Current smokers who commenced smoking as a child (before age 18) had fewer QALYs than those who started later, and heavier smokers had fewer QALYs than those smoking 40 packs per year) compared with non-smokers. Never, former and current smokers had a mean QALY of 16.1, 12.7 and 7.3 years, respectively. 19Ī 2016 study analysing data from the US National Health and Nutrition Examination Survey found a dose–response effect of smoking status on quality-adjusted life years (QALY) for adults aged 65 years and over. 18 HRQOL was also associated with a shorter time to first cigarette (in the morning), indicating that degree of nicotine dependence is associated with HRQOL. 14, 18 A 2015 longitudinal population cohort study of young adults found that smokers who quit and remained abstinent for five years had higher physical measures of HRQOL compared with current smokers. Smoking cessation is associated with improved HRQOL, 14, 13 and longer abstinence is associated with higher scores for psychological health. 17 Among young adults, smokers also had a lower HRQOL than never smokers. 16 A 2017 study from Spain found that smoking had an independent negative effect on HRQOL, although smoking-related diseases, such as lung cancer, were associated with a reduction in HRQOL about five times greater than the difference between current smokers and never smokers. 15 A 2019 cross-sectional study from the US found that among lower-income African Americans, smokers attempting to quit had a lower HRQOL than current smokers.
Male smokers had a lower physical functioning, lower mental health, and a lower overall health related quality of life score compared with non-smokers. 14 A 2019 cross-sectional study from Iran with 2,197 participants found significant differences in the HRQOL between males who smoked and those who did not. Smokers with high or very high dependence reported higher levels of fear and concern about death and pain before death than those with low or very low dependence. 13 A 2019 study in Brazil of older adults found that current smokers had lower scores than never smokers for social participation and intimacy. 12Ī 2014 systematic review of 54 studies concluded that smoking is negatively associated with quality of life with a dose–dependent relationship between differences in QOL scores and the number of cigarettes smoked. There is compelling evidence linking active smoking and poor HRQOL this has been demonstrated in large longitudinal studies conducted in Australia, 2 North America, 3, 4 Spain 5 and Finland 6 in cross-sectional studies conducted in Croatia, 7 Finland 8 China 9 and North America 10 in a large study of Medicare beneficiaries in North America 11 and in a British study conducted among female patients with atherosclerosis.
1 Measuring HRQOL assesses how people’s health affects their wellbeing over time, from their own point of view. HRQOL includes physical and mental health perceptions, such as energy level and mood, and factors that affect these perceptions, such as health risks and conditions, functional status, social support, and socioeconomic status. Health-related quality of life (HRQOL) is a person’s or group’s perceived physical and mental health.
3.22.1 Poorer health-related quality of life The evidence presented here confirms that exposure to tobacco smoke should be considered an important contributing factor to wide-ranging non-specific morbidity and a diminished quality of life. The discussion here goes beyond the burden of morbidity and mortality from specific diseases that are comprehensively described in other sections.
This section is about impacts on health-related quality of life (HRQOL), activities of daily living (ADL) and general health caused by smoking. In Greenhalgh, EM, Scollo, MM and Winstanley, MH. 3.22 Poorer quality of life and loss of function. Suggested citation: Purcell, K, Bellew, B, Winnall, WR, Greenhalgh, EM & Winstanley, MH.
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