Kenneth E. Covinsky, MD, MPH; C. Seth Landefeld, MD
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Covinsky KE, Landefeld CS. Reply: Depression, Smoking, and Health Status. Ann Intern Med. 1997;127:1131-1132. doi: 10.7326/0003-4819-127-12-199712150-00026
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Published: Ann Intern Med. 1997;127(12):1131-1132.
Dr. Jay raises the question of whether smoking status confounds the relation we observed between symptoms of depression and poor health status outcomes in acutely ill hospitalized older persons. This is an important question, given evidence that the rates of cigarette smoking may be higher in persons with depression [1, 2]. However, we believe it unlikely that smoking status explains the adverse health outcomes we observed in depressed patients. Previous studies have found that smokers have a 30% to 50% greater risk for clinically significant symptoms of depression [1, 2]. Because we found that patients with many symptoms of depression had a two- to threefold greater risk for adverse health outcomes than patients with few symptoms, it is unlikely that a potentially higher smoking rate in the more depressed patients would account for these differences in health outcomes. Nonetheless, we agree with Dr. Jay's conclusion that future studies of the relation between depression and health status outcomes in older persons should control for the potential confounding effects of smoking.
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