Department of Microbiology and Molecular Genetics, Lyman Briggs College, Michigan State University, East Lansing, Michigan; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan.
Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan.
Fertil Steril. 2023 May;119(5):838-846. doi: 10.1016/j.fertnstert.2023.01.035. Epub 2023 Jan 27.
To investigate cannabis smoking and tobacco cigarette smoking in relation to adenomyosis risk.
We used data from a case-control study of adenomyosis conducted among enrollees ages 18-59 years of an integrated health care system in Washington State. The case-control study used 2 control groups given the challenge of selecting noncases when cases are diagnosed by hysterectomy.
Cases (n = 386) were enrollees with incident, pathology-confirmed adenomyosis diagnosed between April 1, 2001, and March 31, 2006. The 2 control groups comprised hysterectomy controls (n = 233) with pathology-confirmed absence of adenomyosis and population controls (n = 323) with an intact uterus selected randomly from the health care system population and frequency matched to cases on age.
Detailed data on cannabis and tobacco cigarette smoking history were ascertained through in-person structured interviews, allowing estimation of joint-years of cannabis smoking and pack-years of tobacco cigarette smoking.
Odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between cannabis smoking, tobacco cigarette smoking, and adenomyosis were estimated using multivariable unconditional logistic regression. Analyses were adjusted for age, reference year, menarche age, education, and pack-years of cigarette smoking (or joint-years of cannabis smoking).
No association was observed between cannabis smoking history and adenomyosis risk. However, we did observe the suggestion of an association between ever tobacco cigarette smoking and adenomyosis risk, comparing cases to hysterectomy controls (OR, 1.3; 95% CI, 0.9-1.9) and population controls (OR, 1.2; 95% CI, 0.8-1.8). Our data suggested a 50% increased odds of adenomyosis with >15 pack-years of smoking (vs. never smoking), comparing cases to hysterectomy controls (OR, 1.5; 95% CI, 0.9-2.6; P=.135). The suggestion of a 40% increased adenomyosis odds was observed with smoking >5-15 pack-years (vs. never smoking), comparing cases to population controls (OR, 1.4; 95% CI, 0.8-2.4; P=0.136).
In the first study of cannabis smoking and adenomyosis risk, no association was observed. However, our data suggested an increased odds of adenomyosis with history of tobacco cigarette smoking. Further research is warranted to replicate our results given the substantial morbidity with adenomyosis and frequency of cigarette smoking and recreational and medical cannabis use.
探讨大麻吸烟和烟草香烟吸烟与子宫腺肌病风险的关系。
我们使用了一项在华盛顿州一个综合医疗保健系统中进行的、针对 18-59 岁年龄组患者的子宫腺肌病病例对照研究的数据。这项病例对照研究使用了 2 个对照组，当通过子宫切除术诊断出病例时，这些对照组面临着选择非病例的挑战。
病例（n=386）是在 2001 年 4 月 1 日至 2006 年 3 月 31 日期间确诊为新发病理学证实的子宫腺肌病的参保者。2 个对照组包括接受子宫切除术且病理学证实无子宫腺肌病的对照组（n=233）和从医疗保健系统人群中随机选择且与病例年龄相匹配的、子宫完整的人群对照组（n=323）。
通过面对面的结构化访谈获得了关于大麻和烟草香烟吸烟史的详细数据，从而可以估算大麻联合吸烟年数和烟草香烟吸烟包年数。
使用多变量非条件逻辑回归估计大麻吸烟、烟草香烟吸烟与子宫腺肌病之间的关联的比值比（OR）和 95%置信区间（CI）。分析调整了年龄、参考年份、初潮年龄、教育程度和吸烟包年数（或大麻联合吸烟年数）。
没有观察到大麻吸烟史与子宫腺肌病风险之间存在关联。然而，我们确实观察到了吸烟与子宫腺肌病风险之间存在关联的迹象，将病例与子宫切除术对照组（OR，1.3；95%CI，0.9-1.9）和人群对照组（OR，1.2；95%CI，0.8-1.8）进行比较。我们的数据表明，与从不吸烟的人相比，吸烟超过 15 包年（vs.从不吸烟）的人患子宫腺肌病的几率增加了 50%（OR，1.5；95%CI，0.9-2.6；P=.135）。与人群对照组（OR，1.4；95%CI，0.8-2.4；P=0.136）相比，与从不吸烟的人相比，吸烟超过 5-15 包年（vs.从不吸烟）的人患子宫腺肌病的几率增加了 40%。
在第一项大麻吸烟和子宫腺肌病风险的研究中，没有观察到关联。然而，我们的数据表明，吸烟史与子宫腺肌病的患病几率增加有关。鉴于子宫腺肌病的发病率较高，以及吸烟、吸食大麻和医疗用大麻的频率较高，需要进一步研究来复制我们的结果。
