Department of Preventive Medicine and Microbiology, Universidad Autónoma de Madrid, Madrid, Spain.
CIBERESP, Madrid, Spain.
Nicotine Tob Res. 2022 Nov 12;24(12):2026-2034. doi: 10.1093/ntr/ntac131.
BACKGROUND/AIM: There has been no comprehensive examination of the potential association of SHS with broad functional limitation assessment in older adults, where functional limitations are burdensome and challenging.
We examined 2258 community-dwelling non-smoking older adults from the Seniors-Enrica-2-cohort. At baseline (2017) and follow-up (2019) grip strength was measured with a Jamar dynamometer, lower-extremity performance with the Short Physical Performance Battery (SPPB), overall physical function using the physical component summary (PCS) of the Spanish version of the SF-12, frailty with a Deficits Accumulation Index (DAI), and mobility limitations with the Rosow-Breslau scale. Baseline exposure to SHS was assessed by serum cotinine, and past exposure was self-reported. Cross-sectional analyses were performed using linear and logistic regression models, whereas functional performance changes were examined using repeated measures models with robust SE estimates.
Overall, the median (IQR) serum cotinine concentration was 0.079 (0.035-0.175) ng/ml, with 20 participants presenting concentrations ≥3 ng/ml. Compared to the unexposed, fully-adjusted models showed that the highest exposure group (≥0.239 ng/ml) presented lower grip strength (mean difference: -1.05 kg; 95% CI = -1.80, -0.31) and higher DAI scores (1.52; 95% CI = 0.38, 2.66) at baseline. Similarly, in models of self-reported past exposure, never-smokers who had lived with ≥2 smokers or been exposed to higher SHS cumulative doses showed lower baseline SPPB values, higher DAI scores, and higher prevalence of mobility limitations. In prospective analyses, those in the highest quartile of baseline cotinine presented harmful SPPB [-0.24 (-0.46, -0.02)] and DAI [1.28 (0.00, 2.55)] changes, and higher risk of mobility limitations [hazard ratio: 1.64; 95% CI = 1.01, 2.68] than the unexposed.
SHS exposure over the life-course and during old age may accelerate functional decline.
This manuscript provides a comprehensive examination of the relationship between secondhand smoke exposure and a broad range of functional limitations in older adults. Results show that: (i) non-smokers who had been exposed to higher cumulative doses of SHS in adulthood show worse physical function than non-exposed. (ii) Exposure to SHS during old age, as measured with cotinine concentrations, is associated with accelerated short-term functional declines. (iii) The effects of SHS are stronger among older adults with chronic morbidities. (iv) Results suggest that more efforts are needed to protect older adults from passive smoking, especially to those with chronic conditions because of their potential greater vulnerability to the effects of SHS.
背景/目的：目前尚无研究全面评估二手烟（SHS）与老年人广泛的功能受限评估之间的潜在关联，因为功能受限是令人痛苦和具有挑战性的。
我们对来自 Seniors-Enrica-2 队列的 2258 名不吸烟的社区居住的老年人进行了研究。在基线（2017 年）和随访（2019 年）时，使用 Jamar 测力计测量握力，使用简短身体表现测试（SPPB）测量下肢功能，使用西班牙语版 SF-12 的身体成分摘要（PCS）评估总体身体功能，使用缺陷累积指数（DAI）评估脆弱性，使用 Rosow-Breslau 量表评估移动受限。通过血清可替宁评估基线时的 SHS 暴露情况，通过自我报告评估过去的暴露情况。使用线性和逻辑回归模型进行横断面分析，使用具有稳健 SE 估计的重复测量模型检查功能表现变化。
总体而言，血清可替宁浓度的中位数（IQR）为 0.079（0.035-0.175）ng/ml，有 20 名参与者的浓度≥3ng/ml。与未暴露者相比，完全调整后的模型显示，最高暴露组（≥0.239ng/ml）的基线握力较低（平均差异：-1.05kg；95%CI=-1.80，-0.31），DAI 评分较高（1.52；95%CI=0.38，2.66）。同样，在自我报告的过去暴露模型中，从未吸烟但与≥2 名吸烟者同住或暴露于更高累积 SHS 剂量的人，其基线 SPPB 值较低，DAI 评分较高，且移动受限的患病率较高。在前瞻性分析中，基线可替宁浓度最高四分位数的人 SPPB 恶化[0.24（-0.46，-0.02）]和 DAI 升高[1.28（0.00，2.55）]，移动受限的风险更高[风险比：1.64；95%CI=1.01，2.68]。
一生中以及老年时的 SHS 暴露可能会加速功能下降。
本文全面评估了二手烟暴露与老年人广泛的功能障碍之间的关系。结果表明：（i）成年后暴露于更高累积 SHS 剂量的非吸烟者比未暴露者的身体功能更差。（ii）使用可替宁浓度测量的老年时期的 SHS 暴露与短期功能下降加速有关。（iii）SHS 的影响在患有慢性疾病的老年人中更强。（iv）结果表明，需要更加努力地保护老年人免受被动吸烟的影响，特别是对于患有慢性疾病的老年人，因为他们可能更容易受到 SHS 的影响。
