Equitable access to smoking cessation therapies for older smokers

Date of Approval: 
2016-12-08 00:00:00
Lay Summary: 
Smoking cessation has been found to reduce risks for mortality and morbidity, even among older persons. However, access to smoking cessation therapies for older smokers may be hindered by a variety of factors. Previous qualitative studies have found negative opinions and sceptical attitudes amongst older smokers regarding smoking cessation therapies such as nicotine replacement therapy and psychological counselling, or that they would be able to successfully quit smoking, regardless of the method. Moreover, studies have found GPs to be reluctant to offer quitting advise and/or prescribe various smoking cessation therapies to older smokers. We have completed an analysis of the English Smoking Tool Kit survey and found that older smokers, whilst less nicotine dependent, were less likely to raise smoking with their GPs. Similarly GPs were less likely to refer older smokers to cessation services or provide nicotine replacement therapies (NRTs). This may or may not be appropriate given co-morbidities and life expectancy but we could not examine this within that dataset. We therefore want to use data from the Clinical Practice Research Datalink (CPRD) to examine demographic and clinical factors that may determine smoking cessation therapies amongst older smokers and whether this may or may not reflect inequitable access to services.
Technical Summary: 
We have completed an analysis of the English Smoking Tool Kit survey and found that older smokers, whilst less nicotine dependent, were less likely to raise smoking with their GPs. Similarly GPs were less likely to refer older smokers to cessation services or provide NRTs. We could not examine whether this may or may not be appropriate given co-morbidities and life expectancy. The main objective of this study is to examine factors associated with the provision and uptake of smoking cessation therapies and to identify if there is inequitable access to these therapies amongst older smokers. We plan to use CPRD data to conduct a cohort study of patients who are smokers at baseline. Exposure will be defined as smoking status of current smoker. We will use competing risk survival analysis to investigate whether age of patients predicts receiving any prescription or referral for smoking cessation therapies (pharmacological, counselling, or multiple therapies) adjusting for potential confounders. We will explore whether there is evidence that therapies were used and whether prescription of smoking cessation therapies led to long term smoking cessation. We will specifically examine whether high levels of co-morbidity and/or limited life expectancy explain older patients are less actively managed.
Health Outcomes to be Measured: 
- To examine whether previous findings, that older smokers are less likely to be offered therapies for smoking cessation are replicated in CPRD. Assuming that this is the case, our main aim is to determine whether this may be clinically appropriate as older patients will have more co-morbidity and shorter life expectancy so it may not be felt valuable to try to help them to quit at this stage in their life. In this way we aim to see if smoking cessation therapies are or are not being made available to older people in an equitable fashion. Specific Aims:. - To investigate whether older smokers are as likely as younger smokers to receive referrals and/or prescriptions for smoking cessation therapies; whether types of therapies offered are similar (i.e. pharmacological from the GP, GP advice, referral to a smoking cessation service, or multiple therapies), and whether there are any differences by: a. Gender. b. Area level deprivation. c. Level of co-morbidities. d. Smoking-related diseases (Chronic Obstructive Pulmonary Disease, Cardio-vascular Disease)
Application Number: 
16_216
Collaborators: 

Yoav Ben-Shlomo - Chief Investigator - University of Bristol
Yoav Ben-Shlomo - Corresponding Applicant - University of Bristol
Kate Walters - Collaborator - University College London ( UCL )
Mira Hidajat - Collaborator - University of Bristol
Philippa Williams - Collaborator - University of Bristol

Linkages: 
HES Admitted Patient Care;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation