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postgraduate thesis: The impact of smoking in Chinese older persons in Hong Kong: a life table analysis

TitleThe impact of smoking in Chinese older persons in Hong Kong: a life table analysis
Authors
Advisors
Issue Date2012
PublisherThe University of Hong Kong (Pokfulam, Hong Kong)
AbstractBackground Smoking is a well known risk factor for increased mortality. Although some smokers may survive to older ages, they often suffer from poor health and impaired quality of life (QoL) because of chronic diseases. The construct of health-adjusted life expectancy (HALE) combines mortality and the subjective perception of health-related quality of life (HRQoL) into a single index. The impact of smoking on HALE might be useful information for encouraging smokers to quit or young people not to start smoking. However, scarce information is available, particularly from Chinese populations, on how smoking affects HALE. Aims The study aimed to determine the impact of smoking on HALE among Chinese people aged 65 years or over in Hong Kong who had enrolled in an Elderly Health Centre (EHC). Methods Data on a cohort of 66,820 people enrolled in EHCs of the Department of Health during 1998 to 2001, were used. These were supplemented by a follow-up telephone survey of a stratified (for smoking status) sample of 2,441 from the whole EHC database, which included more recent enrollees. Two measures of HALE were used: (1) based on a simple measure of perceived health and (2) based on quality-adjusted life years (QALYs) estimated. The first measure had been included in the EHC database but current information was obtained by telephone for each year of follow-up. The second measure was only available from the survey. Multi-state life tables and Sullivan?s method were employed to investigate HALEs among current, ex and never smokers. The yearly transition rates between health statuses were calculated using the existing data on self-assessed health and supplemented by the survey data. Utility scores for calculation of QALYs used a local estimation equation for the SF-12. Results Men at age 65 who had never smoked could expect to live a further 20 years and women a further 22 years. This was around 3-5 years more than for current or ex-smokers. Both male and female never smokers at age 65 could expect to be in a good QoL for 16 of those future years. Those still smoking at age 65 could expect 3-4 fewer years in a good QoL. People who had quit smoking before age 65 gained about one more year in good health compared with continuing smokers. Conclusions It has already been estimated that smokers of all ages lose up to about 10 years of life due to smoking. However, the longer they survive, the lower the difference in mortality between ever smoker and never smokers. This study shows that, for those who were still alive at age 65 years in this cohort, smoking was still detrimental to their survival and to their QoL, especially if they were still smoking at that age. Results for males and females were similar. Therefore, even if a smoker does not die prematurely, their HRQoL is still affected and a never smoker will have not only longer life but more life years in good health than an ever smoker. Stopping smoking at an earlier age might gain back some HRQoL.
DegreeMaster of Philosophy
SubjectOlder people - Tobacco use - China - Hong Kong.
Dept/ProgramCommunity Medicine

 

DC FieldValueLanguage
dc.contributor.advisorMcGhee, S-
dc.contributor.advisorFielding, R-
dc.contributor.authorCheung, Wai-ling.-
dc.contributor.author張惠棱.-
dc.date.issued2012-
dc.description.abstractBackground Smoking is a well known risk factor for increased mortality. Although some smokers may survive to older ages, they often suffer from poor health and impaired quality of life (QoL) because of chronic diseases. The construct of health-adjusted life expectancy (HALE) combines mortality and the subjective perception of health-related quality of life (HRQoL) into a single index. The impact of smoking on HALE might be useful information for encouraging smokers to quit or young people not to start smoking. However, scarce information is available, particularly from Chinese populations, on how smoking affects HALE. Aims The study aimed to determine the impact of smoking on HALE among Chinese people aged 65 years or over in Hong Kong who had enrolled in an Elderly Health Centre (EHC). Methods Data on a cohort of 66,820 people enrolled in EHCs of the Department of Health during 1998 to 2001, were used. These were supplemented by a follow-up telephone survey of a stratified (for smoking status) sample of 2,441 from the whole EHC database, which included more recent enrollees. Two measures of HALE were used: (1) based on a simple measure of perceived health and (2) based on quality-adjusted life years (QALYs) estimated. The first measure had been included in the EHC database but current information was obtained by telephone for each year of follow-up. The second measure was only available from the survey. Multi-state life tables and Sullivan?s method were employed to investigate HALEs among current, ex and never smokers. The yearly transition rates between health statuses were calculated using the existing data on self-assessed health and supplemented by the survey data. Utility scores for calculation of QALYs used a local estimation equation for the SF-12. Results Men at age 65 who had never smoked could expect to live a further 20 years and women a further 22 years. This was around 3-5 years more than for current or ex-smokers. Both male and female never smokers at age 65 could expect to be in a good QoL for 16 of those future years. Those still smoking at age 65 could expect 3-4 fewer years in a good QoL. People who had quit smoking before age 65 gained about one more year in good health compared with continuing smokers. Conclusions It has already been estimated that smokers of all ages lose up to about 10 years of life due to smoking. However, the longer they survive, the lower the difference in mortality between ever smoker and never smokers. This study shows that, for those who were still alive at age 65 years in this cohort, smoking was still detrimental to their survival and to their QoL, especially if they were still smoking at that age. Results for males and females were similar. Therefore, even if a smoker does not die prematurely, their HRQoL is still affected and a never smoker will have not only longer life but more life years in good health than an ever smoker. Stopping smoking at an earlier age might gain back some HRQoL.-
dc.languageeng-
dc.publisherThe University of Hong Kong (Pokfulam, Hong Kong)-
dc.relation.ispartofHKU Theses Online (HKUTO)-
dc.rightsThe author retains all proprietary rights, (such as patent rights) and the right to use in future works.-
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.source.urihttp://hub.hku.hk/bib/B48079923-
dc.subject.lcshOlder people - Tobacco use - China - Hong Kong.-
dc.titleThe impact of smoking in Chinese older persons in Hong Kong: a life table analysis-
dc.typePG_Thesis-
dc.identifier.hkulb4807992-
dc.description.thesisnameMaster of Philosophy-
dc.description.thesislevelMaster-
dc.description.thesisdisciplineCommunity Medicine-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.5353/th_b4807992-
dc.date.hkucongregation2012-

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