Mortality attributable to smoking among HIV-1-infected individuals: a nationwide, population-based cohort study

We assessed mortality attributable to smoking among patients with human immunodeficiency virus (HIV). We estimated mortality rates (MRs), mortality rate ratios (MRRs), life expectancies, life-years lost, and population-attributable risk of death associated with smoking and with HIV among current and...

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Published in:Clinical infectious diseases Vol. 56; no. 5; p. 727
Main Authors: Helleberg, Marie, Afzal, Shoaib, Kronborg, Gitte, Larsen, Carsten S, Pedersen, Gitte, Pedersen, Court, Gerstoft, Jan, Nordestgaard, Børge G, Obel, Niels
Format: Journal Article
Language:English
Published: United States 01.03.2013
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ISSN:1537-6591, 1537-6591
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Abstract We assessed mortality attributable to smoking among patients with human immunodeficiency virus (HIV). We estimated mortality rates (MRs), mortality rate ratios (MRRs), life expectancies, life-years lost, and population-attributable risk of death associated with smoking and with HIV among current and nonsmoking individuals from a population-based, nationwide HIV cohort and a cohort of matched HIV-negative individuals. A total of 2921 HIV patients and 10 642 controls were followed for 14 281 and 45 122 person-years, respectively. All-cause and non-AIDS-related mortality was substantially increased among smoking compared to nonsmoking HIV patients (MRR, 4.4 [95% confidence interval {CI}, 3.0-6.7] and 5.3 [95% CI, 3.2-8.8], respectively). Excess MR per 1000 person-years among current vs nonsmokers was 17.6 (95% CI, 13.3-21.9) for HIV patients and 4.8 (95% CI, 3.2-6.4) for controls. A 35-year-old HIV patient had a median life expectancy of 62.6 years (95% CI, 59.9-64.6) for smokers and 78.4 years (95% CI, 70.8-84.0) for nonsmokers; the numbers of life-years lost in association with smoking and HIV were 12.3 (95% CI, 8.1-16.4) and 5.1 (95% CI, 1.6-8.5). The population-attributable risk of death associated with smoking was 61.5% among HIV patients and 34.2% among controls. In a setting where HIV care is well organized and antiretroviral therapy is free of charge, HIV-infected smokers lose more life-years to smoking than to HIV. The excess mortality of smokers is tripled and the population-attributable risk of death associated with smoking is doubled among HIV patients compared to the background population.
AbstractList We assessed mortality attributable to smoking among patients with human immunodeficiency virus (HIV). We estimated mortality rates (MRs), mortality rate ratios (MRRs), life expectancies, life-years lost, and population-attributable risk of death associated with smoking and with HIV among current and nonsmoking individuals from a population-based, nationwide HIV cohort and a cohort of matched HIV-negative individuals. A total of 2921 HIV patients and 10 642 controls were followed for 14 281 and 45 122 person-years, respectively. All-cause and non-AIDS-related mortality was substantially increased among smoking compared to nonsmoking HIV patients (MRR, 4.4 [95% confidence interval {CI}, 3.0-6.7] and 5.3 [95% CI, 3.2-8.8], respectively). Excess MR per 1000 person-years among current vs nonsmokers was 17.6 (95% CI, 13.3-21.9) for HIV patients and 4.8 (95% CI, 3.2-6.4) for controls. A 35-year-old HIV patient had a median life expectancy of 62.6 years (95% CI, 59.9-64.6) for smokers and 78.4 years (95% CI, 70.8-84.0) for nonsmokers; the numbers of life-years lost in association with smoking and HIV were 12.3 (95% CI, 8.1-16.4) and 5.1 (95% CI, 1.6-8.5). The population-attributable risk of death associated with smoking was 61.5% among HIV patients and 34.2% among controls. In a setting where HIV care is well organized and antiretroviral therapy is free of charge, HIV-infected smokers lose more life-years to smoking than to HIV. The excess mortality of smokers is tripled and the population-attributable risk of death associated with smoking is doubled among HIV patients compared to the background population.
