Cigarette smoking, alcohol consumption, and risk of ARDS: a 15-year cohort study in a managed care setting.
OBJECTIVE
To examine the association of cigarette smoking and alcohol consumption with hospital presentation of ARDS in a well-defined, multiethnic population.


METHODS
Retrospective cohort study.


METHODS
Health maintenance organization in Northern California.


METHODS
A total of 121,012 health plan subscribers (54.2% women), aged 25 to 89 years.


METHODS
Hospital presentation of ARDS (validated by medical chart review) from baseline in 1979 to 1985 through the end of 1993 (median, 9.9 years).


RESULTS
There were 56 cases of ARDS (33 in men, 23 in women). The case fatality rate was 39% in both genders. ARDS was independently related to increasing age (rate ratio of 10 years, 1.38; 95% confidence interval [CI], 1.12 to 1.71), to current smoking of < 20 cigarettes/d (rate ratio vs never cigarette smokers, 2.85; 95% CI, 1. 23 to 6.60), and to current cigarette smoking of > or = 20 cigarettes/d (rate ratio vs never smokers, 4.59; 95% CI, 2.13 to 9.88). No association was observed between alcohol consumption and ARDS.


CONCLUSIONS
The results of this study suggest a relationship (with evidence of dose-response effect) between cigarette smoking and ARDS. Assuming a causal relationship, approximately 50% of ARDS cases were attributable to cigarette smoking.
Iribarren
C
C
Kaiser Permanente Division of Research, Oakland, CA 94611, USA. cgi@dor.kaiser.org
Jacobs
D R
DR
Sidney
S
S
Gross
M D
MD
Eisner
M D
MD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects*; D002140:California / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012128:Respiratory Distress Syndrome / Q000145:classification / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D015996:Survival Rate