Objectives: Chronic obstructive pulmonary disease (COPD) is prevalent among adults in China and widespread among smokers. This study assessed health outcomes of COPD-diagnosed smokers vs. never smokers in urban China. Methods: National Health and Wellness Survey (NHWS) 2010 and 2012 China data were analyzed. NHWS is a mixed-methodology, Internet-based, nationwide survey of adults (18+ years) stratified by gender and age to represent the demographic composition of urban China. Respondents self-reporting diagnosis with COPD were categorized as smoking (including [non]smokers in process of quitting) or never having smoked. Respondents reported on health status: SF-36v2-based Mental (MCS) and Physical (PCS) Component Summary scores and SF-6D health utilities; productivity loss: Work Productivity and Activity Impairment questionnaire-based metrics; and resource utilization in the past six months. Regression modeling assessed health outcomes as a function of smoking, controlling for demographics, time since diagnosis, and comorbidities. Results: Among 1,421 diagnosed with COPD, 51.6% never smoked and 35.5% smoked (of whom, 43.8% were attempting to quit). Smokers vs. never smokers were more likely to be male (82.4% vs. 36.4%, respectively), recently diagnosed with COPD (i.e., 8.56 vs. 11.09 years), employed, wealthier, partnered, overweight, and with higher comorbid risk (all p< 0.05). Adjusting for covariates, smokers vs. never smokers had lower health utilities (-0.022 points, p< .001), PCS (-1.26 points, p= .043), and MCS (-2.85 points, p< .001), and higher rates of absenteeism (44.7% greater, p= .002), impairment while working (22.4%, p< .001), overall work impairment (22.3%, p< .001), activity impairment (16.5%, p= .002), emergency room visits (65.6%, p< .001), hospitalizations (142.9%, p< .001), and provider visits (23.0%, p= .038). On average, impairments were greater and more consistently significant among females. Conclusions: Even after adjusting for significant baseline differences, smokers vs. never smokers with COPD in urban China experienced poorer health outcomes, suggesting the importance of secondary prevention of COPD in this population, as well as smoking cessation interventions.
Goren, A., Gupta, S., Chen, C. I., & Feng, Y. (2014). Among Those Diagnosed With Chronic Obstructive Pulmonary Disease In Urban China, Smoking Is Associated With Decreased Health Status And Work Productivity And Increased Health Care Resource Use. Value in Health, 17(3), A178. https://doi.org/10.1016/j.jval.2014.03.1039