We assessed mortality attributable to smoking among patients with human immunodeficiency virus (HIV).BACKGROUNDWe assessed mortality attributable to smoking among patients with human immunodeficiency virus (HIV).We estimated mortality rates (MRs), mortality rate ratios (MRRs), life expectancies, life-years lost, and population-attributable risk of death associated with smoking and with HIV among current and nonsmoking individuals from a population-based, nationwide HIV cohort and a cohort of matched HIV-negative individuals.METHODSWe estimated mortality rates (MRs), mortality rate ratios (MRRs), life expectancies, life-years lost, and population-attributable risk of death associated with smoking and with HIV among current and nonsmoking individuals from a population-based, nationwide HIV cohort and a cohort of matched HIV-negative individuals.A total of 2921 HIV patients and 10 642 controls were followed for 14 281 and 45 122 person-years, respectively. All-cause and non-AIDS-related mortality was substantially increased among smoking compared to nonsmoking HIV patients (MRR, 4.4 [95% confidence interval {CI}, 3.0-6.7] and 5.3 [95% CI, 3.2-8.8], respectively). Excess MR per 1000 person-years among current vs nonsmokers was 17.6 (95% CI, 13.3-21.9) for HIV patients and 4.8 (95% CI, 3.2-6.4) for controls. A 35-year-old HIV patient had a median life expectancy of 62.6 years (95% CI, 59.9-64.6) for smokers and 78.4 years (95% CI, 70.8-84.0) for nonsmokers; the numbers of life-years lost in association with smoking and HIV were 12.3 (95% CI, 8.1-16.4) and 5.1 (95% CI, 1.6-8.5). The population-attributable risk of death associated with smoking was 61.5% among HIV patients and 34.2% among controls.RESULTSA total of 2921 HIV patients and 10 642 controls were followed for 14 281 and 45 122 person-years, respectively. All-cause and non-AIDS-related mortality was substantially increased among smoking compared to nonsmoking HIV patients (MRR, 4.4 [95% confidence interval {CI}, 3.0-6.7] and 5.3 [95% CI, 3.2-8.8], respectively). Excess MR per 1000 person-years among current vs nonsmokers was 17.6 (95% CI, 13.3-21.9) for HIV patients and 4.8 (95% CI, 3.2-6.4) for controls. A 35-year-old HIV patient had a median life expectancy of 62.6 years (95% CI, 59.9-64.6) for smokers and 78.4 years (95% CI, 70.8-84.0) for nonsmokers; the numbers of life-years lost in association with smoking and HIV were 12.3 (95% CI, 8.1-16.4) and 5.1 (95% CI, 1.6-8.5). The population-attributable risk of death associated with smoking was 61.5% among HIV patients and 34.2% among controls.In a setting where HIV care is well organized and antiretroviral therapy is free of charge, HIV-infected smokers lose more life-years to smoking than to HIV. The excess mortality of smokers is tripled and the population-attributable risk of death associated with smoking is doubled among HIV patients compared to the background population.CONCLUSIONSIn a setting where HIV care is well organized and antiretroviral therapy is free of charge, HIV-infected smokers lose more life-years to smoking than to HIV. The excess mortality of smokers is tripled and the population-attributable risk of death associated with smoking is doubled among HIV patients compared to the background population.
Author Helleberg, Marie
Larsen, Carsten S
Afzal, Shoaib
Kronborg, Gitte
Nordestgaard, Børge G
Pedersen, Court
Pedersen, Gitte
Gerstoft, Jan
Obel, Niels
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  givenname: Marie
  surname: Helleberg
  fullname: Helleberg, Marie
  email: mhelleberg@sund.ku.dk
  organization: Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. mhelleberg@sund.ku.dk
– sequence: 2
  givenname: Shoaib
  surname: Afzal
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  givenname: Gitte
  surname: Kronborg
  fullname: Kronborg, Gitte
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  givenname: Carsten S
  surname: Larsen
  fullname: Larsen, Carsten S
– sequence: 5
  givenname: Gitte
  surname: Pedersen
  fullname: Pedersen, Gitte
– sequence: 6
  givenname: Court
  surname: Pedersen
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  surname: Gerstoft
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  surname: Nordestgaard
  fullname: Nordestgaard, Børge G
– sequence: 9
  givenname: Niels
  surname: Obel
  fullname: Obel, Niels
BackLink https://www.ncbi.nlm.nih.gov/pubmed/23254417$$D View this record in MEDLINE/PubMed
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PublicationTitle Clinical infectious diseases
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Snippet We assessed mortality attributable to smoking among patients with human immunodeficiency virus (HIV). We estimated mortality rates (MRs), mortality rate ratios...
We assessed mortality attributable to smoking among patients with human immunodeficiency virus (HIV).BACKGROUNDWe assessed mortality attributable to smoking...
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SubjectTerms Adult
Cause of Death
Cohort Studies
Denmark - epidemiology
Female
HIV Infections - mortality
HIV-1 - pathogenicity
Humans
Kaplan-Meier Estimate
Life Expectancy
Male
Middle Aged
Risk Factors
Smoking - mortality
Title Mortality attributable to smoking among HIV-1-infected individuals: a nationwide, population-based cohort study
URI https://www.ncbi.nlm.nih.gov/pubmed/23254417
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