Real-world tobacco cessation practice in China: findings from the prospective, nationwide multicenter China National Tobacco Cessation Cohort Study (CNTCCS)

Zhao Liu; Rui Qin; Xue-Jun Hu; Li-Jun Liu; Su-Qin Xu; Guo-Chao Shi; Hong Zhou; Jing Bai; Chun-Mei Zhang; Yong Qi; Wei Zhou; Shu-Hua Lan; Jin Tong; Tong-Sheng Su; Qiang Wang; Xin-Yan Yang; De-Jun Sun; Li-Ming Zhu; Xiao-Yang Chen; Hong Chen; Yu-Peng Xie; Zhi-Hua Xiao; Yan-Bin Chen; Bo Zhao; Qiu-Ge Wu; Wen-Li Chen; Dong-Yan Li; Hongbo Liu; An-Qi Cheng; Zi-Yang Cui; Liang Zhao; Jin-Xuan Li; Xiao-Wen Wei; Xin-Mei Zhou; Zheng Su; Kian Fan Chung; Zheng-Ming Chen; Dan Xiao; Chen Wang

doi:10.1016/j.lanwpc.2023.100826

Real-world tobacco cessation practice in China: findings from the prospective, nationwide multicenter China National Tobacco Cessation Cohort Study (CNTCCS)

Lancet Reg Health West Pac. 2023 Jun 16:39:100826. doi: 10.1016/j.lanwpc.2023.100826. eCollection 2023 Oct.

Authors

Zhao Liu^{1

2

3

4

5}, Rui Qin^{1

2

3

4

5

6}, Xue-Jun Hu⁷, Li-Jun Liu⁸, Su-Qin Xu⁹, Guo-Chao Shi¹⁰, Hong Zhou¹¹, Jing Bai¹², Chun-Mei Zhang¹³, Yong Qi¹⁴, Wei Zhou¹⁵, Shu-Hua Lan¹⁶, Jin Tong¹⁷, Tong-Sheng Su¹⁸, Qiang Wang¹⁹, Xin-Yan Yang²⁰, De-Jun Sun²¹, Li-Ming Zhu²², Xiao-Yang Chen²³, Hong Chen²⁴, Yu-Peng Xie²⁵, Zhi-Hua Xiao²⁶, Yan-Bin Chen²⁷, Bo Zhao²⁸, Qiu-Ge Wu²⁹, Wen-Li Chen³⁰, Dong-Yan Li³¹, Hongbo Liu²⁸, An-Qi Cheng^{1

