Abstract
Tobacco smoking and alcohol drinking are associated with several diseases, and studies on the joint effects of smoking and drinking are rare. This study investigates the joint effects of tobacco smoking and alcohol drinking on all-cause and premature mortality in a contemporary cohort. The China Health and Retirement Longitudinal Study (CHARLS) is an ongoing nationally representative survey of subjects aged over 45 years in China that was performed every two years for a total of three waves from 2011 to 2015 in China. We used weighted logistic regression models to estimate the joint effects of tobacco smoking and alcohol drinking on all-cause and premature mortality. After adjusting for prespecified confounders, the odds ratios (ORs) of all-cause mortality were 1.51 (95% CI: 1.09-2.10) and 1.47 (95% CI: 1.03-2.08) in smokers and smokers/drinkers, respectively. Compared with nonsmokers/nondrinkers, the OR of smokers/drinkers for premature death was 3.14 (95% CI: 1.56-6.34). In the female subgroup, there was an approximately 5-fold (OR = 4.95; 95% CI: 2.00-12.27) odds of premature mortality for smokers/drinkers compared to nonsmokers/nondrinkers. This study found a joint effect of tobacco smoking and alcohol drinking on all-cause and premature mortality among a contemporary and nationally representative cohort in China. Our results suggested that the joint effects were more pronounced in women, but further research is needed.
Highlights
Tobacco smoking is a well-established risk factor for many diseases, including stroke and coronary heart disease [1]
There was an approximately 5-fold (OR = 4.95; 95% confidence intervals (CIs): 2.00–12.27) odds of premature mortality for smokers/drinkers compared to nonsmokers/nondrinkers
This study found a joint effect of tobacco smoking and alcohol drinking on all-cause and premature mortality among a contemporary and nationally representative cohort in China
Summary
Tobacco smoking is a well-established risk factor for many diseases, including stroke and coronary heart disease [1]. Some studies reported a J-shaped association between alcohol drinking and all-cause mortality, which suggested that low alcohol use may confer some degree of protection [9,10], this view was challenged by recent Mendelian randomization studies and meta-analyses [8,11,12]. These protective associations between moderate alcohol drinking and health may, be attributed to the effect of biases (e.g., from study design, confounders, selection of participants) [12,13]. Tobacco smoking and alcohol drinking are associated with several diseases, and studies on the joint effects of smoking and drinking are rare
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