Abstract 18350: Impact of Amount vs Duration of Smoking on Incident Heart Failure and Mortality Among Community-dwelling Older Adults: Need to Reassess the Role of Pack-years as a Tool to Estimate Smoking
Bibliographic record
Abstract
Background: Clinicians and public health professionals often use pack-years (PY) to quantify amount and duration of smoking. Thus, 40 PY of smoking may mean 1 pack of cigarette a day for 40 years or 4 packs a day for 10 years. However, it is unknown if the impact of smoking as measured by PY may vary by amount and duration. Methods: Of the 3185 community-dwelling adults ≥65 years without prevalent heart failure (HF) in the Cardiovascular Health Study (CHS), 2556 were never-smokers. The 629 current smokers smoked a median of 1 (20 cigarettes) pack a day (PPD) for a median of 51 years resulting in a median of 42 PYs of smoking. Of 319 smoking ≥1 PPD, 125 smoked <51 years (higher-amount-“shorter”-duration; median 49 PY) and of 336 smoking ≥51 years, 142 smoked <1 PPD (lower-amount-longer-duration; median 27 PY). Age-sex-race-adjusted hazard ratios (aHR) and 95% CI for centrally-adjudicated incident HF and all-cause mortality during 13 (mean, 10) years of follow-up for the two smoker groups (vs. never smokers) were estimated in Cox regression models. Results: Patients (N=2823) had a mean (±SD) age of 74 (±6) years, 70% were women, and 16% African American. Incident HF occurred in 21%, 24% and 28% of never smokers, higher-amount-“shorter”-duration (aHR, 1.32; 95% CI, 0.91-1.91) and lower-amount-longer-duration smokers (aHR, 1.60; 95% CI, 1.14-2.16), respectively (Figure; left panel). Respective rates for all-cause mortality were 39%, 48% (aHR, 1.34; 95% CI, 1.04-1.74) and 58% (aHR, 1.73; 95% CI, 1.39-2.17; Figure; right panel). . Conclusions: Smokers who survived into older age and smoked larger amount for “shorter” duration appear to have numerically higher risk for incident HF and death than those who smoked smaller amount for longer duration, despite the fact that former group had lower pack-year estimates. These findings suggest that the use of pack-year to estimate smoking may underestimate the risk of prolonged smoking.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.015 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".