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Rey-Brandariz J, Pérez-Ríos M, Ahluwalia JS, Beheshtian K, Fernández-Villar A, Represas-Represas C, Piñeiro M, Alfageme I, Ancochea J, Soriano JB, Casanova C, Cosío BG, García-Río F, Miravitlles M, de Lucas P, Rodríguez González-Moro JM, Soler-Cataluña JJ, Ruano-Ravina A. Tobacco Patterns and Risk of Chronic Obstructive Pulmonary Disease: Results From a Cross-Sectional Study. Arch Bronconeumol 2023; 59:717-724. [PMID: 37500327 DOI: 10.1016/j.arbres.2023.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/09/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION There is still uncertainty about which aspects of cigarette smoking influence the risk of Chronic Obstructive Pulmonary Disease (COPD). The aim of this study was to estimate the COPD risk as related to duration of use, intensity of use, lifetime tobacco consumption, age of smoking initiation and years of abstinence. METHODS We conducted an analytical cross-sectional study based on data from the EPISCAN-II study (n=9092). All participants underwent a face-to-face interview and post-bronchodilator spirometry was performed. COPD was defined as post-bronchodilator FEV1/FVC<70%. Parametric and nonparametric logistic regression models with generalized additive models were used. RESULTS 8819 persons were included; 858 with COPD and 7961 without COPD. The COPD risk increased with smoking duration up to ≥50 years [OR 3.5 (95% CI: 2.3-5.4)], with smoking intensity up to ≥39cig/day [OR 10.1 (95% CI: 5.3-18.4)] and with lifetime tobacco consumption up to >29 pack-years [OR 3.8 (95% CI: 3.1-4.8)]. The COPD risk for those who started smoking at 22 or later was 0.9 (95% CI: 0.6-1.4). The risk of COPD decreased with increasing years of cessation. In comparison with both never smokers and current smokers, the lowest risk of COPD was found after 15-25 years of abstinence. CONCLUSION COPD risk increases with duration, intensity, and lifetime tobacco consumption and decreases importantly with years of abstinence. Age at smoking initiation shows no effect. After 15-25 years of cessation, COPD risk could be equal to that of a never smoker. This work suggests that the time it takes to develop COPD in a smoker is about 30 years.
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Affiliation(s)
- Julia Rey-Brandariz
- Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Mónica Pérez-Ríos
- Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain; Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Santiago de Compostela, Spain.
| | - Jasjit S Ahluwalia
- Department of Behavioral and Social Sciences and Center for Alcohol and Addiction Studies, Brown University School of Public Health, USA; Department of Medicine, Alpert Medical School, Brown University, USA; Legoretta Cancer Center, Brown University, Providence, RI, USA
| | - Kiana Beheshtian
- Department of Behavioral and Social Sciences and Center for Alcohol and Addiction Studies, Brown University School of Public Health, USA
| | - Alberto Fernández-Villar
- Department of Pneumology, Alvaro Cunqueiro University Teaching Hospital, NeumoVigo I+i Research Group, Southern Galician Institute of Health Research (Instituto de Investigación Sanitaria Galicia Sur - IISGS), Vigo, Spain
| | - Cristina Represas-Represas
- Department of Pneumology, Alvaro Cunqueiro University Teaching Hospital, NeumoVigo I+i Research Group, Southern Galician Institute of Health Research (Instituto de Investigación Sanitaria Galicia Sur - IISGS), Vigo, Spain
| | - María Piñeiro
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Santiago de Compostela, Spain
| | | | - Julio Ancochea
- Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias), Instituto de Salud Carlos III, Madrid, Spain; Pulmonary Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain; School of Medicine, Universidad Autónoma de Madrid (UAM), Spain
| | - Joan B Soriano
- Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias), Instituto de Salud Carlos III, Madrid, Spain; Pulmonary Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain; School of Medicine, Universidad Autónoma de Madrid (UAM), Spain
| | - Ciro Casanova
- Pulmonary Department-Research Unit, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
| | - Borja G Cosío
- Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias), Instituto de Salud Carlos III, Madrid, Spain; Department of Pulmonary Medicine, Hospital Universitario Son Espases-IdISBa, University of the Balearic Islands, Palma, Spain
| | - Francisco García-Río
- Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias), Instituto de Salud Carlos III, Madrid, Spain; Pulmonary Department, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
| | - Marc Miravitlles
- Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias), Instituto de Salud Carlos III, Madrid, Spain; Pneumology Department, Hospital Universitari Vall dHebron/Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Pilar de Lucas
- Pulmonary Department, Hospital General Gregorio Marañón, Madrid, Spain
| | | | - Juan José Soler-Cataluña
- Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias), Instituto de Salud Carlos III, Madrid, Spain; Pulmonary Department, Hospital Arnau de Vilanova-Lliria, Medicine Department, Valencia University, Valencia, Spain
| | - Alberto Ruano-Ravina
- Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain; Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Santiago de Compostela, Spain
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Sangani RG, Deepak V, Anwar J, Patel Z, Ghio AJ. Cigarette Smoking, and Blood Monocyte Count Correlate with Chronic Lung Injuries and Mortality. Int J Chron Obstruct Pulmon Dis 2023; 18:431-446. [PMID: 37034898 PMCID: PMC10076620 DOI: 10.2147/copd.s397667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/27/2023] [Indexed: 04/04/2023] Open
Abstract
Background Cigarette smoking (CS)-related monocytosis contributes to the development of chronic lung injuries via complex mechanisms. We aim to determine correlations between measures of CS and monocytes, their capacities to predict chronic lung diseases, and their associations with mortality. Methods A single-center retrospective study of patients undergoing surgical resection for suspected lung nodules/masses was performed. CS was quantified as cigarettes smoked per day (CPD), duration of smoking, composite pack years (CPY), current smoking status, and smoking cessation years. A multivariate logistic regression analysis was performed. Results Of 382 eligible patients, 88% were ever smokers. In this group, 45% were current smokers with mean CPD of 27.2±40.0. CPY and duration of smoking showed positive linear correlations with percentage monocyte count. Physiologically, CPY was associated with progressive obstruction, hyperinflation, and reduced diffusion capacity (DLCO). Across the quartiles of smoking, there was an accumulation of radiologic and histologic abnormalities. Anthracosis and emphysema were associated with CPD, while lung cancer, respiratory bronchiolitis (RB), emphysema, and honeycombing were statistically related to duration of smoking. Analysis using consecutive CPY showed associations with lung cancer (≥10 and <30), fibrosis (≥20 and <40), RB (≥50), anthracosis and emphysema (≥10 and onwards). Percentage monocytes correlated with organizing pneumonia (OP), fibrosis, and emphysema. The greater CPY increased mortality across the groups. Significant predictors of mortality included percentage monocyte, anemia, GERD, and reduced DLCO. Conclusion Indices of CS and greater monocyte numbers were associated with endpoints of chronic lung disease suggesting a participation in pathogenesis. Application of these easily available metrics may support a chronology of CS-induced chronic lung injuries. While a relative lesser amount of smoking can be associated with lung cancer and fibrosis, greater CPY increases the risk for emphysema. Monocytosis predicted lung fibrosis and mortality. Duration of smoking may serve as a better marker of monocytosis and associated chronic lung diseases.
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Affiliation(s)
- Rahul G Sangani
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, West Virginia University, Morgantown, WV, USA
- Correspondence: Rahul G Sangani, Section of Pulmonary, Critical Care, and Sleep Medicine, West Virginia University School of Medicine, 1 Medical Center Dr, PO BOX 9166, Morgantown, WV, 26506, USA, Tel +1 304 293-4661 option #2, Fax +1 304-293-3724, Email
| | - Vishal Deepak
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, West Virginia University, Morgantown, WV, USA
| | - Javeria Anwar
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, West Virginia University, Morgantown, WV, USA
| | - Zalak Patel
- Department of Radiology, West Virginia University, Morgantown, WV, USA
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Lee JO, Hill KG, Jeong CH, Steeger C, Kosterman R. Associations of attention problems and family context in childhood and adolescence with young adult daily smoking: General and smoking-specific family contexts. Drug Alcohol Depend 2022; 240:109629. [PMID: 36116156 PMCID: PMC9838555 DOI: 10.1016/j.drugalcdep.2022.109629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/30/2022] [Accepted: 09/04/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND The potential heterogeneity in daily smoking across young adulthood has been relatively understudied. Relatedly, the unique and joint associations of earlier risk factors with young adults' daily smoking largely remain unknown. To address these gaps, this work identified subgroups of daily smoking trajectories during young adulthood and linked them to earlier attention problems and smoking-specific and general family context. METHODS Data came from the Seattle Social Development Project, a longitudinal study following a community sample (N = 808). Participants' daily smoking was measured from ages 21-33. Earlier attention problems were assessed at ages 14-16 and 18. Earlier smoking-specific and general family factors were assessed at ages 10-16 and 18. RESULTS Growth mixture models produced four profiles: chronic daily smokers, increasers, decreasers, and no-daily smokers. Results from multinomial logistic regressions revealed that earlier attention problems and smoking-specific family factors may contribute to daily smoking in the early 20 s, whereas earlier general family context provided protection for trajectories of daily smoking characterized by changes in the late 20 s and early 30 s DISCUSSION: Selective prevention strategies that expand people's repertoire of healthy options to address attention problems might be helpful, considering the possibility of using tobacco as means to mitigate attention problems. Our findings also highlight the importance of nurturing earlier general family context, a relatively overlooked dimension in smoking prevention efforts, to facilitate young adult smokers' desistence from daily smoking, particularly those who have attention problems in adolescence.
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Affiliation(s)
- Jungeun Olivia Lee
- Suzanne Dworak-Peck School of Social Work, University of Southern California, United States.
| | - Karl G Hill
- Psychology and Neuroscience, University of Colorado Boulder, United States.
| | - Chung Hyeon Jeong
- Department of Social Work, College of Health and Human Services, University of New Hampshire, United States.
| | - Christine Steeger
- Institute of Behavioral Science, University of Colorado Boulder, United States.
| | - Rick Kosterman
- Social Development Research Group, School of Social Work, University of Washington, United States.
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Whitsel N, Reynolds CA, Buchholz EJ, Pahlen S, Pearce RC, Hatton SN, Elman JA, Gillespie NA, Gustavson DE, Puckett OK, Dale AM, Eyler LT, Fennema-Notestine C, Hagler DJ, Hauger RL, McEvoy LK, McKenzie R, Neale MC, Panizzon MS, Sanderson-Cimino M, Toomey R, Tu XM, Williams MKE, Bell T, Xian H, Lyons MJ, Kremen WS, Franz CE. Long-term associations of cigarette smoking in early mid-life with predicted brain aging from mid- to late life. Addiction 2022; 117:1049-1059. [PMID: 34605095 PMCID: PMC8904283 DOI: 10.1111/add.15710] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 09/03/2021] [Accepted: 09/15/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Smoking is associated with increased risk for brain aging/atrophy and dementia. Few studies have examined early associations with brain aging. This study aimed to measure whether adult men with a history of heavier smoking in early mid-life would have older than predicted brain age 16-28 years later. DESIGN Prospective cohort observational study, utilizing smoking pack years data from average age 40 (early mid-life) predicting predicted brain age difference scores (PBAD) at average ages 56, 62 (later mid-life) and 68 years (early old age). Early mid-life alcohol use was also evaluated. SETTING Population-based United States sample. PARTICIPANTS/CASES Participants were male twins of predominantly European ancestry who served in the United States military between 1965 and 1975. Structural magnetic resonance imaging (MRI) began at average age 56. Subsequent study waves included most baseline participants; attrition replacement subjects were added at later waves. MEASUREMENTS Self-reported smoking information was used to calculate pack years smoked at ages 40, 56, 62, and 68. MRIs were processed with the Brain-Age Regression Analysis and Computation Utility software (BARACUS) program to create PBAD scores (chronological age-predicted brain age) acquired at average ages 56 (n = 493; 2002-08), 62 (n = 408; 2009-14) and 68 (n = 499; 2016-19). FINDINGS In structural equation modeling, age 40 pack years predicted more advanced age 56 PBAD [β = -0.144, P = 0.012, 95% confidence interval (CI) = -0.257, -0.032]. Age 40 pack years did not additionally predict PBAD at later ages. Age 40 alcohol consumption, but not a smoking × alcohol interaction, predicted more advanced PBAD at age 56 (β = -0.166, P = 0.001, 95% CI = -0.261, -0.070) with additional influences at age 62 (β = -0.115, P = 0.005, 95% CI = -0.195, -0.036). Age 40 alcohol did not predict age 68 PBAD. Within-twin-pair analyses suggested some genetic mechanism partially underlying effects of alcohol, but not smoking, on PBAD. CONCLUSIONS Heavier smoking and alcohol consumption by age 40 appears to predict advanced brain aging by age 56 in men.
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Affiliation(s)
- Nathan Whitsel
- Department of Psychiatry, University of California San Diego, La Jolla, San Diego, CA, USA
- Center for Behavior Genetics of Aging, University of California, La Jolla, San Diego, CA, USA
| | - Chandra A Reynolds
- Department of Psychology, University of California, Riverside, Riverside, CA, USA
| | - Erik J Buchholz
- Department of Psychiatry, University of California San Diego, La Jolla, San Diego, CA, USA
- Center for Behavior Genetics of Aging, University of California, La Jolla, San Diego, CA, USA
| | - Shandell Pahlen
- Department of Psychology, University of California, Riverside, Riverside, CA, USA
| | - Rahul C Pearce
- Department of Psychiatry, University of California San Diego, La Jolla, San Diego, CA, USA
- Center for Behavior Genetics of Aging, University of California, La Jolla, San Diego, CA, USA
| | - Sean N Hatton
- Department of Neuroscience, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Jeremy A Elman
- Department of Psychiatry, University of California San Diego, La Jolla, San Diego, CA, USA
- Center for Behavior Genetics of Aging, University of California, La Jolla, San Diego, CA, USA
| | - Nathan A Gillespie
- Virginia Institute for Psychiatric and Behavior Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Daniel E Gustavson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Olivia K Puckett
- Department of Psychiatry, University of California San Diego, La Jolla, San Diego, CA, USA
- Center for Behavior Genetics of Aging, University of California, La Jolla, San Diego, CA, USA
| | - Anders M Dale
- Department of Neuroscience, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Lisa T Eyler
- Department of Psychiatry, University of California San Diego, La Jolla, San Diego, CA, USA
- Center for Behavior Genetics of Aging, University of California, La Jolla, San Diego, CA, USA
| | - Christine Fennema-Notestine
- Department of Psychiatry, University of California San Diego, La Jolla, San Diego, CA, USA
- Center for Behavior Genetics of Aging, University of California, La Jolla, San Diego, CA, USA
- Department of Neuroscience, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Donald J Hagler
- Department of Neuroscience, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Richard L Hauger
- Department of Psychiatry, University of California San Diego, La Jolla, San Diego, CA, USA
- Center for Behavior Genetics of Aging, University of California, La Jolla, San Diego, CA, USA
