Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA.
BMJ Open. 2021 Oct 25;11(10):e050374. doi: 10.1136/bmjopen-2021-050374.
There is a lack of information on cotinine levels in rural populations in low-income and middle-income countries like Guatemala. Therefore, there is a need to explore smoking status and biomarkers of tobacco use in epidemiological research in rural, low-income populations, in particular those at-risk for chronic kidney disease of unknown origin (CKDu).
We evaluated self-reported smoking status against urinary cotinine levels, the gold standard biomarker of tobacco smoke exposure, among agricultural workers at four separate cross-sectional time points.
Guatemala.
283 sugarcane workers.
Compared self-reported smoking status and urinary cotinine levels in two agricultural worker studies.
Self-reported smoking prevalence was 12% among workers. According to cotinine levels (≥50 ng/mL), the smoking prevalence was 34%. Self-reported smoking status had 28% sensitivity and 96% specificity. Urinary cotinine levels show that smoking prevalence is underestimated in this worker population.
According to our findings, smoking status should be objectively measured with biomarkers rather than self-reported in CKDu epidemiological research. Self-reported smoking status is likely an underestimate of the true smoking prevalence among agricultural workers. Research on the CKDu epidemic in Central America and other parts of the world might be underestimating tobacco exposure as a potential contributor to the development of CKDu.
危地马拉等中低收入国家农村地区的可铁宁（尼古丁的代谢产物）水平信息有限。因此，需要在农村低收入人群，特别是慢性肾病原因不明（CKDu）高危人群的流行病学研究中，探索吸烟状况和烟草使用的生物标志物。
我们在四个不同的横断面时间点，评估了农业工人的自我报告吸烟状况与尿液可铁宁水平（烟草烟雾暴露的金标准生物标志物）之间的关系。
危地马拉。
283 名甘蔗工人。
比较了两项农业工人研究中的自我报告吸烟状况和尿液可铁宁水平。
工人中自我报告的吸烟率为 12%。根据可铁宁水平（≥50ng/ml），吸烟率为 34%。自我报告的吸烟状况的敏感性为 28%，特异性为 96%。尿液可铁宁水平表明，在该工人群体中，吸烟率被低估了。
根据我们的发现，在 CKDu 流行病学研究中，吸烟状况应通过生物标志物客观测量，而不是自我报告。自我报告的吸烟状况可能低估了农业工人中真实的吸烟流行率。中美洲和世界其他地区的 CKDu 流行研究可能低估了烟草暴露作为 CKDu 发展的潜在因素。
