Healthcare factors, rather than sociodemographic factors, are more predictive of potential smoking cessation in patients with rheumatoid arthritis (RA), according to research published in Arthritis Care & Research. These results demonstrate the importance of the health system in promoting smoking cessation efforts among this patient population.

Researchers sought to identify predictors of smoking cessation in patients with RA in order to guide implementation efforts for future cessation interventions. Electronic health records for patients at 2 Midwestern health systems were used to screen for cohort eligibility.

The total cohort included 3577 patients across both health systems, of whom 26% were former smokers (n=915) and 14% were current smokers (n=507). Current smokers were more frequently men and between 40 and 59 years of age; patients in this group were also more likely to be black (4.1% of current smokers vs 1.5% of never smokers) and to have Medicaid insurance (42.8% of current smokers vs 15.2% of never smokers).

Cardiac comorbidities were common at baseline in current and never smokers but were 2 times more common in former smokers; pulmonary comorbidities were more common among current and former smokers than in never smokers. Diabetes was also most common among former smokers.


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The investigators found that among patients with RA who were baseline smokers, being new to rheumatology care increased a patient’s odds of smoking cessation by 60% (adjusted odds ratio [aOR] 1.60; 95% CI, 1.02-2.50). Patients within the rural community health system were 1.66 times more likely to quit smoking (aOR 1.66; 95% CI, 1.03-2.69). Seropositivity decreased a patient’s odds of quitting by 43% (aOR 0.57; 95% CI, 0.35-0.91), while age, sex, race, ethnicity, and ever having Medicaid coverage were not predictive of smoking cessation.

Results of a generalized linear mixed model sensitivity analysis, which accounted for clustering by health system, found that seropositivity remained significant while newness to rheumatology care did not reach statistical significance.

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Study limitations included unmeasured differences in patient populations, like education level and income, data being underpowered to detect some differences based on race and ethnicity, the potential of misclassification bias, and an inability to capture interim quit attempts and recidivism.

“Our findings identify further opportunities to target cessation efforts to patients who are new to rheumatology care or seropositive,” the researchers concluded. “The results of this study 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.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Schletzbaum M, Wang X, Greenlee R, Piper ME, Bartels CM. Predictors of smoking cessation in patients with rheumatoid arthritis in two cohorts: Healthcare factors most predictive [published online March 3, 2020]. Arthritis Care Res. doi: 10.1002/acr.24154