| | - Linda K McEvoy
- Department of Neuroscience, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Ruth McKenzie
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Michael C Neale
- Virginia Institute for Psychiatric and Behavior Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Matthew S Panizzon
- Department of Psychiatry, University of California San Diego, La Jolla, San Diego, CA, USA
- Center for Behavior Genetics of Aging, University of California, La Jolla, San Diego, CA, USA
| | - Mark Sanderson-Cimino
- Department of Psychiatry, University of California San Diego, La Jolla, San Diego, CA, USA
- Center for Behavior Genetics of Aging, University of California, La Jolla, San Diego, CA, USA
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, La Jolla, CA, USA
| | - Rosemary Toomey
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Xin M Tu
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Mc Kenna E Williams
- Department of Psychiatry, University of California San Diego, La Jolla, San Diego, CA, USA
- Center for Behavior Genetics of Aging, University of California, La Jolla, San Diego, CA, USA
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, La Jolla, CA, USA
| | - Tyler Bell
- Department of Psychiatry, University of California San Diego, La Jolla, San Diego, CA, USA
- Center for Behavior Genetics of Aging, University of California, La Jolla, San Diego, CA, USA
| | - Hong Xian
- Department of Epidemiology and Biostatistics, St Louis University, St Louis, MO, USA
| | - Michael J Lyons
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - William S Kremen
- Department of Psychiatry, University of California San Diego, La Jolla, San Diego, CA, USA
- Center for Behavior Genetics of Aging, University of California, La Jolla, San Diego, CA, USA
| | - Carol E Franz
- Department of Psychiatry, University of California San Diego, La Jolla, San Diego, CA, USA
- Center for Behavior Genetics of Aging, University of California, La Jolla, San Diego, CA, USA
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Di Credico G, Edefonti V, Polesel J, Pauli F, Torelli N, Serraino D, Negri E, Luce D, Stucker I, Matsuo K, Brennan P, Vilensky M, Fernandez L, Curado MP, Menezes A, Daudt AW, Koifman R, Wunsch-Filho V, Holcatova I, Ahrens W, Lagiou P, Simonato L, Richiardi L, Healy C, Kjaerheim K, Conway DI, Macfarlane TV, Thomson P, Agudo A, Znaor A, Boaventura Rios LF, Toporcov TN, Franceschi S, Herrero R, Muscat J, Olshan AF, Zevallos JP, La Vecchia C, Winn DM, Sturgis EM, Li G, Fabianova E, Lissowska J, Mates D, Rudnai P, Shangina O, Swiatkowska B, Moysich K, Zhang ZF, Morgenstern H, Levi F, Smith E, Lazarus P, Bosetti C, Garavello W, Kelsey K, McClean M, Ramroth H, Chen C, Schwartz SM, Vaughan TL, Zheng T, Menvielle G, Boccia S, Cadoni G, Hayes RB, Purdue M, Gillison M, Schantz S, Yu GP, Brenner H, D'Souza G, Gross ND, Chuang SC, Boffetta P, Hashibe M, Lee YCA, Dal Maso L. Joint effects of intensity and duration of cigarette smoking on the risk of head and neck cancer: A bivariate spline model approach. Oral Oncol 2019; 94:47-57. [PMID: 31178212 PMCID: PMC7117823 DOI: 10.1016/j.oraloncology.2019.05.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 03/27/2019] [Accepted: 05/05/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVES This study aimed at re-evaluating the strength and shape of the dose-response relationship between the combined (or joint) effect of intensity and duration of cigarette smoking and the risk of head and neck cancer (HNC). We explored this issue considering bivariate spline models, where smoking intensity and duration were treated as interacting continuous exposures. MATERIALS AND METHODS We pooled individual-level data from 33 case-control studies (18,260 HNC cases and 29,844 controls) participating in the International Head and Neck Cancer Epidemiology (INHANCE) consortium. In bivariate regression spline models, exposures to cigarette smoking intensity and duration (compared with never smokers) were modeled as a linear piecewise function within a logistic regression also including potential confounders. We jointly estimated the optimal knot locations and regression parameters within the Bayesian framework. RESULTS For oral-cavity/pharyngeal (OCP) cancers, an odds ratio (OR) >5 was reached after 30 years in current smokers of ∼20 or more cigarettes/day. Patterns of OCP cancer risk in current smokers differed across strata of alcohol intensity. For laryngeal cancer, ORs >20 were found for current smokers of ≥20 cigarettes/day for ≥30 years. In former smokers who quit ≥10 years ago, the ORs were approximately halved for OCP cancers, and ∼1/3 for laryngeal cancer, as compared to the same levels of intensity and duration in current smokers. CONCLUSION Referring to bivariate spline models, this study better quantified the joint effect of intensity and duration of cigarette smoking on HNC risk, further stressing the need of smoking cessation policies.
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Affiliation(s)
- Gioia Di Credico
- Department of Statistics, Padua University, Padua, Italy; Department of Economics, Business, Mathematics and Statistics, University of Trieste, Trieste, Italy
| | - Valeria Edefonti
- Branch of Medical Statistics, Biometry and Epidemiology "G. A. Maccacaro", Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy.
