Mixed evidence for the compression of morbidity hypothesis for smoking elimination-a systematic literature review

Charlotte M Dieteren; Timor Faber; Job van Exel; Werner B F Brouwer; Johan P Mackenbach; Wilma J Nusselder

doi:10.1093/eurpub/ckaa235

Mixed evidence for the compression of morbidity hypothesis for smoking elimination-a systematic literature review

Charlotte M Dieteren^*, Timor Faber, Job van Exel, Werner B F Brouwer, Johan P Mackenbach, Wilma J Nusselder

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

BACKGROUND: There is debate around the composition of life years gained from smoking elimination. The aim of this study was to conduct a systematic review of the literature to synthesize existing evidence on the effect of smoking status on health expectancy and to examine whether smoking elimination leads to compression of morbidity.

METHODS: Five databases were systematically searched for peer-reviewed articles. Studies that presented quantitative estimates of health expectancy for smokers and non-/never-smokers were eligible for inclusion. Studies were searched, selected and reviewed by two reviewers who extracted the relevant data and assessed the risk of bias of the included articles independently.

RESULTS: The search identified 2491 unique records, whereof 20 articles were eligible for inclusion (including 26 cohorts). The indicators used to measure health included disability/activity limitations (n=9), health-related quality of life (EQ-5D) (n=2), weighted disabilities (n=1), self-rated health (n=9), chronic diseases (n=6), cardiovascular diseases (n=4) and cognitive impairment (n=1). Available evidence showed consistently that non-/never-smokers experience more healthy life years throughout their lives than smokers. Findings were inconsistent on the effect of smoking on the absolute number of unhealthy life years. Findings concerning the time proportionally spent unhealthy were less heterogeneous: nearly all included articles reported that non-/never-smokers experience relatively less unhealthy life years (e.g. relative compression of morbidity).

CONCLUSIONS: Support for the relative compression of morbidity due to smoking elimination was evident. Further research is needed into the absolute compression of morbidity hypothesis since current evidence is mixed, and methodology of studies needs to be harmonized.

Original language	English
Pages (from-to)	409-417
Number of pages	9
Journal	European Journal of Public Health
Volume	31
Issue number	2
Early online date	18 Dec 2020
DOIs	https://doi.org/10.1093/eurpub/ckaa235 https://doi.org/10.1093/eurpub/ckaa235
Publication status	Published - Apr 2021

Bibliographical note

Funding:
Charlotte M Dieteren is employed and supported by the Erasmus University Rotterdam and Timor Faber by the Erasmus Medical Centre. Wilma J. Nusselder received funding as part of the project ‘Longer life, longer in good health, working longer? Implications of educational differences for the pension system’, which has received financial support from Netspar (Network for Studies on Pensions, Aging and Retirement).

© The Author(s) 2020. Published by Oxford University Press on behalf of the European Public Health Association.

Research programs

ESHPM - non EUR result
EMC NIHES-02-65-01

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cite this

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title = "Mixed evidence for the compression of morbidity hypothesis for smoking elimination-a systematic literature review",

abstract = "BACKGROUND: There is debate around the composition of life years gained from smoking elimination. The aim of this study was to conduct a systematic review of the literature to synthesize existing evidence on the effect of smoking status on health expectancy and to examine whether smoking elimination leads to compression of morbidity.METHODS: Five databases were systematically searched for peer-reviewed articles. Studies that presented quantitative estimates of health expectancy for smokers and non-/never-smokers were eligible for inclusion. Studies were searched, selected and reviewed by two reviewers who extracted the relevant data and assessed the risk of bias of the included articles independently.RESULTS: The search identified 2491 unique records, whereof 20 articles were eligible for inclusion (including 26 cohorts). The indicators used to measure health included disability/activity limitations (n=9), health-related quality of life (EQ-5D) (n=2), weighted disabilities (n=1), self-rated health (n=9), chronic diseases (n=6), cardiovascular diseases (n=4) and cognitive impairment (n=1). Available evidence showed consistently that non-/never-smokers experience more healthy life years throughout their lives than smokers. Findings were inconsistent on the effect of smoking on the absolute number of unhealthy life years. Findings concerning the time proportionally spent unhealthy were less heterogeneous: nearly all included articles reported that non-/never-smokers experience relatively less unhealthy life years (e.g. relative compression of morbidity).CONCLUSIONS: Support for the relative compression of morbidity due to smoking elimination was evident. Further research is needed into the absolute compression of morbidity hypothesis since current evidence is mixed, and methodology of studies needs to be harmonized.",

author = "Dieteren, {Charlotte M} and Timor Faber and {van Exel}, Job and Brouwer, {Werner B F} and Mackenbach, {Johan P} and Nusselder, {Wilma J}",

note = "Funding: Charlotte M Dieteren is employed and supported by the Erasmus University Rotterdam and Timor Faber by the Erasmus Medical Centre. Wilma J. Nusselder received funding as part of the project {\textquoteleft}Longer life, longer in good health, working longer? Implications of educational differences for the pension system{\textquoteright}, which has received financial support from Netspar (Network for Studies on Pensions, Aging and Retirement). {\textcopyright} The Author(s) 2020. Published by Oxford University Press on behalf of the European Public Health Association.",

