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Cigarette Smoking and Risk of Infection-Related Mortality: A Cohort Study
33 Pages Posted: 16 Jul 2020
More...Abstract
Background: Cigarette smoking is the leading cause of death and is associated with various diseases. However, few studies on smoking status and infection-related death have been published. This study examines the relationship between smoking and infection-related mortality in men and women.
Methods: A cohort of 539,835 Korean adults were followed for up to 17 years. Vital status and cause of death were ascertained using national death records.
Findings: During a median follow-up of 8.5 years, 344 infection-related deaths (104 women and 240 men) were identified. Current smoking, but not former smoking, was positively associated with an increased risk of infection-related mortality in both men and women, and the association was stronger in women (P for interaction = 0.046). After adjusting for possible confounders, the multivariable-adjusted hazard ratios (95% confidence intervals) for infection-related mortality comparing former and current smokers with never smokers were 1.58 (0.73–3.41) and 4.52 (2.55–8.01), respectively, in women and 1.01 (0.69–1.46) and 1.96 (1.36–2.81), respectively, in men. The number of cigarettes and pack-years were positively associated with an increased risk of infection-related mortality in both men and women (P for trend < 0.05). These associations were similar after introducing changes in smoking status and other confounders as time-varying covariates during follow-up. After excluding mortality due to pneumonia, influenza, and tuberculosis, the association between current smoking and infection-related mortality was consistent.
Interpretation: Current smoking, its intensity, and pack-years were associated with an increased risk of death due to infections which are both established and unestablished as being caused by smoking, and this association was stronger in women than in men.
Funding Statement: None.
Declaration of Interests: The authors have no conflicts of interest to disclose.
Ethics Approval Statement: This study was approved by the Institutional Review Board (IRB) of Kangbuk Samsung Hospital (IRB No. KBSMC 2020-03-023), which waived the requirement for informed consent due to the use of anonymized retrospective data that were routinely collected during the health-screening process and were already linked to mortality data from the Korea National Statistical Office (KNSO).
Keywords: infection; mortality; cohort study; infection-related mortality; smoking
Suggested Citation: Suggested Citation