title: Association between smoking and the risk of acute mountain sickness: a meta-analysis of observational studies.
abstract: People rapidly ascending to high altitudes (>2500 m) may suffer from acute mountain sickness (AMS). The association between smoking and AMS risk remains unclear. Therefore, we performed a meta-analysis to evaluate the association between smoking and AMS risk.
  
  
  
  The association between smoking and AMS risk was determined according to predefined criteria established by our team. Meta-analysis was conducted according to the PRISMA guidelines. We included all relevant studies listed in the PubMed and Embase databases as of September 2015 in this meta-analysis and performed systemic searches using the terms "smoking", "acute mountain sickness" and "risk factor". The included studies were required to provide clear explanations regarding their definitions of smoking, the final altitudes reached by their participants and the diagnostic criteria used to diagnose AMS. Odds ratios (ORs) were used to evaluate the association between smoking and AMS risk across the studies, and theQstatistic was used to testORheterogeneity, which was considered significant whenP< 0.05. We also computed 95% confidence intervals (CIs). Data extracted from the articles were analyzed with Review Manager 5.3 (Cochrane Collaboration, Oxford, UK).
  
  
  
  We used seven case-control studies including 694 smoking patients and 1986 non-smoking controls to analyze the association between smoking and AMS risk. We observed a significant association between AMS and smoking (OR= 0.71, 95% CI 0.52-0.96,P= 0.03).
  
  
  
  We determined that smoking may protect against AMS development. However, we do not advise smoking to prevent AMS. More studies are necessary to confirm the role of smoking in AMS risk.
authors.affiliation: Department of Military Medical Geography, Third Military Medical University, Chongqing, 400038 China ; Battalion 5 of Cadet Brigade, Third Military Medical University, Chongqing, 400038 China ; Key Laboratory of High Altitude Environmental Medicine (Ministry of Education), Third Military Medical University, Chongqing, 400038 China.
authors.forename: Chen
authors.initials: C
authors.lastname: Xu
authors.affiliation: Department of Military Medical Geography, Third Military Medical University, Chongqing, 400038 China ; Key Laboratory of High Altitude Environmental Medicine (Ministry of Education), Third Military Medical University, Chongqing, 400038 China.
authors.forename: Hong-Xiang
authors.initials: HX
authors.lastname: Lu
authors.affiliation: Department of Military Medical Geography, Third Military Medical University, Chongqing, 400038 China ; Key Laboratory of High Altitude Environmental Medicine (Ministry of Education), Third Military Medical University, Chongqing, 400038 China.
authors.forename: Yu-Xiao
authors.initials: YX
authors.lastname: Wang
authors.affiliation: Department of Military Medical Geography, Third Military Medical University, Chongqing, 400038 China ; Key Laboratory of High Altitude Environmental Medicine (Ministry of Education), Third Military Medical University, Chongqing, 400038 China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Mountain Sickness Research Institute, 18th Hospital of PLA, Yecheng, Xinjiang 844900 China.
authors.forename: Sheng-Hong
authors.initials: SH
authors.lastname: Yang
authors.affiliation: Department of Military Medical Geography, Third Military Medical University, Chongqing, 400038 China ; Key Laboratory of High Altitude Environmental Medicine (Ministry of Education), Third Military Medical University, Chongqing, 400038 China.
authors.forename: Yong-Jun
authors.initials: YJ
authors.lastname: Luo
mesh_terms: D000328:Adult; D000532:Altitude Sickness / Q000150:complications* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D064887:Observational Studies as Topic; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D055815:Young Adult
keywords: Acute mountain sickness; Association; High altitude; Meta-analysis; Risk factor; Smoking