A case-control study of the protective effect of alcohol, coffee, and cigarette consumption on Parkinson disease risk: time-since-cessation modifies the effect of tobacco smoking.
The aim of this study was to investigate the possible reduced risk of Parkinson Disease (PD) due to coffee, alcohol, and/or cigarette consumption. In addition, we explored the potential effect modification by intensity, duration and time-since-cessation of smoking on the association between cumulative pack-years of cigarette smoking (total smoking) and PD risk. Data of a hospital based case-control study was used including 444 PD patients, diagnosed between 2006 and 2011, and 876 matched controls from 5 hospitals in the Netherlands. A novel modeling method was applied to derive unbiased estimates of the potential modifying effects of smoking intensity, duration, and time-since-cessation by conditioning on total exposure. We observed no reduced risk of PD by alcohol consumption and only a weak inverse association between coffee consumption and PD risk. However, a strong inverse association of total smoking with PD risk was observed (OR=0.27 (95%CI: 0.18-0.42) for never smokers versus highest quartile of tobacco use). The observed protective effect of total smoking was significantly modified by time-since-cessation with a diminishing protective effect after cessation of smoking. No effect modification by intensity or duration of smoking was observed indicating that both intensity and duration have an equal contribution to the reduced PD risk. Understanding the dynamics of the protective effect of smoking on PD risk aids in understanding PD etiology and may contribute to strategies for prevention and treatment.
Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
Marianne
M
van der Mark
Department of Neurology, St Elisabeth Hospital, Tilburg, the Netherlands; Department of Neurology, TweeSteden Hospital, Tilburg, the Netherlands.
Peter C G
PC
Nijssen
Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
Jelle
J
Vlaanderen
Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
Anke
A
Huss
Department of Neurology, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands.
Wim M
WM
Mulleners
Department of Neurology, Vlietland Hospital, Schiedam, the Netherlands.
Antonetta M G
AM
Sas
Department of Neurology, University Medical Center, Groningen, the Netherlands.
Teus
T
van Laar
Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
Hans
H
Kromhout
Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; Julius Centre for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands.
Roel
R
Vermeulen
D000428:Alcohol Drinking; D016022:Case-Control Studies; D003069:Coffee; D006801:Humans; D010300:Parkinson Disease / Q000517:prevention & control*; D012907:Smoking; D016540:Smoking Cessation; D014026:Nicotiana
D003069:Coffee