Smoking paradox in the development of psoriatic arthritis among patients with psoriasis: a population-based study

被引:71
作者
Nguyen, Uyen-Sa D. T. [1 ,2 ]
Zhang, Yuqing [2 ,3 ]
Lu, Na [2 ,3 ]
Louie-Gao, Qiong [2 ]
Niu, Jingbo [2 ,4 ]
Ogdie, Alexis [5 ,6 ,7 ,8 ]
Gelfand, Joel M. [5 ,6 ,7 ,8 ]
LaValley, Michael P. [2 ]
Dubreuil, Maureen [2 ]
Sparks, Jeffrey A. [9 ]
Karlson, Elizabeth W.
Choi, Hyon K. [2 ,3 ]
机构
[1] Univ Massachusetts, Sch Med, Dept Orthoped & Phys Rehabil, 55 Lake Ave North, Worcester, MA 01655 USA
[2] Univ Massachusetts, Sch Med, Dept Med, Clin Epidemiol Res & Training Unit, Worcester, MA USA
[3] Harvard Med Sch, Massachusetts Gen Hosp, Div Rheumatol, Boston, MA USA
[4] Baylor Med Sch, Dept Med, Houston, TX USA
[5] Univ Penn, Dept Med, Perelman Sch Med, Philadelphia, PA 19104 USA
[6] Univ Penn, Dept Dermatol, Perelman Sch Med, Philadelphia, PA 19104 USA
[7] Univ Penn, Dept Biostat, Perelman Sch Med, Philadelphia, PA 19104 USA
[8] Univ Penn, Dept Epidemiol, Perelman Sch Med, Philadelphia, PA 19104 USA
[9] Harvard Med Sch, Brigham & Womens Hosp, Div Rheumatol Immunol & Allergy, Dept Med, Boston, MA USA
关键词
HEALTH IMPROVEMENT NETWORK; RISK-FACTORS; DISEASE; VALIDITY; WOMEN; THIN;
D O I
10.1136/annrheumdis-2017-211625
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives Smoking is associated with an increased risk of psoriatic arthritis (PsA) in the general population, but not among patients with psoriasis. We sought to clarify the possible methodological mechanisms behind this paradox. Methods Using 1995-2015 data from The Health Improvement Network, we performed survival analysis to examine the association between smoking and incident PsA in the general population and among patients with psoriasis. We clarified the paradox using mediation analysis and conducted bias sensitivity analyses to evaluate the potential impact of index event bias and quantify its magnitude from uncontrolled/unmeasured confounders. Results Of 6.65 million subjects without PsA at baseline, 225 213 participants had psoriasis and 7057 developed incident PsA. Smoking was associated with an increased risk of PsA in the general population (HR 1.27; 95% CI 1.19 to 1.36), but with a decreased risk among patients with psoriasis (HR 0.91; 95% CI 0.84 to 0.99). Mediation analysis showed that the effect of smoking on the risk of PsA was mediated almost entirely through its effect on psoriasis. Bias-sensitivity analyses indicated that even when the relation of uncontrolled confounders to either smoking or PsA was modest (both HRs=similar to 1.5), it could reverse the biased effect of smoking among patients with psoriasis (HR=0.9). Conclusions In this large cohort representative of the UK general population, smoking was positively associated with PsA risk in the general population, but negatively associated among patients with psoriasis. Conditioning on a causal intermediate variable (psoriasis) may even reverse the association between smoking and PsA, potentially explaining the smoking paradox for the risk of PsA among patients with psoriasis.
引用
收藏
页码:119 / 123
页数:5
相关论文
共 21 条
[1]  
Blak Betina T, 2011, Inform Prim Care, V19, P251
[2]   Selection bias in rheumatic disease research [J].
Choi, Hyon K. ;
Nguyen, Uyen-Sa ;
Niu, Jingbo ;
Danaei, Goodarz ;
Zhang, Yuqing .
NATURE REVIEWS RHEUMATOLOGY, 2014, 10 (07) :403-412
[3]   The association between smoking and the development of psoriatic arthritis among psoriasis patients [J].
Eder, Lihi ;
Shanmugarajah, Sutha ;
Thavaneswaran, Arane ;
Chandran, Vinod ;
Rosen, Cheryl F. ;
Cook, Richard J. ;
Gladman, Dafna D. .
ANNALS OF THE RHEUMATIC DISEASES, 2012, 71 (02) :219-224
[4]   AJC Editor's Consensus: Psoriasis and Coronary Artery Disease [J].
Friedewald, Vincent E. ;
Cather, Jennifer C. ;
Gelfand, Joel A. ;
Gordon, Kenneth B. ;
Gibbons, Gary H. ;
Grundy, Scott M. ;
Jarratt, Michael T. ;
Krueger, James G. ;
Ridker, Paul M. ;
Stone, Neil ;
Roberts, William C. .
AMERICAN JOURNAL OF CARDIOLOGY, 2008, 102 (12) :1631-1643
[5]   Epidemiology of psoriatic arthritis in the population of the United States [J].
Gelfand, JM ;
Gladman, DD ;
Mease, PJ ;
Smith, N ;
Margolis, DJ ;
Nijsten, T ;
Stern, RS ;
Feldman, SR ;
Rolstad, T .
JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY, 2005, 53 (04) :573-577
[6]   The prevalence of previously diagnosed and undiagnosed psoriasis in US adults: Results from NHANES 2003-2004 [J].
Kurd, Shanu Kohli ;
Gelfand, Joel M. .
JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY, 2009, 60 (02) :218-224
[7]   A Simple Unified Approach for Estimating Natural Direct and Indirect Effects [J].
Lange, Theis ;
Vansteelandt, Stijn ;
Bekaert, Maarten .
AMERICAN JOURNAL OF EPIDEMIOLOGY, 2012, 176 (03) :190-195
[8]   Validation studies of the health improvement network (THIN) database for pharmacoepidemiology research [J].
Lewis, James D. ;
Schinnar, Rita ;
Bilker, Warren B. ;
Wang, Xingmei ;
Strom, Brian L. .
PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, 2007, 16 (04) :393-401
[9]   Smoking and risk of incident psoriatic arthritis in US women [J].
Li, Wenqing ;
Han, Jiali ;
Qureshi, Abrar A. .
ANNALS OF THE RHEUMATIC DISEASES, 2012, 71 (06) :804-808
[10]   Obesity and the risk of psoriatic arthritis: a population-based study [J].
Love, Thorvardur Jon ;
Zhu, Yanyan ;
Zhang, Yuqing ;
Wall-Burns, Lindsay ;
Ogdie, Alexis ;
Gelfand, Joel M. ;
Choi, Hyon K. .
ANNALS OF THE RHEUMATIC DISEASES, 2012, 71 (08) :1273-1277