Exploring causality of the association between smoking and Parkinson's disease
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Published version
Author(s)
Type
Journal Article
Abstract
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.
Date Issued
2019-06
Date Acceptance
2018-10-11
Citation
International Journal of Epidemiology, 2019, 48 (3), pp.912-925
ISSN
1464-3685
Publisher
Oxford University Press (OUP)
Start Page
912
End Page
925
Journal / Book Title
International Journal of Epidemiology
Volume
48
Issue
3
Copyright Statement
© The Author(s) 2018. Published by Oxford University Press on behalf of the International Epidemiological Association. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/ 4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Sponsor
Michael J Fox Foundation
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/30462234
PII: 5184917
Grant Number
MJFF Research grant 2010 prog
Subjects
EPIC
NeuroEPIC4PD
Parkinson’s disease
causal inference
cohort study
passive smoking
smoking
smoking patterns
0104 Statistics
1117 Public Health and Health Services
Epidemiology
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2018-11-20