As I have stated many times in the past, women are undertreated and underserved when it comes to cardiovascular disease and stroke. Now, more than ever, this may even be more important due to several recent studies that have been published in the last few weeks. Several investigations have demonstrated two troublesome facts: In certain areas of the country, life expectancy for women is decreasing AND women who smoke are much more likely to have lung cancer than men who smoke. These facts argue for more aggressive treatment of women and more targeted gender specific prevention efforts–no longer can women’s risk for disease be discounted. Although awareness efforts are continuing, we continue to fall short in identifying and treating women with cardiovascular disease.
In a study published last week in the journal Health Affairs, researchers compared mortality rates from 1992-96 with those from 2002-06 in 3,140 counties in the United States. In the study, female mortality rates increased in 42% of counties while rates in men only increased by 3.4%. Factors associated with lower mortality rates in women included higher education, location not in the south or west and non use of tobacco. These findings are incredibly troubling in that over the same time period, mortality rates in men have fallen in these same counties.
In a related article published this year in the New England Journal of Medicine, it was found that smoking in women is associated with a higher risk for lung cancer, cardiovascular disease and death as compared to smoking in men. Among men, the risks of death from smoking have plateaued since the 1980s. In the 1980s women who smoked were 13 times more likely to die from lung cancer –in contrast, women are now found to be 26 times more likely to die as compared to those who do not smoke. However, there are data that show that smokers who quit by age 40 are able to reduce their risk for death significantly and in fact add 10 additional years to their life span.
So, altogether, it seems that smoking for women is a significant public health issue. Women are smoking in greater numbers and those that began smoking in the 1960s are now seeing the long term effects–this cohort of women is truly the first group of long term female smokers that have been studied. The results are truly sobering. As healthcare providers we must do our best to prevent chronic disease. Certainly in this era of cost containment and the new Affordable Care Act, we must strive to modify risk. Smoking cessation is something that all providers, regardless of specialty, must work to encourage. In fact, I believe that individual cost and access to insurance coverage should be based on one’s smoking habits. Those who choose to smoke should pay significantly higher premiums as they will be using more resources down the line. Physicians will be held accountable for documenting smoking status and smoking cessation counselling–why then can’t patients and consumers of healthcare be held accountable for their own reckless behaviors (such as smoking).
But, back to the issue at hand. Once again, we find that women are under treated and underserved. According to recent studies, women are less likely to be referred or counseled for smoking cessation. In addition, data from the NCBI indicates that women have more difficulty quitting. According to NCBI researchers, unique factors affecting a woman’s ability to successfully stop smoking include concerns over weight gain, mood variability and withdrawal symptoms associated with hormonal changes during the menstrual cycle.
Ultimately, we must do a better job helping women with smoking cessation. Mortality statistics such as the those recently presented serve as a failing report card when it comes to prevention activities in women. We must identify female patients at risk and push for smoking cessation. Once again, we must empower women to take an active role in their healthcare and engage them in healthy lifestyle modification activities.