2

3

4

5}, Zi-Yang Cui³², Liang Zhao^{1

2

3

4

5}, Jin-Xuan Li^{1

2

3

4

5

33}, Xiao-Wen Wei^{1

2

3

4

5

33}, Xin-Mei Zhou^{1

2

3

4

5}, Zheng Su^{1

2

3

4

5}, Kian Fan Chung³⁴, Zheng-Ming Chen³⁵, Dan Xiao^{1

2

3

4

5

6

33

36}, Chen Wang^{2

3

4

5

36}

Affiliations

¹ Department of Tobacco Control and Prevention of Respiratory Disease, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.
² WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China.
³ China National Center for Respiratory Medicine, Beijing, China.
⁴ China National Clinical Research Center for Respiratory Diseases, Beijing, China.
⁵ Institute of Respiratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁶ Graduate School of Peking Union Medical College, Beijing, China.
⁷ Department of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning Province, China.
⁸ Department of Respiratory and Critical Care Medicine, Baiyin First People's Hospital of Gansu Province, Baiyin, Gansu Province, China.
⁹ Department of Pulmonary and Critical Care Medicine, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
¹⁰ Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
¹¹ Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China.
¹² Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, China.
¹³ Department of Respiratory and Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, China.
¹⁴ Department of Pulmonary and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou, Henan Province, China.
¹⁵ Department of Pulmonary and Critical Care Medicine, Beijing Hospital, Beijing, China.
¹⁶ Department of Pulmonary and Critical Care Medicine, Nanping People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Nanping, Fujian Province, China.
¹⁷ Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
¹⁸ 3rd Department of Acupuncture and Moxibustion, Shaanxi Hospital of Traditional Chinese Medicine, Xi'an, Shaanxi Province, China.
¹⁹ Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China.
²⁰ Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China.
²¹ Department of Respiratory and Critical Care Medicine, The People's Hospital of Inner Mongolia Autonomous Region, Hohhot, Inner Mongolia Autonomous Region, China.
²² Department of Respiratory and Critical Care Medicine, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan Province, China.
²³ Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China.
²⁴ Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
²⁵ Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China.
²⁶ Department of Respiratory and Critical Care Medicine, The Third People's Hospital of Datong City, Datong, Shanxi Province, China.
²⁷ Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.
²⁸ Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China.
²⁹ Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.
³⁰ Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Chengde Medical College, Chengde, Hebei Province, China.
³¹ Department of Pulmonary and Critical Care Medicine, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China.
³² Department of Geriatric Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
³³ Capital Medical University China-Japan Friendship School of Clinical Medicine, Beijing, China.
³⁴ National Heart and Lung Institute, Imperial College London and Royal Brompton and Harefield NHS Trust, London, UK.
³⁵ Nuffield Department of Population Health, University of Oxford, Oxford, UK.
³⁶ Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.

Abstract

Background: Tobacco cessation is proven to be the most effective and cost-effective strategy for smokers to reduce their risk of smoking-related disease and premature death. Providing effective, efficient, safe, and patient-centred tobacco cessation treatment to reach those who need them is a significant challenge. To date, only a few nationwide studies in China have assessed the overall clinical care practice and treatment outcome of tobacco cessation.

Methods: This a prospective, nationwide, multicenter, cohort study covering all Eastern China, Northwest China, Central China, North China, Southwest China, Northeast China, and South China. Participants who were current smokers aged 18-85 years attending clinic for smoking cessation were included. All the participants were treated with 3-month cessation treatment and followed up for 3 months. Data were collected prospectively using online system. The primary outcome was 7-day point abstinence rate at 24 weeks, validated biochemically by an expired carbon monoxide level of less than 10 ppm. The participants lost to follow-up or not providing validation were included as non-abstainers.

Findings: A representative sample of 3557 participants were recruited and 2943 participants were included into this analysis. These participants had mean age of 53.05 years, and 94.8% were males, with 75.8% showing symptoms of tobacco dependence. A total of 965 (32.8%) participants were treated with Bupropion + behavioural counselling, followed by 935 (31.8%) with behavioural counselling, 778 (26.4%) with Varenicline + behavioural counselling, 135 (4.6%) with alternative treatments + behavioural counselling, and 130 (4.4%) with nicotine replacement therapy (NRT) + behavioural counselling. After 3-month treatment and 3-month follow-up, 21.74% of the participants quit smoking at 24 weeks. In the multivariable-adjusted analyses, quitting smoking was significantly associated with female, higher socioeconomic status, poor health condition, different treatment received, and less smoking intensity. The tobacco cessation treatment varied widely across different areas of China. In particular, the areas with higher usage of cessation medication were associated with better cessation treatment outcome.

Interpretation: The CNTCCS is the first large-scale nationwide cohort study of smoking cessation in China. Rich data collected from this prospective cohort study provided the opportunity to evaluate the clinical practice of tobacco cessation treatment in China.

Funding: Chinese Academy of Medical Sciences (CAMS) Initiative for Innovative Medicine (CAMS 2021-I2M-1-010), Heilongjiang Provincial Science and Technology Key Program (2022ZXJ03C02), and National Key R&D Program of China (grant no. 2017YFC1309400).

Keywords: China National Tobacco Cessation Cohort Study (CNTCCS); Cohort study; Smoking; Smoking cessation.