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Sex differences in smoking, alcohol consumption, and risk of Parkinson's disease: A nationwide cohort study

  • Ryul Kim
    Affiliations
    Department of Neurology, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea

    Department of Neurology, Seoul National University Hospital, Seoul, South Korea
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  • Dallah Yoo
    Affiliations
    Department of Neurology, Kyung Hee University Hospital, Seoul, South Korea
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  • Yu Jin Jung
    Affiliations
    Department of Neurology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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  • Kyungdo Han
    Affiliations
    Department of Biostatistics, The Catholic University of Korea, Seoul, South Korea
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  • Jee-Young Lee
    Correspondence
    Corresponding author. Department of Neurology, Seoul National University Boramae Medical Center, College of Medicine, Seoul National University, 20 Boramae−ro 5−gil, Dongjak−gu, Seoul, 07061, South Korea.
    Affiliations
    Department of Neurology, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
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      Highlights

      • Current male smokers tended to have a lower risk of PD than current female smokers at equal smoking intensity and duration.
      • At equal alcohol intakes, PD risk tended to be lower in female drinkers than in male drinkers.
      • A superadditive interaction between smoking and alcohol was found in current male smokers and female ex-smokers.

      Abstract

      Objective

      We assessed the influence of sex on the effects of smoking and alcohol consumption on the risk of Parkinson's disease (PD).

      Methods

      This population-based cohort study examined data of 6,795,816 Koreans aged ≥40 years from the Korean National Health Insurance Service database who completed a national program for general health check-up at 2009. For a maximum 9 years’ observation period, incident PD was tracked, and hazard ratios and 95% confidence intervals (CIs) were computed using the Cox proportional hazard models, adjusted for potential confounding factors for each sex group. We tested interactions on the addictive scale by estimating the relative excess risk due to interaction (RERI).

      Results

      3,400,538 men and 3,395,278 women generated 24,365,694 and 24,754,154 person-years, respectively. A total of 13,223 men (0.39%) and 14,818 women (0.44%) developed PD during follow-up. Current smoking and alcohol independently reduced the risk of PD in both sexes. Current male smokers tended to have a lower risk of PD than current female smokers at equal smoking intensity (P < 0.0001 for interaction) and duration (P < 0.0001 for interaction). In contrast, at equal alcohol intakes, PD risk tended to be lower in female drinkers than in male drinkers (P < 0.0001 for interaction). A superadditive interaction between smoking and alcohol was found in current male smokers (RERI, 0.19; 95% CI, 0.04 to 0.34; P = 0.015) and female ex-smokers (RERI, 0.42; 95% CI, 0.09 to 0.76; P = 0.014).

      Conclusion

      Our data suggest sex-related differences in individual and joint impacts of smoking and alcohol intake on the risk of PD.

      Keywords

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