Ritz Beate, Ascherio Alberto, Checkoway Harvey, Marder Karen S, Nelson Lorene M, Rocca Walter A, Ross G Webster, Strickland Daniel, Van Den Eeden Stephen K, Gorell Jay
Department of Epidemiology and Environmental Health Sciences, UCLA School of Public Health, 650 Charles Young Smith Dr S, Los Angeles, CA 90095-1772, USA.
Arch Neurol. 2007 Jul;64(7):990-7. doi: 10.1001/archneur.64.7.990.
Epidemiologic studies have reported that cigarette smoking is inversely associated with Parkinson disease (PD). However, questions remain regarding the effect of age at smoking onset, time since quitting, and race/ethnicity that have not been addressed due to sample size constraints. This comprehensive assessment of the apparent reduced risk of PD associated with smoking may provide important leads for treatment and prevention.
To determine whether race/ethnicity, sex, education, age at diagnosis, and type of tobacco modify the observed effects of smoking on PD.
DESIGN, SETTING, AND PARTICIPANTS: We conducted the first ever pooled analysis of PD combining individual-level data from 8 US case-control and 3 cohort studies (Nurses' Health Study, Health Professionals Follow-Up Study, and Honolulu-Asia Aging Study) conducted between 1960 and 2004. Case-control studies provided data for 2328 PD cases and 4113 controls matched by age, sex, and ethnicity; cohort studies contributed 488 cases and 4880 controls selected from age- and sex-matched risk sets.
Incident PD.
We confirmed inverse associations between PD and smoking and found these to be generally stronger in current compared with former smokers; the associations were stronger in cohort than in case-control studies. We observed inverse trends with pack-years smoked at every age at onset except the very elderly (>75 years of age), and the reduction of risk lessened with years since quitting smoking. The risk reductions we observed for white and Asian patients were not seen in Hispanic and African American patients. We also found an inverse association both for smoking cigars and/or pipes and for chewing tobacco in male subjects.
Our data support a dose-dependent reduction of PD risk associated with cigarette smoking and potentially with other types of tobacco use. Importantly, effects seemed not to be influenced by sex or education. Differences observed by race and age at diagnosis warrant further study.
流行病学研究报告称，吸烟与帕金森病（PD）呈负相关。然而，由于样本量的限制，吸烟起始年龄、戒烟时间以及种族/民族的影响等问题仍未得到解决。对与吸烟相关的PD明显降低风险的这一全面评估可能为治疗和预防提供重要线索。
确定种族/民族、性别、教育程度、诊断年龄和烟草类型是否会改变观察到的吸烟对PD的影响。
设计、地点和参与者：我们对PD进行了首次汇总分析，合并了1960年至2004年间美国8项病例对照研究和3项队列研究（护士健康研究、卫生专业人员随访研究和檀香山-亚洲老年研究）的个体水平数据。病例对照研究提供了2328例PD病例和4113例按年龄、性别和种族匹配的对照的数据；队列研究贡献了488例病例和4880例从年龄和性别匹配的风险组中选择的对照。
新发PD。
我们证实了PD与吸烟之间的负相关，并发现与既往吸烟者相比，当前吸烟者的这种相关性通常更强；队列研究中的相关性比病例对照研究中的更强。我们观察到，除了非常年长（>75岁）的人群外，在每个起始年龄，PD风险都与吸烟包年数呈负相关，并且随着戒烟时间的延长，风险降低的幅度减小。我们在白人和亚洲患者中观察到的风险降低在西班牙裔和非裔美国患者中未观察到。我们还发现，男性中吸烟雪茄和/或烟斗以及咀嚼烟草也与PD呈负相关。
我们的数据支持吸烟与PD风险呈剂量依赖性降低，其他类型的烟草使用可能也有此作用。重要的是，这种影响似乎不受性别或教育程度的影响。按种族和诊断年龄观察到的差异值得进一步研究。