| | - Jerry Polesel
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Francesco Pauli
- Department of Economics, Business, Mathematics and Statistics, University of Trieste, Trieste, Italy
| | - Nicola Torelli
- Department of Economics, Business, Mathematics and Statistics, University of Trieste, Trieste, Italy
| | - Diego Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Eva Negri
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milano, Italy
| | - Daniele Luce
- Université de Rennes, INSERM, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), UMR_S 1085, Pointe-à-Pitre, France
| | - Isabelle Stucker
- Inserm, Center for Research in Epidemiology and Population Health (CESP), Cancer and Environment team, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | | | - Paul Brennan
- International Agency for Research on Cancer, Lyon, France
| | - Marta Vilensky
- Institute of Oncology Angel H. Roffo, University of Buenos Aires, Argentina
| | | | | | - Ana Menezes
- Universidade Federal de Pelotas, Pelotas, Brazil
| | | | - Rosalina Koifman
- Escola Nacional de Saude Publica, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Ivana Holcatova
- Institute of Hygiene & Epidemiology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology, BIPS, Bremen, Germany; University of Bremen, Faculty of Mathematics and Computer Science, Bremen, Germany
| | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Lorenzo Simonato
- Department of Cardiovascular and Thoracic Sciences and Public Health, University of Padova, Padova, Italy
| | | | - Claire Healy
- Trinity College School of Dental Science, Dublin, Ireland
| | | | - David I Conway
- School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, UK
| | - Tatiana V Macfarlane
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK and School of Medicine, University of Dundee, Dundee, UK
| | | | | | - Ariana Znaor
- International Agency for Research on Cancer, Lyon, France
| | | | | | - Silvia Franceschi
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | | | | | - Andrew F Olshan
- University of North Carolina School of Public Health, Chapel Hill, NC, USA
| | - Jose P Zevallos
- Division of Head and Neck Surgical Oncology in the Department of Otolaryngology/Head and Neck Surgery at Washington University School of Medicine, USA
| | - Carlo La Vecchia
- Branch of Medical Statistics, Biometry and Epidemiology "G. A. Maccacaro", Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy
| | - Deborah M Winn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | | | - Guojun Li
- UT - M.D. Anderson Cancer Center, Houston, TX, USA
| | | | - Jolanda Lissowska
- The M. Skasodowska-Curie Memorial Cancer Center and Institute of Oncology, Dept. of Cancer Epidemiology and Prevention, Warsaw, Poland
| | - Dana Mates
- National Institute of Public Health, Bucharest, Romania
| | - Peter Rudnai
- National Institute of Environmental Health to National Public Health Institute, Budapest, Hungary
| | | | | | | | | | - Hal Morgenstern
- Departments of Epidemiology and Environmental Health Sciences, School of Public Health and Department of Urology, Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Fabio Levi
- Institut Universitaire de Medecine Sociale et Preventive (IUMSP), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Elaine Smith
- College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Philip Lazarus
- Washington State University College of Pharmacy and Pharmaceutical Sciences, Spokane, WA, USA
| | - Cristina Bosetti
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Werner Garavello
- Department of Otorhinolaryngology, School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy
| | | | | | | | - Chu Chen
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Stephen M Schwartz
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Thomas L Vaughan
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Tongzhang Zheng
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Gwenn Menvielle
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, Department of Social Epidemiology, F75012 Paris, France
| | - Stefania Boccia
- Department of Woman and Child Health and Public Health, Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Gabriella Cadoni
- Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Istituto di Clinica Otorinolaringoiatrica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Richard B Hayes
- Division of Epidemiology, New York University School Of Medicine, New York, NY, USA
| | - Mark Purdue
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Maura Gillison
- "Thoracic/Head and Neck Medical Oncology", The University of Texas MD Anderson Cancer Center, TX, USA
| | | | - Guo-Pei Yu
- Medical Informatics Center, Peking University, China
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Neil D Gross
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shu-Chun Chuang
- Institute of Population Health Sciences, National Health Research Institutes, Taiwan
| | - Paolo Boffetta
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mia Hashibe
- Division of Public Health, Department of Family & Preventive Medicine and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Yuan-Chin Amy Lee
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
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6
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Ryan BM. Lung cancer health disparities. Carcinogenesis 2019; 39:741-751. [PMID: 29547922 DOI: 10.1093/carcin/bgy047] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 03/13/2018] [Indexed: 12/16/2022] Open
Abstract
Compared with all other racial and ethnic groups in the United States, African Americans are disproportionally affected by lung cancer, both in terms of incidence and survival. It is likely that smoking, as the main etiological factor associated with lung cancer, contributes to these disparities, but the precise mechanism is still unclear. This paper seeks to explore the history of lung cancer disparities and review to the literature regarding the various factors that contribute to them.
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Affiliation(s)
- Bríd M Ryan
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
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7
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Remen T, Pintos J, Abrahamowicz M, Siemiatycki J. Risk of lung cancer in relation to various metrics of smoking history: a case-control study in Montreal. BMC Cancer 2018; 18:1275. [PMID: 30567516 PMCID: PMC6299933 DOI: 10.1186/s12885-018-5144-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 11/27/2018] [Indexed: 12/25/2022] Open
Abstract
Background Few epidemiologic findings are as well established as the association between smoking and lung cancer. It is therefore somewhat surprising that there is not yet a clear consensus about the exposure-response relationships between various metrics of smoking and lung cancer risk. In part this is due to heterogeneity of how exposure-response results have been presented and the relative paucity of published results using any particular metric of exposure. The purposes of this study are: to provide new data on smoking-lung cancer associations and to explore the relative impact of different dimensions of smoking history on lung cancer risk. Methods Based on a large lung cancer case-control study (1203 cases and 1513 controls) conducted in Montreal in 1996–2000, we estimated the lifetime prevalence of smoking and odds ratios in relation to several smoking metrics, both categorical and continuous based on multivariable unconditional logistic regression. Results Odds ratios (ORs) for ever vs never smoking were 7.82 among males and 11.76 among females. ORs increased sharply with every metric of smoking examined, more so for duration than for daily intensity. In models using continuous smoking variables, all metrics had strong effects on OR and mutual adjustment among smoking metrics did not noticeably attenuate the OR estimates, indicating that each metric carries some independent risk-related information. Among all the models tested, the one based on a smoking index that integrates several smoking dimensions, provided the best fitting model. Similar patterns were observed for the different histologic types of lung cancer. Conclusions This study provides many estimates of exposure-response relationships between smoking and lung cancer; these can be used in future meta-analyses. Irrespective of the histologic type of lung cancer and the smoking metric examined, high levels of smoking led to high levels of risk, for both men and women. Electronic supplementary material The online version of this article (10.1186/s12885-018-5144-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- T Remen
- University of Montreal Hospital Research Center (CRCHUM), Montreal, Canada.
