From the Department of Clinical Medicine, Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus University, Aarhus, Denmark.
Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, NC.
Epidemiology. 2023 Mar 1;34(2):293-301. doi: 10.1097/EDE.0000000000001566. Epub 2022 Nov 23.
Existing evidence on the link between smoking and appendicitis is scarce and ambiguous. We therefore conducted a population-based cohort study in Denmark to investigate whether smoking during pregnancy is associated with an increased risk of appendicitis in offspring.
We used the Danish Birth Registry to include all singletons born during 1991-2017 and to identify maternal smoking status during pregnancy. We followed the children from birth until date of appendicitis, emigration, death, or administrative end of study (31 December 2018), whichever came first. We calculated crude and adjusted hazard ratios (HRs) of appendicitis with 95% confidence intervals (CIs) comparing children of mothers who smoked during pregnancy to children of nonsmokers. Further, we conducted a bias analysis and sibling analysis.
We included 1,659,526 singletons of whom 19% were born to mothers who smoked during pregnancy. After maximum 28 years of follow-up, hazard rates for children of smokers were slightly higher than for children of nonsmokers [adjusted HR: 1.07 (95% CI = 1.04, 1.10)]. Stratification by sex revealed no association for males [adjusted HR: 1.02 (95% CI = 0.99, 1.06)], but a higher HR for females [adjusted HR: 1.13 (95% CI = 1.09, 1.18)]. This association increased with increasing length of follow-up, indicating that the association may be mediated by later-life exposures. The bias analysis indicated that misclassification of maternal smoking could attenuate a true association, while the sibling analysis showed no association.
Maternal smoking during pregnancy and appendicitis in the offspring may be associated.
现有关于吸烟与阑尾炎之间关联的证据有限且存在歧义。因此，我们在丹麦开展了一项基于人群的队列研究，旨在调查孕妇吸烟是否与子女阑尾炎风险增加有关。
我们利用丹麦出生登记处的数据，纳入了 1991 年至 2017 年间出生的所有单胎，并确定了孕妇怀孕期间的吸烟状况。我们从出生开始随访儿童，直至阑尾炎发病、移民、死亡或研究截止日期（2018 年 12 月 31 日），以先发生者为准。我们计算了母亲怀孕期间吸烟的儿童与不吸烟者的儿童的阑尾炎粗发病率比（HR）和 95%置信区间（CI），比较了两组儿童。此外，我们还进行了偏倚分析和同胞分析。
我们纳入了 1659526 名单胎，其中 19%的儿童母亲在怀孕期间吸烟。在最长 28 年的随访后，吸烟者子女的发病风险略高于不吸烟者子女[调整 HR：1.07（95%CI=1.04，1.10)]。按性别分层显示，男性无关联[调整 HR：1.02（95%CI=0.99，1.06)]，但女性关联较强[调整 HR：1.13（95%CI=1.09，1.18)]。这种关联随着随访时间的延长而增加，表明这种关联可能是由生命后期暴露引起的。偏倚分析表明，母亲吸烟的分类错误可能会削弱真实关联，而同胞分析则显示无关联。
孕妇怀孕期间吸烟与子女阑尾炎之间可能存在关联。
