Impact of Smoking Intensity and Initiation Age on Cardio-Cerebrovascular Disease and Mortality Risk in Patients with CKD: A Nationwide Population-Based Cohort Study

초록

Background:Tobacco use is a significant modifiable risk factor for numerous diseases. While previous research had shown the adverse health outcomes related to smoking, the impact of smoking initiation age and intensity on chronic kidney disease (CKD) patients remains further investigation.Methods:We conducted a retrospective cohort study with National Health Insurance Database of South Korea, encompassing 652,223 adults aged 20 and above, who underwent national health screening in 2009. Participants with CKD were identified, and their smoking status, smoking initiation age, pack-years, and clinical outcomes were assessed. Cox regression analysis was employed to investigate the association between smoking parameters and the risk of cardio-cerebrovascular diseases (CCVDs) and all-cause mortality, adjusting for potential confounders.Results:The risks of CCVDs and all-cause deaths according to the smoking initiation age and pack years were assessed. Among CKD patients, higher pack-years and younger smoking initiation ages were associated with elevated risks of CCVDs and all-cause mortality. Participants with pack years < 20 and smoking initiation age below 20 exhibited an increased risk of all-cause death (HR 1.83; 95% CI 1.67-2.00). Among high-risk groups (with 30, 40, and 50 pack years), those with smoking initiation age below 20 showed elevated risk of CCVDs and all-cause death (Figure 1).Conclusion:Our findings highlight the importance of smoking cessation in CKD patients, as early initiation and higher intensity of smoking are associated with heightened risks of CCVDs and all-cause mortality. Encouraging smoking cessation, particularly in younger individuals, may mitigate the burden of cardiovascular diseases and mortality among CKD population.