| | - J Pintos
- University of Montreal Hospital Research Center (CRCHUM), Montreal, Canada
| | - M Abrahamowicz
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - J Siemiatycki
- University of Montreal Hospital Research Center (CRCHUM), Montreal, Canada
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8
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Molina BS, Howard AL, Swanson JM, Stehli A, Mitchell JT, Kennedy TM, Epstein JN, Arnold LE, Hechtman L, Vitiello B, Hoza B. Substance use through adolescence into early adulthood after childhood-diagnosed ADHD: findings from the MTA longitudinal study. J Child Psychol Psychiatry 2018; 59:692-702. [PMID: 29315559 PMCID: PMC5985671 DOI: 10.1111/jcpp.12855] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Inconsistent findings exist regarding long-term substance use (SU) risk for children diagnosed with attention-deficit/hyperactivity disorder (ADHD). The observational follow-up of the Multimodal Treatment Study of Children with ADHD (MTA) provides an opportunity to assess long-term outcomes in a large, diverse sample. METHODS Five hundred forty-seven children, mean age 8.5, diagnosed with DSM-IV combined-type ADHD and 258 classmates without ADHD (local normative comparison group; LNCG) completed the Substance Use Questionnaire up to eight times from mean age 10 to mean age 25. RESULTS In adulthood, weekly marijuana use (32.8% ADHD vs. 21.3% LNCG) and daily cigarette smoking (35.9% vs. 17.5%) were more prevalent in the ADHD group than the LNCG. The cumulative record also revealed more early substance users in adolescence for ADHD (57.9%) than LNCG (41.9%), including younger first use of alcohol, cigarettes, marijuana, and illicit drugs. Alcohol and nonmarijuana illicit drug use escalated slightly faster in the ADHD group in early adolescence. Early SU predicted quicker SU escalation and more SU in adulthood for both groups. CONCLUSIONS Frequent SU for young adults with childhood ADHD is accompanied by greater initial exposure at a young age and slightly faster progression. Early SU prevention and screening is critical before escalation to intractable levels.
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Affiliation(s)
- Brooke S.G. Molina
- Departments of Psychiatry, Psychology, & Pediatrics, University of Pittsburgh
| | | | | | | | - John T. Mitchell
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center
| | - Traci M. Kennedy
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | | | | | - Lily Hechtman
- Division of Child Psychiatry, McGill University and Montreal Children’s Hospital
| | | | - Betsy Hoza
- Department of Psychological Science, University of Vermont
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9
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Clarke MA, Joshu CE. Early Life Exposures and Adult Cancer Risk. Epidemiol Rev 2018; 39:11-27. [PMID: 28407101 DOI: 10.1093/epirev/mxx004] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 01/19/2017] [Indexed: 12/14/2022] Open
Abstract
Very little is known about the influence of early life exposures on adult cancer risk. The purpose of this narrative review was to summarize the epidemiologic evidence relating early life tobacco use, obesity, diet, and physical activity to adult cancer risk; describe relevant theoretical frameworks and methodological strategies for studying early life exposures; and discuss policies and research initiatives focused on early life. Our findings suggest that in utero exposures may indirectly influence cancer risk by modifying biological pathways associated with carcinogenesis; however, more research is needed to firmly establish these associations. Initiation of exposures during childhood and adolescence may impact cancer risk by increasing duration and lifetime exposure to carcinogens and/or by acting during critical developmental periods. To expand the evidence base, we encourage the use of life course frameworks, causal inference methods such as Mendelian randomization, and statistical approaches such as group-based trajectory modeling in future studies. Further, we emphasize the need for objective exposure biomarkers and valid surrogate endpoints to reduce misclassification. With the exception of tobacco use, there is insufficient evidence to support the development of new cancer prevention policies; however, we highlight existing policies that may reduce the burden of these modifiable risk factors in early life.
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10
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Lubin JH, Albanes D, Hoppin JA, Chen H, Lerro CC, Weinstein SJ, Sandler DP, Beane Freeman LE. Greater Coronary Heart Disease Risk With Lower Intensity and Longer Duration Smoking Compared With Higher Intensity and Shorter Duration Smoking: Congruent Results Across Diverse Cohorts. Nicotine Tob Res 2017; 19:817-825. [PMID: 27941116 PMCID: PMC5896542 DOI: 10.1093/ntr/ntw290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 10/17/2016] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Relative risks (RRs) for coronary heart disease (CHD) by cigarettes/day exhibit a concave pattern, implying the RR increase with each additional cigarette/day consumed decreases with greater intensity. Interpreting this pattern faces limitations, since cigarettes/day alone does not fully characterize smoking-related exposure. A more complete understanding of smoking and CHD risk requires a more comprehensive representation of smoking. METHODS Using Poisson regression, we applied a RR model in pack-years and cigarettes/day to analyze two diverse cohorts, the US Agricultural Health Study, with 4396 CHD events and 1 425 976 person-years of follow-up, and the Finnish Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study, with 5979 CHD events and 486 643 person-years. RESULTS In both cohorts, the concave RR pattern with cigarettes/day was consistent with cigarettes/day modifying a linear RR association for CHD by pack-years within categories of cigarettes/day, indicating that strength of the pack-years association depended on cigarettes/day (p < .01). For example, at 50 pack-years (365 000 total cigarettes), estimated RRs of CHD were 2.1 for accrual at 20 cigarettes/day and 1.5 for accrual at 50 cigarettes/day. CONCLUSIONS RRs for CHD increased with pack-years with smoking intensities affecting the strength of association. For equal pack-years, smoking fewer cigarettes/day for longer duration was more deleterious than smoking more cigarettes/day for shorter duration. We have now observed inverse smoking intensity effects in multiple cohorts with differing smoking patterns and other characteristics, suggesting a common underlying phenomenon. IMPLICATIONS Risk of CHD increases with pack-years of smoking, but accrual intensity strongly influences the strength of the association, such that smoking fewer cigarettes/day for longer duration is more deleterious than smoking more cigarettes/day for shorter duration. This observation offers clues to better understanding biological mechanisms, and reinforces the importance of cessation rather than smoking less to reduce CHD risk.
