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Association of Changes in Smoking Intensity With Risk of Dementia in Korea

IMPORTANCE: Several observational studies have reported that smoking cessation is associated with a lower risk of dementia. However, no studies have examined the association between change in smoking intensity and risk of dementia. OBJECTIVE: To investigate the association between a change in smokin...

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Autores principales: Jeong, Su-Min, Park, Junhee, Han, Kyungdo, Yoo, Juhwan, Yoo, Jung Eun, Lee, Cheol Min, Jung, Wonyoung, Lee, Jinkook, Kim, Sang Yun, Shin, Dong Wook
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9857334/
https://www.ncbi.nlm.nih.gov/pubmed/36656579
http://dx.doi.org/10.1001/jamanetworkopen.2022.51506
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author Jeong, Su-Min
Park, Junhee
Han, Kyungdo
Yoo, Juhwan
Yoo, Jung Eun
Lee, Cheol Min
Jung, Wonyoung
Lee, Jinkook
Kim, Sang Yun
Shin, Dong Wook
author_facet Jeong, Su-Min
Park, Junhee
Han, Kyungdo
Yoo, Juhwan
Yoo, Jung Eun
Lee, Cheol Min
Jung, Wonyoung
Lee, Jinkook
Kim, Sang Yun
Shin, Dong Wook
author_sort Jeong, Su-Min
collection PubMed
description IMPORTANCE: Several observational studies have reported that smoking cessation is associated with a lower risk of dementia. However, no studies have examined the association between change in smoking intensity and risk of dementia. OBJECTIVE: To investigate the association between a change in smoking intensity, including smoking reduction and smoking cessation, and risk of all dementia. DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the National Health Insurance Service database of Korea. The cohort included participants 40 years or older who underwent biennial health examinations (2009 and 2011) and had current smoking status at the first health examination. The cohort was followed up until December 31, 2018, and statistical analysis was performed between July and December 2021. EXPOSURES: Change in smoking intensity from baseline was defined operationally as follows: quitters (stopped smoking), reducers I (decreased number of cigarettes smoked per day by ≥50%), reducers II (decreased number of cigarettes smoked per day by 20%-50%), sustainers (maintained [decreased or increased] number of cigarettes smoked per day by less than 20%), or increasers (increased number of cigarettes smoked per day by ≥20%). MAIN OUTCOMES AND MEASURES: The primary outcome was newly diagnosed dementia, which was identified by prescribed antidementia medications with concomitant International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes for dementia. Adjusted hazard ratios and 95% CIs were used to determine the association between change in smoking intensity and incidence of dementia, including Alzheimer disease (AD) and vascular dementia (VaD). RESULTS: A total of 789 532 participants (756 469 males [95.8%]; mean [SD] age, 52.2 [8.5] years) were included. During a median (IQR) follow-up period of 6.3 (6.1-6.6) years, 11 912 dementia events, including 8800 AD and 1889 VaD events, were identified. Overall, participants in the quitter group had a significantly lower risk of all dementia (adjusted hazard ratio [aHR], 0.92; 95% CI, 0.87-0.97) compared with those in the sustainer group. Those in the reducer I (aHR, 1.25; 95% CI, 1.18-1.33) and increaser (aHR, 1.12; 95% CI, 1.06-1.18) groups had a significantly higher risk of all dementia compared with those in the sustainer group.The patterns for AD and VaD remained consistent with patterns for all dementia. CONCLUSIONS AND RELEVANCE: The results of this study showed that smoking cessation was associated with a lower risk of dementia compared with sustained smoking intensity, while smoking reduction was associated with a higher risk. Smoking cessation should be emphasized in efforts to reduce the disease burden of dementia.
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spelling pubmed-98573342023-02-03 Association of Changes in Smoking Intensity With Risk of Dementia in Korea Jeong, Su-Min Park, Junhee Han, Kyungdo Yoo, Juhwan Yoo, Jung Eun Lee, Cheol Min Jung, Wonyoung Lee, Jinkook Kim, Sang Yun Shin, Dong Wook JAMA Netw Open Original Investigation IMPORTANCE: Several observational studies have reported that smoking cessation is associated with a lower risk of dementia. However, no studies have examined the association between change in smoking intensity and risk of dementia. OBJECTIVE: To investigate the association between a change in smoking intensity, including smoking reduction and smoking cessation, and risk of all dementia. DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the National Health Insurance Service database of Korea. The cohort included participants 40 years or older who underwent biennial health examinations (2009 and 2011) and had current smoking status at the first health examination. The cohort was followed up until December 31, 2018, and statistical analysis was performed between July and December 2021. EXPOSURES: Change in smoking intensity from baseline was defined operationally as follows: quitters (stopped smoking), reducers I (decreased number of cigarettes smoked per day by ≥50%), reducers II (decreased number of cigarettes smoked per day by 20%-50%), sustainers (maintained [decreased or increased] number of cigarettes smoked per day by less than 20%), or increasers (increased number of cigarettes smoked per day by ≥20%). MAIN OUTCOMES AND MEASURES: The primary outcome was newly diagnosed dementia, which was identified by prescribed antidementia medications with concomitant International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes for dementia. Adjusted hazard ratios and 95% CIs were used to determine the association between change in smoking intensity and incidence of dementia, including Alzheimer disease (AD) and vascular dementia (VaD). RESULTS: A total of 789 532 participants (756 469 males [95.8%]; mean [SD] age, 52.2 [8.5] years) were included. During a median (IQR) follow-up period of 6.3 (6.1-6.6) years, 11 912 dementia events, including 8800 AD and 1889 VaD events, were identified. Overall, participants in the quitter group had a significantly lower risk of all dementia (adjusted hazard ratio [aHR], 0.92; 95% CI, 0.87-0.97) compared with those in the sustainer group. Those in the reducer I (aHR, 1.25; 95% CI, 1.18-1.33) and increaser (aHR, 1.12; 95% CI, 1.06-1.18) groups had a significantly higher risk of all dementia compared with those in the sustainer group.The patterns for AD and VaD remained consistent with patterns for all dementia. CONCLUSIONS AND RELEVANCE: The results of this study showed that smoking cessation was associated with a lower risk of dementia compared with sustained smoking intensity, while smoking reduction was associated with a higher risk. Smoking cessation should be emphasized in efforts to reduce the disease burden of dementia. American Medical Association 2023-01-19 /pmc/articles/PMC9857334/ /pubmed/36656579 http://dx.doi.org/10.1001/jamanetworkopen.2022.51506 Text en Copyright 2023 Jeong SM et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Jeong, Su-Min
Park, Junhee
Han, Kyungdo
Yoo, Juhwan
Yoo, Jung Eun
Lee, Cheol Min
Jung, Wonyoung
Lee, Jinkook
Kim, Sang Yun
Shin, Dong Wook
Association of Changes in Smoking Intensity With Risk of Dementia in Korea
title Association of Changes in Smoking Intensity With Risk of Dementia in Korea
title_full Association of Changes in Smoking Intensity With Risk of Dementia in Korea
title_fullStr Association of Changes in Smoking Intensity With Risk of Dementia in Korea
title_full_unstemmed Association of Changes in Smoking Intensity With Risk of Dementia in Korea
title_short Association of Changes in Smoking Intensity With Risk of Dementia in Korea
title_sort association of changes in smoking intensity with risk of dementia in korea
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9857334/
https://www.ncbi.nlm.nih.gov/pubmed/36656579
http://dx.doi.org/10.1001/jamanetworkopen.2022.51506
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