Comprehensive Assessment of Lifetime Cigarette Smoking and Its Association with Health-Related Quality of Life among Older US Adults-A Cross-sectional Study

Background: Cigarette smoking is an established risk factor for lower health-related quality of life (HRQOL). Studies to date have not used comprehensive measures of tobacco exposures across the life course. We examined the association between a lifetime cigarette smoke exposure index (LCSEI) and HRQOL among older US adults.

Methods: Cross-sectional analysis of N=7,001 U.S. adults ≥40y from Wave 5(2018-19) of the Population Assessment of Tobacco and Health Study. The 11-point LCSEI included heaviness of current smoking, pack-years, childhood smoking, and second-hand smoke exposure. HRQOL measures included PROMIS global physical and mental health (GPH, GMH) scores. We estimated the independent association between LCSEI scores and mean GPH or GMH separately using multivariable linear regression adjusted for sociodemographics, body mass index, geographic location, and weekly exercise.

Results: Sociodemographics were reflective of the US population over 40 years; 6.7% smoked during childhood, and 16.9% currently smoked (2.1% <10cig/d, 4.8% 11-20 cig/d, and 10.0% >20 cig/d). Mean (std dev) for the LCSEI, GPH and GMH were 2.4 (2.9), 14.8 (3.1), and 14.5 (3.3) respectively, and 15% had LCSEI scores of 5 or more. In the multivariable analysis, the LCSEI retained a strong association with GPH and GMH, -0.20 (-0.23, -0.17) and -0.22 (-0.25, -0.18) respectively for each 1-point increase in the LCSEI. The LCSEI-HRQOL associations over its 11-point range (-2.14 GPH, -2.16 GMH) were significantly higher than for education (-0.44 and -0.77) and about 30% higher than for the negative influence of poverty (<25K/yr) vs. affluence (>=100K/yr) (-1.61 and -1.65). Sensitivity analysis found that associations remained significant even after further adjustment for smoking-related diseases.

Conclusion: In this US sample, associations between life course cigarette smoking and both physical and mental health were as strong as associations that contrasted extremes of socioeconomic status.