Nurose Karim, MD

Parikh NS, Parasram M, White H, Merkler AE, Navi BB, Kamel H. Smoking Cessation in Stroke Survivors in the United States: A Nationwide Analysis. Stroke. 2021.

Smoking is one of the leading and preventable causes of stroke. After a primary stroke, there is an increased risk for future strokes, and recurrent strokes are usually more disabling. This article is highlighting two major topics: rate of smoking cessation in stroke survivors and comparing it with cancer survivors. The hypothesis is that smoker cessation rate is higher in cancer survivors as compared to stroke survivors.

This is a retrospective study of prospective data from 2013-2019 from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (BRFSS), which includes patients above age 18. Pregnant patients and those with incomplete information regarding their stroke, cancer or smoking status were excluded. A total of 3,029,122 respondents were identified, and their information was validated. Smoking status was self-reported and was validated as well. Quit ratio is defined as the proportion of ever smokers who quit. “Ever smokers,” by definition, smoked at least 100 cigarettes in a person’s lifetime. Inverse of the quit ratio is the proportion of ever smokers who continue to smoke.

These ratios were categorized into several variables: age (<60; >60); gender; race/ethnicity (self-reported as Non-Hispanic White, Non-Hispanic Black, Hispanic, Alaskan Native or American Indian, Asian or Hawaiian or other Pacific Islander, and multiracial or other); geography (stroke belt, rural); comorbidities (hypertension, hyperlipidemia, diabetes); cardiovascular history; education (less than high school, high school, college); and income.

Among stroke survivors, 58.8% had history of smoking. This means, unfortunately, that approximately two out of five stroke survivors with a history of smoking remain active smokers. Among cancer survivors, 52.9% had smoking history. Quit ratio for stroke survivors was 60.8%, while that of cancer survivors was 71.3%. This difference remained even after adjusting demographics, rurality, and smoking-related comorbidities. Among stroke survivors, those less likely to quit were: <60 years, women, Non-Hispanic Black, and those from the stroke belt and rural areas.

The reason for a high quit ratio among cancer survivors is the fact that it has become a top priority for the oncologists with the dedicated establishment of the Cancer Center Cessation Initiative. We need similar dedicated cessation programs to improve the long-term outcome of our stroke survivors to help them in decreasing their risk for future events.