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Smoking and tobacco
Research
Use of varenicline and nicotine replacement therapy in people with and without general practitioner-recorded dementia: retrospective cohort study of routine electronic medical records
  1. Taha Itani1,2,
  2. Richard Martin1,3,4,
  3. Dheeraj Rai3,5,6,
  4. Tim Jones7,
  5. Gemma Taylor8,
  6. Kyla Thomas4,
  7. Marcus Munafo1,2,
  8. Neil Davies1,4,
  9. Amy Taylor3,4
  1. 1 Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
  2. 2 UK Centre for Tobacco and Alcohol Studies, School of Psychological Science, University of Bristol, Bristol, UK
  3. 3 NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
  4. 4 Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
  5. 5 Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
  6. 6 Avon & Wiltshire Partnership NHS Mental Health Trust, Bristol, UK
  7. 7 National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  8. 8 Addiction and Mental Health Group (AIM) Department of Psychology, University of Bath, Bath, UK
  1. Correspondence to Dr Taha Itani; ti17926{at}bristol.ac.uk

Abstract

Objectives Our primary objective was to estimate smoking prevalence and prescribing rates of varenicline and nicotine replacement therapy (NRT) in people with and without general practitioner (GP)-recorded dementia. Our secondary objective was to assess and compare quit rates of smokers with versus without GP-recorded dementia who were prescribed varenicline or NRT for smoking cessation.

Design A retrospective cohort study based on the analysis of electronic medical records within the Clinical Practice Research Datalink (2007–2015).

Setting 683 general practices in England.

Participants People with and without GP-recorded dementia, aged 18 years and have a code indicating that they are a current smoker.

Intervention Index prescription of varenicline or NRT (from 1 September 2006).

Outcome measures The primary outcomes were smoking prevalence and prescribing rates of varenicline and NRT (2007–2015). The secondary outcome was smoking cessation at 2 years.

Results Age and sex-standardised prevalence of smoking was slightly higher in people with GP-recorded dementia than in those without. There were 235 314 people aged 18 years and above prescribed NRT or varenicline. Among smokers with GP-recorded dementia (N=447), 409 were prescribed NRT and 38 varenicline. Smokers with GP-recorded dementia were 74% less likely (95% CI 64% to 82%) to be prescribed varenicline than NRT, compared with smokers without GP-recorded dementia. Compared with people without GP-recorded dementia, people with GP-recorded dementia had consistently lower prescribing rates of varenicline from 2007 to 2015. Two years after prescription, there was no clear evidence for a difference in the likelihood of smoking cessation after prescription of these medications between individuals with and without dementia (OR 1.0, 95% CI 0.8 to 1.2).

Conclusions Between 2007 and 2015, people with GP-recorded dementia were less likely to be prescribed varenicline than those without dementia. Quit rates following prescription of either NRT or varenicline were similar in those with and without dementia.

  • dementia
  • smoking cessation
  • smoking prevalence

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjopen-2018-027569

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    Footnotes

    • Contributors TI contributed to data cleaning, data analysis, interpretation of results and writing the manuscript. RM, GT, ND, AT and KT contributed to study conceptualisation, study design, interpretation of results, data analysis and writing the manuscript. MM and DR contributed to study conceptualisation, study design, interpretation of results and writing the manuscript. TJ extracted the data and contributed to writing the manuscript. TI, AT and ND had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    • Funding KT is funded by a National Institute for Health Research postdoctoral fellowship (PDF-2017-10-068). TJ receives funding from the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) West. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. RM is supported by the NIHR Bristol Biomedical Research Centre, a partnership between the University Hospitals Bristol NHS Foundation Trust and the University of Bristol; and by a Cancer Research UK Programme Grant (C18281/A19169). GT is funded by a Cancer Research UK Population Researcher Postdoctoral Fellowship Award (C56067/A21330). This research was supported by Global Research Awards for Nicotine Dependence (GRAND), an independently reviewed competitive grants program supported by Pfizer, to the University of Bristol.

    • Disclaimer The funder had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available.

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