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Affiliation(s)
- Jay H Lubin
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, US National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Demetrius Albanes
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, US National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Jane A Hoppin
- Department of Biological Sciences and Center for Human Health and the Environment, North Carolina State University, Raleigh, NC
| | - Honglei Chen
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, Durham, NC
| | - Catherine C Lerro
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, US National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Stephanie J Weinstein
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, US National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, Durham, NC
| | - Laura E Beane Freeman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, US National Cancer Institute, National Institutes of Health, Bethesda, MD
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Lubin JH, Couper D, Lutsey PL, Yatsuya H. Synergistic and Non-synergistic Associations for Cigarette Smoking and Non-tobacco Risk Factors for Cardiovascular Disease Incidence in the Atherosclerosis Risk In Communities (ARIC) Study. Nicotine Tob Res 2017; 19:826-835. [PMID: 27651477 PMCID: PMC5896551 DOI: 10.1093/ntr/ntw235] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 09/19/2016] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Cigarette smoking, various metabolic and lipid-related factors and hypertension are well-recognized cardiovascular disease (CVD) risk factors. Since smoking affects many of these factors, use of a single imprecise smoking metric, for example, ever or never smoked, may allow residual confounding and explain inconsistencies in current assessments of interactions. METHODS Using a comprehensive model in pack-years and cigarettes/day for the complex smoking-related relative risk (RR) of CVD to reduce residual confounding, we evaluated interactions with non-tobacco risk factors, including additive (non-synergistic) and multiplicative (synergistic) forms. Data were from the prospective Atherosclerosis Risk in Communities (ARIC) Study from four areas of the United States recruited in 1987-1989 with follow-up through 2008. Analyses included 14 127 participants, 207 693 person-years and 2857 CVD events. RESULTS Analyses revealed distinct interactions with smoking: including statistical consistency with additive (body mass index [BMI], waist to hip ratio [WHR], diabetes mellitus [DM], glucose, insulin, high density lipoproteins [HDL] and HDL(2)); and multiplicative (hypertension, total cholesterol [TC], low density lipoproteins [LDLs], apolipoprotein B [apoB], TC to HDL ratio and HDL(3)) associations, as well as indeterminate (apolipoprotein A-I [apoA-I] and triglycerides) associations. CONCLUSIONS The forms of the interactions were revealing but require confirmation. Improved understanding of joint associations may help clarify the public health burden of smoking for CVD, links between etiologic factors and biological mechanisms, and the consequences of joint exposures, whereby synergistic associations highlight joint effects and non-synergistic associations suggest distinct contributions. IMPLICATIONS Joint associations for cigarette smoking and non-tobacco risk factors were distinct, revealing synergistic/multiplicative (hypertension, TC, LDL, apoB, TC/HDL, HDL(3)), non-synergistic/additive (BMI, WHR, DM, glucose, insulin, HDL, HDL(2)) and indeterminate (apoA-I and TRIG) associations. If confirmed, these results may help better define the public health burden of smoking on CVD risk and identify links between etiologic factors and biologic mechanisms, where synergistic associations highlight joint impacts and non-synergistic associations suggest distinct contributions from each factor.
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Affiliation(s)
- Jay H Lubin
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, US National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - David Couper
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
| | - Hiroshi Yatsuya
- Department of Public Health, Fujita Health University School of Medicine, Kutsukake-cho, Japan
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Risk of Cardiovascular Disease from Cumulative Cigarette Use and the Impact of Smoking Intensity. Epidemiology 2017; 27:395-404. [PMID: 26745609 DOI: 10.1097/ede.0000000000000437] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Relative risks (RRs) for cardiovascular disease (CVD) by smoking rate exhibit a concave pattern, with RRs in low rate smokers exceeding a linear extrapolation from higher rate smokers. However, cigarettes/day does not by itself fully characterize smoking-related risks. A reexamination of the concave pattern using a comprehensive representation of smoking may enhance insights. METHODS Data were from the Atherosclerosis Risk in Communities (ARIC) Study, a prospective cohort enrolled in four areas of the US in 1987-1989. Follow-up was through 2008. Analyses included 14,233 participants, 245,915 person-years, and 3,411 CVD events. RESULTS The concave RRs with cigarettes/day were consistent with cigarettes/day modifying a linear RR association of pack-years with CVD (i.e., strength of the pack-years association depended on cigarettes/day, indicating that the manner of pack-years accrual impacted risk). Smoking fewer cigarettes/day for longer duration was more deleterious than smoking more cigarettes/day for shorter duration (P < 0.01). For 50 pack-years (365,000 cigarettes), estimated RRs of CVD were 2.1 for accrual at 20 cigarettes/day and 1.6 for accrual at 50 cigarettes/day. Years since smoking cessation did not alter the diminishing strength of association with increasing cigarettes/day. Analyses that accounted for competing risks did not affect findings. CONCLUSION Pack-years remained the primary determinant of smoking-related CVD risk; however, accrual influenced RRs. For equal pack-years, smoking fewer cigarettes/day for longer duration was more deleterious than smoking more cigarettes/day for shorter duration. This observation provides clues to better understanding the biological mechanisms, and reinforces the importance of cessation rather than smoking less to reduce CVD risk.
