title: Smoking-Related Mortality in Patients With Early Rheumatoid Arthritis: A Retrospective Cohort Study Using the Clinical Practice Research Datalink.
abstract: To investigate the association between smoking status and smoking cessation with mortality in patients with rheumatoid arthritis (RA).
  
  
  
  An incident cohort of patients with RA was identified using the Clinical Practice Research Datalink, a database of UK primary care electronic medical records. Time-varying smoking status, years of cessation, and amount smoked were determined from patients' medical records. The date and underlying cause of death were identified by linkage with Office for National Statistics records. The associations between smoking status and smoking cessation with all-cause and cause-specific mortality (circulatory disease, all cancers, lung cancer, respiratory disease, and respiratory infection) were investigated using adjusted Cox (all-cause mortality) and Fine-Gray (cause-specific mortality) regression.
  
  
  
  The cohort comprised 5,677 patients (median age 61.4 years, 68% women), with 40% as never smokers, 34% former smokers, and 26% current smokers at baseline. Compared to never smoking, current smoking was associated with an increased risk of all-cause mortality (hazard ratio 1.98 [95% confidence interval (95% CI) 1.56, 2.53]), and mortality due to circulatory disease (subdistribution hazard ratio [SHR] 1.96 [95% CI 1.33, 2.90]) and lung cancer (SHR 23.2 [95% CI 5.15, 105]). Each year of smoking cessation was associated with a decreased risk of all-cause mortality (former heavy smokers SHR 0.85 [95% CI 0.77, 0.94], former light smokers SHR 0.90 [95% CI 0.84, 0.97]).
  
  
  
  Current smoking is associated with an increased risk of all-cause, cardiovascular, and lung cancer mortality in patients with RA. Each year of cessation is associated with a reduced risk of all-cause mortality. This information may prove helpful in smoking cessation programs for patients with RA.
authors.affiliation: NIHR Manchester Musculoskeletal Biomedical Research Centre, Central Manchester University Hospital NHS Foundation Trust, Manchester, UK.
authors.forename: Rebecca M
authors.identifier: 0000-0002-0147-0712
authors.initials: RM
authors.lastname: Joseph
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Movahedi
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK.
authors.forename: William G
authors.initials: WG
authors.lastname: Dixon
authors.affiliation: NIHR Manchester Musculoskeletal Biomedical Research Centre, Central Manchester University Hospital NHS Foundation Trust, and Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK. deborah.symmons@manchester.ac.uk.
authors.forename: Deborah P M
authors.initials: DP
authors.lastname: Symmons
mesh_terms: D001172:Arthritis, Rheumatoid / Q000150:complications / Q000401:mortality*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D002423:Cause of Death; D016208:Databases, Factual; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012140:Respiratory Tract Diseases / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000401:mortality*; D016540:Smoking Cessation / Q000706:statistics & numerical data; D006113:United Kingdom