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Exploring causality of the association between smoking and Parkinson's disease
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2019 (English)In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 48, no 3, p. 912-925Article in journal (Refereed) Published
Abstract [en]

Background: The aim of this paper is to investigate the causality of the inverse association between cigarette smoking and Parkinson's disease (PD). The main suggested alternatives include a delaying effect of smoking, reverse causality or an unmeasured confounding related to a low-risk-taking personality trait.

Methods: A total of 715 incident PD cases were ascertained in a cohort of 220 494 individuals from NeuroEPIC4PD, a prospective European population-based cohort study including 13 centres in eight countries. Smoking habits were recorded at recruitment. We analysed smoking status, duration, and intensity and exposure to passive smoking in relation to PD onset.

Results: Former smokers had a 20% decreased risk and current smokers a halved risk of developing PD compared with never smokers. Strong dose-response relationships with smoking intensity and duration were found. Hazard ratios (HRs) for smoking <20 years were 0.84 [95% confidence interval (CI) 0.67-1.07], 20-29 years 0.73 (95% CI 0.56-0.96) and >30 years 0.54 (95% CI 0.43-0.36) compared with never smokers. The proportional hazard assumption was verified, showing no change of risk over time, arguing against a delaying effect. Reverse causality was disproved by the consistency of dose-response relationships among former and current smokers. The inverse association between passive smoking and PD, HR 0.70 (95% CI 0.49-0.99) ruled out the effect of unmeasured confounding.

Conclusions: These results are highly suggestive of a true causal link between smoking and PD, although it is not clear which is the chemical compound in cigarette smoking responsible for the biological effect.

Place, publisher, year, edition, pages
Oxford University Press, 2019. Vol. 48, no 3, p. 912-925
National Category
Neurology
Research subject
Neurology
Identifiers
URN: urn:nbn:se:umu:diva-156190DOI: 10.1093/ije/dyy230ISI: 000486642400030PubMedID: 30462234OAI: oai:DiVA.org:umu-156190DiVA, id: diva2:1286574
Funder
Wellcome trustSwedish Cancer SocietySwedish Research CouncilVästerbotten County CouncilAvailable from: 2019-02-07 Created: 2019-02-07 Last updated: 2020-01-09Bibliographically approved

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