title: Burden of smoking among adults with COPD, chronic bronchitis, and emphysema in urban China.
abstract: OBJECTIVE
  Tobacco, widely used in China, poses a major risk for chronic obstructive pulmonary disease (COPD). This study assessed health outcomes of COPD-diagnosed smokers vs. never smokers and examined treatment patterns of patients attempting to quit smoking in urban China.
  
  
  METHODS
  National Health and Wellness Survey (NHWS) 2010 and 2012 China data were analysed. Respondents self-reporting diagnosis with COPD, chronic bronchitis, or emphysema were categorised: quit attempters (current smokers 'trying to quit' or non-smokers 'in the process of quitting'), smokers (including quit attempters) and those who never smoked. Respondents reported smoking cessation treatment utilisation; health status: SF-36v2-based scores and SF-6D health utilities; Work Productivity and Activity Impairment questionnaire-based metrics; and resource utilisation. Regression modelling assessed health outcomes, controlling for covariates.
  
  
  RESULTS
  Among 1421 (3.6%) diagnosed respondents, 51.6% never smoked and 35.5% smoked (of whom, 43.8% were attempting to quit). After adjustments, smokers vs. never smokers had significantly lower health utilities, lower mental/physical health status and greater absenteeism, presenteeism, overall work impairment, activity impairment, emergency room visits, hospitalisations and provider visits. Quit attempters were diagnosed an average 6.9 years (SD = 7.7) previously, with 25.3% reporting moderate/severe COPD. Most-reported main causes of COPD were: smoking (57.5%), illnesses/conditions (53.8%) and pollutants (44.3%). Among quit attempters, 82.8% smoked currently. Use of prescription cessation treatments was reported by 12.7%.
  
  
  CONCLUSIONS
  Smokers experienced poorer health outcomes, reinforcing importance of prevention in mitigating disease burden. Among quit attempters, few reported using prescription cessation treatments. Given the high burden imposed by smoking in China, effective interventions may be beneficial.
authors.affiliation: Kantar Health, New York, NY, USA.
authors.forename: A
authors.identifier: http://orcid.org/0000-0002-4388-8869
authors.initials: A
authors.lastname: Goren
authors.affiliation: Kantar Health, Princeton, NJ, USA.
authors.forename: S
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Pfizer Investment Co., Ltd., Beijing, China.
authors.forename: P
authors.initials: P
authors.lastname: Dong
authors.affiliation: Pfizer Investment Co., Ltd., Beijing, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Feng
authors.affiliation: Pfizer Investment Co., Ltd., Beijing, China.
authors.forename: C
authors.initials: C
authors.lastname: Chen
authors.affiliation: Pfizer Investment Co., Ltd., Beijing, China.
authors.forename: D
authors.initials: D
authors.lastname: Liu
mesh_terms: D000041:Absenteeism; D000328:Adult; D000368:Aged; D029481:Bronchitis, Chronic / Q000453:epidemiology*; D002681:China / Q000453:epidemiology; D017281:Cost of Illness; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology*; D011656:Pulmonary Emphysema / Q000453:epidemiology*; D011788:Quality of Life; D012044:Regression Analysis; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*; D014505:Urban Population / Q000706:statistics & numerical data