Cigarette smoking and smoking-attributable diseases among Estonian physicians: a cross-sectional study

BACKGROUND Smoking is a risk factor for several diseases. Physicians are role models for their patients. Physicians who smoke underestimate the health risks of smoking and may be less likely to offer advice to help their patients to quit. The aim of this study was to: provide an overview of smoking behaviour among Estonian physicians; assess the relationship between smoking and ischaemic heart disease (IHD), chronic bronchitis (CB), and lung emphysema (LE); and estimate fractions of prevalences of the three diseases attributable to smoking. METHODS Self-administered questionnaires were sent to practising physicians (n = 5666) in Estonia in 2014. Prevalence of smoking and relative risks for IHD, CB and LE as well as the risks of IHD, CB and LE attributable to smoking were calculated by age and sex. Post-stratification was used to compensate non-response. RESULTS There were 535 male and 2404 female physicians participating. The prevalence of daily smoking was 12.4% (95% CI 10.4-14.4%) among men and 5.0% (95% CI 4.4-5.6%) among women. Mean duration of smoking among male and female daily smokers was 28.6 (95% CI 26.1-31.1) and 28.6 (95% CI 27.1-30.2) years. Compared to lifelong non-smokers, the age-adjusted risk for IHD was 1.29 times (95% CI 0.88-1.89) higher for men, but 1.69 times (95% CI 1.17-2.40) lower for all women who have ever smoked. The risk for CB was 2.29 (95% CI 1.30-4.03) times higher for smokers among men and, 1.32 (95% CI 0.95-1.82) among women; the risk ratio for LE was 4.92 (95% CI 1.14-21.1) among men and 2.45 (95% CI 0.63-9.52) among women. The smoking-attributable risk for IHD was 3.2% (95% CI 2.3-4.1%) among men and - 0.1% (95% CI -0.7-0.4%) among women; for CB 6.9% (95% CI 6.0-7.8%) and 4.2% (95% CI 3.5-4.8%); and for LE 18.8% (95% CI 17.0-22.5%) and 22.6% (95% CI 18.5-26.9%), respectively. CONCLUSION Prevalence of daily smoking was relatively low among Estonian physicians (and twice lower among female physicians). The risk attributable to smoking was higher for LE and CB than for IHD.