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Cited by 48Smoking Behavior and CessationDementia and Cognitive Impairment ResearchAcute Ischemic Stroke Management

Association of Changes in Smoking Intensity With Risk of Dementia in Korea

Open access
Jeong, Su-Min, Park, Junhee, Han, Kyungdo, Yoo, Juhwan, Yoo, Jung Eun, Lee, Cheol Min, Jung, Wonyoung, Lee, Jinkook +2 more·2023·JAMA Network Open
DOI 10.1001/jamanetworkopen.2022.51506PMC PMC9857334
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Abstract

Importance: Several observational studies have reported that smoking cessation is associated with a lower risk of dementia. However, no studies have examined the association between change in smoking intensity and risk of dementia. Objective: To investigate the association between a change in smoking intensity, including smoking reduction and smoking cessation, and risk of all dementia. Design, Setting, and Participants: This cohort study used data from the National Health Insurance Service database of Korea. The cohort included participants 40 years or older who underwent biennial health examinations (2009 and 2011) and had current smoking status at the first health examination. The cohort was followed up until December 31, 2018, and statistical analysis was performed between July and December 2021. Exposures: Change in smoking intensity from baseline was defined operationally as follows: quitters (stopped smoking), reducers I (decreased number of cigarettes smoked per day by ≥50%), reducers II (decreased number of cigarettes smoked per day by 20%-50%), sustainers (maintained [decreased or increased] number of cigarettes smoked per day by less than 20%), or increasers (increased number of cigarettes smoked per day by ≥20%). Main Outcomes and Measures: The primary outcome was newly diagnosed dementia, which was identified by prescribed antidementia medications with concomitant International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes for dementia. Adjusted hazard ratios and 95% CIs were used to determine the association between change in smoking intensity and incidence of dementia, including Alzheimer disease (AD) and vascular dementia (VaD). Results: A total of 789 532 participants (756 469 males [95.8%]; mean [SD] age, 52.2 [8.5] years) were included. During a median (IQR) follow-up period of 6.3 (6.1-6.6) years, 11 912 dementia events, including 8800 AD and 1889 VaD events, were identified. Overall, participants in the quitter group had a significantly lower risk of all dementia (adjusted hazard ratio [aHR], 0.92; 95% CI, 0.87-0.97) compared with those in the sustainer group. Those in the reducer I (aHR, 1.25; 95% CI, 1.18-1.33) and increaser (aHR, 1.12; 95% CI, 1.06-1.18) groups had a significantly higher risk of all dementia compared with those in the sustainer group.The patterns for AD and VaD remained consistent with patterns for all dementia. Conclusions and Relevance: The results of this study showed that smoking cessation was associated with a lower risk of dementia compared with sustained smoking intensity, while smoking reduction was associated with a higher risk. Smoking cessation should be emphasized in efforts to reduce the disease burden of dementia.

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Authors
Jeong, S.-M., Park, J., Han, K., Yoo, J., Yoo, J. E., Lee, C. M., Jung, W., Lee, J., Kim, S., & Shin, D. W.
Affiliations
  • Seoul National University (KR)
  • Samsung Medical Center (KR)
  • Soongsil University (KR)
  • University of Southern California (US)
Corresponding author
Shin, Dong Wook
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2023-01-19
Volume
6
Issue
1
Pages
e2251506
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2022.51506
PMC
PMC9857334
OpenAlex
W4317436887
Cited by
48
References
43
Citations by year
2026: 10 · 2025: 17 · 2024: 12 · 2023: 9
FWCI
8.52
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Network Open (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
Keywords
smoking intensity, smoking cessation, smoking reduction, dementia risk, Alzheimer's disease, vascular dementia, tobacco use, dementia incidence, Korea, health examination data, tobacco control
MeSH terms
Alzheimer Disease, Humans, Male, Middle Aged, Smoking, Cohort Studies, Smoking Cessation, Republic of Korea

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