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doi = "10.1093/eurpub/ckaa235",

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AU - Faber, Timor

AU - van Exel, Job

AU - Brouwer, Werner B F

AU - Mackenbach, Johan P

AU - Nusselder, Wilma J

N1 - Funding: Charlotte M Dieteren is employed and supported by the Erasmus University Rotterdam and Timor Faber by the Erasmus Medical Centre. Wilma J. Nusselder received funding as part of the project ‘Longer life, longer in good health, working longer? Implications of educational differences for the pension system’, which has received financial support from Netspar (Network for Studies on Pensions, Aging and Retirement). © The Author(s) 2020. Published by Oxford University Press on behalf of the European Public Health Association.

PY - 2021/4

Y1 - 2021/4

N2 - BACKGROUND: There is debate around the composition of life years gained from smoking elimination. The aim of this study was to conduct a systematic review of the literature to synthesize existing evidence on the effect of smoking status on health expectancy and to examine whether smoking elimination leads to compression of morbidity.METHODS: Five databases were systematically searched for peer-reviewed articles. Studies that presented quantitative estimates of health expectancy for smokers and non-/never-smokers were eligible for inclusion. Studies were searched, selected and reviewed by two reviewers who extracted the relevant data and assessed the risk of bias of the included articles independently.RESULTS: The search identified 2491 unique records, whereof 20 articles were eligible for inclusion (including 26 cohorts). The indicators used to measure health included disability/activity limitations (n=9), health-related quality of life (EQ-5D) (n=2), weighted disabilities (n=1), self-rated health (n=9), chronic diseases (n=6), cardiovascular diseases (n=4) and cognitive impairment (n=1). Available evidence showed consistently that non-/never-smokers experience more healthy life years throughout their lives than smokers. Findings were inconsistent on the effect of smoking on the absolute number of unhealthy life years. Findings concerning the time proportionally spent unhealthy were less heterogeneous: nearly all included articles reported that non-/never-smokers experience relatively less unhealthy life years (e.g. relative compression of morbidity).CONCLUSIONS: Support for the relative compression of morbidity due to smoking elimination was evident. Further research is needed into the absolute compression of morbidity hypothesis since current evidence is mixed, and methodology of studies needs to be harmonized.

AB - BACKGROUND: There is debate around the composition of life years gained from smoking elimination. The aim of this study was to conduct a systematic review of the literature to synthesize existing evidence on the effect of smoking status on health expectancy and to examine whether smoking elimination leads to compression of morbidity.METHODS: Five databases were systematically searched for peer-reviewed articles. Studies that presented quantitative estimates of health expectancy for smokers and non-/never-smokers were eligible for inclusion. Studies were searched, selected and reviewed by two reviewers who extracted the relevant data and assessed the risk of bias of the included articles independently.RESULTS: The search identified 2491 unique records, whereof 20 articles were eligible for inclusion (including 26 cohorts). The indicators used to measure health included disability/activity limitations (n=9), health-related quality of life (EQ-5D) (n=2), weighted disabilities (n=1), self-rated health (n=9), chronic diseases (n=6), cardiovascular diseases (n=4) and cognitive impairment (n=1). Available evidence showed consistently that non-/never-smokers experience more healthy life years throughout their lives than smokers. Findings were inconsistent on the effect of smoking on the absolute number of unhealthy life years. Findings concerning the time proportionally spent unhealthy were less heterogeneous: nearly all included articles reported that non-/never-smokers experience relatively less unhealthy life years (e.g. relative compression of morbidity).CONCLUSIONS: Support for the relative compression of morbidity due to smoking elimination was evident. Further research is needed into the absolute compression of morbidity hypothesis since current evidence is mixed, and methodology of studies needs to be harmonized.

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SN - 1101-1262

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JO - European Journal of Public Health

JF - European Journal of Public Health

IS - 2

ER -

Mixed evidence for the compression of morbidity hypothesis for smoking elimination-a systematic literature review

Abstract

Bibliographical note

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