	26.6 (22.5–30.6)	32.0 (27.6–36.4)
Stroke	29.8 (22.8–36.8)	24.7 (19.3–30.2)
Diabetes	17.3 (15.0–19.7)	27.9 (25.0–30.8)
Cancer associated with smoking^c	30.0 (22.5–37.4)	34.2 (26.0–42.4)
≥2 Chronic diseases	32.5 (27.8–37.1)	32.1 (27.6–36.7)
Aged ≥65 y
Any chronic disease^b	10.1 (9.0–11.3)	45.9 (44.0–47.7)
Chronic obstructive pulmonary disease	21.5 (18.4–24.5)	57.6 (54.1–61.1)
Coronary heart disease	7.8 (6.1–9.5)	51.3 (48.4–54.3)
Stroke	10.8 (7.8–13.7)	46.6 (42.5–50.7)
Diabetes	6.0 (4.7–7.4)	42.8 (39.9–45.8)
Cancer associated with smoking^c	14.0 (10.1–17.9)	48.5 (43.1–53.8)
≥2 Chronic diseases	10.7 (8.6–12.9)	53.9 (50.4–57.3)

Table 1. Prevalence of Cigarette Smoking by Chronic Disease Associated With Smoking Among Adults Aged ≥18 Years, National Health Interview Survey, US, 2019

Chronic disease, by age group

Current cigarette smoking,^a % (95% CI)

Former cigarette smoking, % (95% CI)

Aged 18–44 y

Any chronic disease^b

27.8 (23.3–32.3)

13.6 (10.6–16.6)

Chronic obstructive pulmonary disease

34.5 (25.5–43.4)

18.8 (11.5–26.2)

Coronary heart disease

34.4 (22.2–46.7

Stroke

35.0 (23.1–46.8)

Diabetes

22.6 (16.4–28.8)

14.5 (10.1–19.0)

Cancer associated with smoking^c

45.3 (31.8–58.8)

≥2 Chronic diseases

51.9 (37.4–66.5)

20.0 (9.0–31.0)

Aged 45–64 y

Any chronic disease^b

26.0 (23.9–28.1)

28.2 (25.9–30.5)

Chronic obstructive pulmonary disease

49.1 (44.2–53.9)

32.5 (28.2–36.9)

Coronary heart disease

26.6 (22.5–30.6)

32.0 (27.6–36.4)

Stroke

29.8 (22.8–36.8)

24.7 (19.3–30.2)

Diabetes

17.3 (15.0–19.7)

27.9 (25.0–30.8)

Cancer associated with smoking^c

30.0 (22.5–37.4)

34.2 (26.0–42.4)

≥2 Chronic diseases

32.5 (27.8–37.1)

32.1 (27.6–36.7)

Aged ≥65 y

Any chronic disease^b

10.1 (9.0–11.3)

45.9 (44.0–47.7)

Chronic obstructive pulmonary disease

21.5 (18.4–24.5)

57.6 (54.1–61.1)

Coronary heart disease

7.8 (6.1–9.5)

51.3 (48.4–54.3)

Stroke

10.8 (7.8–13.7)

46.6 (42.5–50.7)

Diabetes

6.0 (4.7–7.4)

42.8 (39.9–45.8)

Cancer associated with smoking^c

14.0 (10.1–17.9)

48.5 (43.1–53.8)

≥2 Chronic diseases

10.7 (8.6–12.9)

53.9 (50.4–57.3)

Table 2. Trends in Current Cigarette Smoking by Age Group and Chronic Disease in the US, National Health Interview Survey, 2010–2019
Chronic disease, by age group	Current cigarette smoking^a
Annual percentage change^b (95% CI)	P value
Aged 18–44 y
Any chronic disease^c	−2.3 (−4.8 to 0.3)	.07
Chronic obstructive pulmonary disease	−2.1 (−4.3 to 0.1)	.06
Coronary heart disease	NR	NR
Stroke	0 (−5.6 to 5.8)	.99
Diabetes	0 (−2.6 to 2.7)	.99
Cancer associated with smoking^d	−3.5 (−8.6 to 1.9)	.17
≥2 chronic diseases	−0.9 (−6.5 to 4.9)	.71
Aged 45–64 y
Any chronic disease^c	−0.8 (−1.9 to 0.3)	.15
Chronic obstructive pulmonary disease	1.2 (−0.7 to 3.2)	.17
Coronary heart disease	−0.8 (−2.2 to 0.7)	.28
Stroke	−1.1 (−3.1 to 1.0)	.27
Diabetes	−1.8 (−3.4 to −0.1)	.04
Cancer associated with smoking^d	−0.8 (−3.4 to 1.9)	.51
≥2 chronic diseases	0.3 (−1.5 to 2.1)	.75
Aged ≥65 y
Any chronic disease^c	0.7 (−0.7 to 2.2)	.28
Chronic obstructive pulmonary disease	−0.2 (−2.0 to 1.5)	.76
Coronary heart disease
2010–2016	5.3 (0.3 to 10.5)	.04
2016–2019	−8.6 (−20.2 to 4.7)	.15
Stroke	−0.3 (−4.6 to 4.3)	.89
Diabetes	−0.8 (−3.5 to 2.1)	.54
Cancer associated with smoking^d	3.8 (−1.6 to 9.6)	.15
≥2 Chronic diseases
2010–2016	3.8 (−1.8 to 9.8)	.15
2016–2019	−9.6 (−21.9 to 4.7)	.07

Table 2. Trends in Current Cigarette Smoking by Age Group and Chronic Disease in the US, National Health Interview Survey, 2010–2019

Chronic disease, by age group

Current cigarette smoking^a

Annual percentage change^b (95% CI)

P value

Aged 18–44 y

Any chronic disease^c

−2.3 (−4.8 to 0.3)

.07

Chronic obstructive pulmonary disease

−2.1 (−4.3 to 0.1)

.06

Coronary heart disease

Stroke

0 (−5.6 to 5.8)

.99

Diabetes

0 (−2.6 to 2.7)

.99

Cancer associated with smoking^d

−3.5 (−8.6 to 1.9)

.17

≥2 chronic diseases

−0.9 (−6.5 to 4.9)

.71

Aged 45–64 y

Any chronic disease^c

−0.8 (−1.9 to 0.3)

.15

Chronic obstructive pulmonary disease

1.2 (−0.7 to 3.2)

.17

Coronary heart disease

−0.8 (−2.2 to 0.7)

.28

Stroke

−1.1 (−3.1 to 1.0)

.27

Diabetes

−1.8 (−3.4 to −0.1)

.04

Cancer associated with smoking^d

−0.8 (−3.4 to 1.9)

.51

≥2 chronic diseases

0.3 (−1.5 to 2.1)

.75

Aged ≥65 y

Any chronic disease^c

0.7 (−0.7 to 2.2)

.28

Chronic obstructive pulmonary disease

−0.2 (−2.0 to 1.5)

.76

Coronary heart disease

2010–2016

5.3 (0.3 to 10.5)

.04

2016–2019

−8.6 (−20.2 to 4.7)

.15

Stroke

−0.3 (−4.6 to 4.3)

.89

Diabetes

−0.8 (−3.5 to 2.1)

.54

Cancer associated with smoking^d

3.8 (−1.6 to 9.6)

.15

≥2 Chronic diseases

2010–2016

3.8 (−1.8 to 9.8)

.15

2016–2019

−9.6 (−21.9 to 4.7)

.07

Cigarette Smoking Among US Adults With Selected Chronic Diseases Associated With Smoking, 2010–2019

Abstract and Introduction

Abstract

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