Effect modification of the association between total cigarette smoking and ALS risk by intensity, duration and time-since-quitting: Euro-MOTOR. Issue 1 (21st August 2019)

• Record Type: Journal Article
• Authors: Peters, Susan; Visser, Anne E; D'Ovidio, Fabrizio; Vlaanderen, Jelle; Portengen, Lützen; Beghi, Ettore; Chio, Adriano; Logroscino, Giancarlo; Hardiman, Orla; Pupillo, Elisabetta; Veldink, Jan H; Vermeulen, Roel; van den Berg, Leonard H
• Other Names: author non-byline.; Kooi Anneke J van der author non-byline.; Raaphorst Joost author non-byline.; Calvo Andrea author non-byline.; Moglia Cristina author non-byline.; Casale Federico author non-byline.; Fuda Giuseppe author non-byline.; Canosa Antonio author non-byline.; Manera Umberto author non-byline.; Bombaci Alessandro author non-byline.; Grassano Maurizio author non-byline.; Vasta Rosario author non-byline.; Salamone Paolina author non-byline.; Marrali Giuseppe author non-byline.; PsyD Barbara Iazzolino author non-byline.; Mazzini Letizia author non-byline.; Rooney James author non-byline.; Heverin Mark author non-byline.; Vajda Alice author non-byline.; Comi Giancarlo author non-byline.; Riva Nilo author non-byline.; DrBT Francesca Gerardi author non-byline.; Filosto Massimiliano author non-byline.; Cotelli Maria Sofia author non-byline.; Rinaldi Fabrizio author non-byline.; Chiveri Luca author non-byline.; Guaita Maria Cristina author non-byline.; Perrone Patrizia author non-byline.; Mauro Ceroni author non-byline.; Ferrarese Carlo author non-byline.; Tremolizzo Lucio author non-byline.; Delodovici Maria Luisa author non-byline.; Bono Giorgio author non-byline.; Tortelli Rosanna author non-byline.; Panico Card. G. author non-byline.; Zecca Chiara author non-byline.;
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 91:Issue 1(2020)
• Page Start: 33
• Page End: 39
• Publication Date: 2019-08-21
• Subjects: amyotrophic lateral sclerosis -- case–control study -- pooled analysis -- tobacco; Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp-2019-320986
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : 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 (ptrend =0.001) rather than intensity (ptrend =0.86), although the trend for duration disappeared after adjustment for time-since-quitting. Time-since-quitting was inversely related to ALS (ptrend <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.