Does mortality risk of cigarette smoking depend on serum concentrations of persistent organic pollutants? Prospective investigation of the vasculature in Uppsala seniors (PIVUS) study.
Cigarette smoking is an important cause of preventable death globally, but associations between smoking and mortality vary substantially across country and calendar time. Although methodological biases have been discussed, it is biologically plausible that persistent organic pollutants (POPs) like polychlorinated biphenyls (PCBs) and organochlorine (OC) pesticides can affect this association. This study was performed to evaluate if associations of cigarette smoking with mortality were modified by serum concentrations of PCBs and OC pesticides. We evaluated cigarette smoking in 111 total deaths among 986 men and women aged 70 years in the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) with mean follow-up for 7.7 years. The association between cigarette smoking and total mortality depended on serum concentration of PCBs and OC pesticides (P value for interaction = 0.02). Among participants in the highest tertile of the serum POPs summary score, former and current smokers had 3.7 (95% CI, 1.5-9.3) and 6.4 (95% CI, 2.3-17.7) times higher mortality hazard, respectively, than never smokers. In contrast, the association between cigarette smoking and total mortality among participants in the lowest tertile of the serum POPs summary score was much weaker and statistically non-significant. The strong smoking-mortality association observed among elderly people with high POPs was mainly driven by low risk of mortality among never smokers with high POPs. As smoking is increasing in many low-income and middle-income countries and POPs contamination is a continuing problem in these areas, the interactions between these two important health-related issues should be considered in future research.
Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, Korea; BK21 Plus KNU Biomedical Convergence Program, Department of Biomedical Science, Kyungpook National University, Daegu, Korea.
Duk-Hee
DH
Lee
Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University Hospital, Uppsala, Sweden.
Lars
L
Lind
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America; Department of Nutrition, University of Oslo, Oslo, Norway.
David R
DR
Jacobs
MTM Research Center, School of Science and Technology, Örebro University, Örebro, Sweden.
Samira
S
Salihovic
MTM Research Center, School of Science and Technology, Örebro University, Örebro, Sweden.
Bert
B
van Bavel
Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
P Monica
PM
Lind
D000368:Aged; D000369:Aged, 80 and over; D004147:Dioxins / Q000097:blood; D004781:Environmental Exposure; D004785:Environmental Pollutants / Q000097:blood; D005260:Female; D055768:Halogenated Diphenyl Ethers / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010575:Pesticides / Q000097:blood*; D011078:Polychlorinated Biphenyls / Q000097:blood*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D012907:Smoking / Q000009:adverse effects / Q000097:blood* / Q000401:mortality*; D013548:Sweden / Q000453:epidemiology; D014026:Nicotiana / Q000009:adverse effects
D004147:Dioxins; D004785:Environmental Pollutants; D055768:Halogenated Diphenyl Ethers; D010575:Pesticides; D011078:Polychlorinated Biphenyls