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The Effects of Viral Load Burden on Pregnancy Loss among HIV-Infected Women in the United States. Infect Dis Obstet Gynecol 2015; 2015:362357. [PMID: 26582966 PMCID: PMC4637076 DOI: 10.1155/2015/362357] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/29/2015] [Accepted: 09/30/2015] [Indexed: 12/02/2022] Open
Abstract
Background. To evaluate the effects of HIV viral load, measured cross-sectionally and cumulatively, on the risk of miscarriage or stillbirth (pregnancy loss) among HIV-infected women enrolled in the Women's Interagency HIV Study between 1994 and 2013. Methods. We assessed three exposures: most recent viral load measure before the pregnancy ended, log10 copy-years viremia from initiation of antiretroviral therapy (ART) to conception, and log10 copy-years viremia in the two years before conception. Results. The risk of pregnancy loss for those with log10 viral load >4.00 before pregnancy ended was 1.59 (95% confidence interval (CI): 0.99, 2.56) times as high as the risk for women whose log10 viral load was ≤1.60. There was not a meaningful impact of log10 copy-years viremia since ART or log10 copy-years viremia in the two years before conception on pregnancy loss (adjusted risk ratios (aRRs): 0.80 (95% CI: 0.69, 0.92) and 1.00 (95% CI: 0.90, 1.11), resp.). Conclusions. Cumulative viral load burden does not appear to be an informative measure for pregnancy loss risk, but the extent of HIV replication during pregnancy, as represented by plasma HIV RNA viral load, predicted loss versus live birth in this ethnically diverse cohort of HIV-infected US women.
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de Vocht F, Burstyn I, Sanguanchaiyakrit N. Rethinking cumulative exposure in epidemiology, again. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2015; 25:467-473. [PMID: 25138292 DOI: 10.1038/jes.2014.58] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 06/06/2014] [Accepted: 06/15/2014] [Indexed: 06/03/2023]
Abstract
The use of cumulative exposure, the product of intensity and duration, has enjoyed great popularity in epidemiology of chronic diseases despite numerous known caveats in its interpretation. We briefly review the history of use of cumulative exposure in epidemiology and propose an alternative method for relating time-integrated exposures to health risks. We argue, as others before us have, that cumulative exposure metrics obscures the interplay of exposure intensity and duration. We propose to use a computationally simple alternative in which duration and intensity of exposure are modelled as a main effect and their interaction, cumulative exposure, only be added if there is evidence of deviation from this additive model. We also consider the Lubin-Caporaso model of interplay of exposure intensity and duration. The impact of measurement error in intensity on model selection was also examined. The value of this conceptualization is demonstrated using a simulation study and further illustrated in the context of respiratory health and occupational exposure to latex dust. We demonstrate why cumulative exposure has been so popular because the cumulative exposure metric per se gives a robust answer to the existence of an association, regardless of the underlying true mechanism of disease. Treating cumulative exposure as the interaction of main effects of exposure duration and intensity enables epidemiologists to derive more information about mechanism of disease then fitting cumulative exposure metric by itself, and without the need to collect additional data. We propose that the practice of fitting duration, intensity and cumulative exposure separately to epidemiologic data should lead to conceptualization of cumulative exposure as interaction of main effects of duration and intensity of exposure.
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Affiliation(s)
- Frank de Vocht
- 1] School of Social and Community Medicine, University of Bristol, Bristol, UK [2] Centre for Occupational and Environmental Health, Centre for Epidemiology, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
| | - Igor Burstyn
- Department of Environmental and Occupational Health, School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Nuthchyawach Sanguanchaiyakrit
- 1] Centre for Occupational and Environmental Health, Centre for Epidemiology, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK [2] Occupational Safety and Health Standard Development Group, Occupational Safety and Health Bureau, Department of Labour protection and Welfare, Bangkok, Thailand
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Abstract
Cumulative exposure--the product of intensity and duration for a constant exposure rate or its integral over time if variable--has been widely used in epidemiologic analyses of extended exposures, for example, the "pack-years" variable for tobacco smoking. Although the effects of intensity and duration are known to differ for exposures like smoking and ionizing radiation and simple cumulative exposure does not explicitly allow for modification by other time-related variables, such as age at exposure or time since exposure, the cumulative exposure variable has the merit of simplicity and has been shown to be one of the best predictors for many exposure-response relationships. This commentary discusses recent refinements of the pack-years variable, as discussed in this issue of the Journal by Vlaanderen et al. (Am J Epidemiol. 2014;179(3):290-298), in the broader context of general exposure-time-response relationships.
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Reply: misunderstandings in the misconception on the use of pack-years in analysis of smoking. Br J Cancer 2013; 108:1221. [PMID: 23449356 PMCID: PMC3619087 DOI: 10.1038/bjc.2013.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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