Home > Effect modification of the association between total cigarette smoking and ALS risk by intensity, duration and time-since-quitting: Euro-MOTOR.

Peters, Susan and Visser, Anne E and D'Ovidio, Fabrizio and Vlaanderen, Jelle and Portengen, Lützen and Beghi, Ettore and Chio, Adriano and Logroscino, Giancarlo and Hardiman, Orla and Pupillo, Elisabetta and Veldink, Jan H and Vermeulen, Roel and van den Berg, Leonard H . (2019) Effect modification of the association between total cigarette smoking and ALS risk by intensity, duration and time-since-quitting: Euro-MOTOR. BMJ Publishing. Journal of Neurology, Neurosurgery, and Psychiatry, Early online

URL: https://jnnp.bmj.com/content/early/2019/08/20/jnnp...

BACKGROUND
We investigated the association between cigarette smoking and risk of amyotrophic lateral sclerosis (ALS) in a pooled analysis of population-based case-control studies and explored the independent effects of intensity, duration and time-since-quitting.

METHODS
ALS cases and controls, matched by age, sex and region, were recruited in the Netherlands, Italy and Ireland (*Euro-MOTOR project). Demographics and detailed lifetime smoking histories were collected through questionnaires. Effects of smoking status, intensity (cigarettes/day), duration (years), pack-years and time-since-quitting (years) on ALS risk were estimated using logistic regression models, adjusting for age, sex, alcohol, education and centre. We further investigated effect modification of the linear effects of pack-years by intensity, duration and time-since-quitting using excess OR (eOR) models.

RESULTS
Analyses were performed on 1410 cases and 2616 controls. Pack-years were positively associated with ALS risk; OR=1.26 (95% CI: 1.03 to 1.54) for the highest quartile compared with never smokers. This association appeared to be predominantly driven by smoking duration (p=0.001) rather than intensity (p=0.86), although the trend for duration disappeared after adjustment for time-since-quitting. Time-since-quitting was inversely related to ALS (p<0.0001). The eOR decreased with time-since-quitting smoking, until about 10 years prior to disease onset. High intensity smoking with shorter duration appeared more deleterious than lower intensity for a longer duration.

CONCLUSIONS
Our findings provide further support for the association between smoking and ALS. Pack-years alone may be insufficient to capture effects of different smoking patterns. Time-since-quitting appeared to be an important factor, suggesting that smoking may be an early disease trigger.


Item Type:Evidence resource
Drug Type:Tobacco
Intervention Type:AOD prevention
Date:21 August 2019
Publisher:BMJ Publishing
Volume:Early online
EndNote:View
Accession Number:HRB (Electronic Only)
Subjects:B Substances > Tobacco (cigarette smoking)
VA Geographic area > International aspects
VA Geographic area > Europe > Ireland

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