Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Department of Psychology, University of Southern California, Los Angeles, CA, USA.
Int J Epidemiol. 2017 Jun 1;46(3):872-880. doi: 10.1093/ije/dyw294.
Cigarette smoking is associated with a lower risk of Parkinson's disease. It is unclear what constituent of tobacco smoke may lower the risk. Use of Swedish moist smokeless tobacco (snus) can serve as a model to disentangle what constituent of tobacco smoke may lower the risk. The aim of this study was to determine whether snus use was associated with a lower risk of Parkinson's disease.
Individual participant data were collected from seven prospective cohort studies, including 348 601 men. We used survival analysis with multivariable Cox regression to estimate study-specific relative risk of Parkinson's disease due to snus use, and random-effects models to pool estimates in a meta-analysis. The primary analyses were restricted to never-smokers to eliminate the potential confounding effect of tobacco smoking.
During a mean follow-up time of 16.1 years, 1199 incident Parkinson's disease cases were identified. Among men who never smoked, ever-snus users had about 60% lower Parkinson's disease risk compared with never-snus users [pooled hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.28-0.61]. The inverse association between snus use and Parkinson's disease risk was more pronounced in current (pooled HR 0.38, 95% CI 0.23-0.63), moderate-heavy amount (pooled HR 0.41, 95% CI 0.19-0.90) and long-term snus users (pooled HR 0.44, 95% CI 0.24-0.83).
Non-smoking men who used snus had a substantially lower risk of Parkinson's disease. Results also indicated an inverse dose-response relationship between snus use and Parkinson's disease risk. Our findings suggest that nicotine or other components of tobacco leaves may influence the development of Parkinson's disease.
吸烟与帕金森病的风险降低有关。目前尚不清楚烟草烟雾中的哪种成分可能降低风险。使用瑞典湿无烟烟草（鼻烟）可以作为一种模型，以厘清烟草烟雾中的哪种成分可能降低风险。本研究的目的是确定使用鼻烟是否与帕金森病的风险降低有关。
从 7 项前瞻性队列研究中收集了个体参与者数据，包括 348601 名男性。我们使用生存分析和多变量 Cox 回归来估计因使用鼻烟而导致的帕金森病的研究特异性相对风险，并使用随机效应模型对荟萃分析中的估计值进行汇总。主要分析仅限于从不吸烟者，以消除吸烟的潜在混杂影响。
在平均 16.1 年的随访期间，共确定了 1199 例帕金森病新发病例。在从不吸烟者中，曾经使用过鼻烟的男性患帕金森病的风险比从未使用过鼻烟的男性低约 60%（汇总危险比 0.41，95%置信区间 0.28-0.61）。鼻烟使用与帕金森病风险之间的反比关系在当前（汇总 HR 0.38，95%CI 0.23-0.63）、中重度用量（汇总 HR 0.41，95%CI 0.19-0.90）和长期使用鼻烟者（汇总 HR 0.44，95%CI 0.24-0.83）中更为明显。
从不吸烟且使用鼻烟的男性患帕金森病的风险显著降低。结果还表明，鼻烟使用与帕金森病风险之间呈负剂量反应关系。我们的研究结果表明，尼古丁或烟草叶的其他成分可能会影响帕金森病的发生。
