背景:戒烟可降低椎体和髋部骨折的风险,但通常会增加体重。由于体重过轻被认为是椎体骨折的危险因素,戒烟被认为对椎骨骨折有保护作用。然而,戒烟后体重变化对椎体骨折风险的实际影响尚不确定.
本研究旨在评估报告戒烟者的椎体骨折风险,并特别关注体重变化。研究设计:基于全国健康保险数据库的回顾性队列研究患者样本:参与者来自韩国国家健康保险局在2007年至2009年间进行的全国两年一次的健康检查。从2010年到2018年对参与者进行了随访,以发现新出现的椎骨骨折的发生率。
方法:发病率定义为每1000人年(PY)的发病率(IR)。Cox比例回归分析用于分析椎体骨折的风险,以根据吸烟状况和体重变化确定与椎体骨折发生率相关的风险比(HR)。
方法:根据他们的自我报告问卷,参与者被分为三组:目前的吸烟者,戒烟者,和非吸烟者。戒烟者被定义为2007年吸烟者并于2009年戒烟的个人。戒烟者根据基线和两年前的体重变化进行分类:体重维持(体重变化的-5~5%),体重减轻(<-5%的重量变化),和体重增加(>5%的重量变化)。我们使用Cox比例风险分析,根据吸烟状况和两年内体重的时间变化,确定与椎体骨折发生率相关的风险比(HR)。
结果:本研究评估了913,805名符合条件的参与者,其中672,858人被归类为不吸烟者,34,143名戒烟者,和206,804为当前吸烟者。在戒烟者中,2372人(6.9%)体重下降,和7,816(22.9%)的体重增加超过两年。23,952人(70.2%)体重维持两年以上。戒烟者的椎体骨折总体风险显著高于非吸烟者(调整后的HR[aHR]=1.110,95%置信区间[CI]1.013-1-216),但低于目前吸烟者(aHR=1.197,CI1.143-1.253),不考虑戒烟后体重的变化。然而,戒烟后体重下降的个体出现椎体骨折的风险明显高于目前吸烟者(aHR=1.321,CI1.004~1.461).在女性人口中,与目前的女性吸烟者相比,戒烟后体重增加与椎骨骨折的风险较高(aHR=1.470,CI1.002-2.587).
结论:戒烟后保持体重可以减轻椎体骨折的风险。戒烟后体重减轻会对一般人群中戒烟对椎体骨折的保护作用产生不利影响。
BACKGROUND: Smoking cessation reduces the risk of vertebral and hip fractures but usually increases body weight. Since underweight is known as a risk factor for vertebral fractures, smoking cessation is considered to have a protective effect on vertebral fractures. However, the actual effect of weight change after smoking cessation on the risk of vertebral fractures remains uncertain.
UNASSIGNED: This study aimed to assess the risk of vertebral fractures among individuals who reported smoking cessation with a specific focus on changes in body weight.
METHODS: Retrospective cohort study based on nationwide health insurance database.
METHODS: Participants were from nationwide biennial health checkups between 2007 and 2009 conducted by the Korean National Health Insurance Service. Participants were followed up from 2010 to 2018 to find incidence of newly developed vertebral fractures.
METHODS: The incidence rate was defined as the incidence rate (IR) per 1,000 person-years (PY). Cox proportional regression analysis was used to analyze the risk of vertebral fracture to determine the hazard ratio (HR) associated with the incidence of vertebral fractures based on smoking status and weight changes.
METHODS: Based on their self-reported questionnaires, the participants were classified into three groups: current smokers, quitters, and nonsmokers. The quitter was defined as an individual who were smokers in 2007 and ceased smoking in 2009. Individuals with smoking cessation were categorized according to the weight change between baseline and 2 years prior: weight maintenance (-5∼5 % of weight change), weight loss (<-5 % of weight change), and weight gain (>5 % of weight change). We used Cox proportional hazards analysis to determine the hazard ratio (HR) associated with the incidence of vertebral fractures based on smoking status and temporal weight change over 2 years.
RESULTS: This study evaluated 913,805 eligible participants, of whom 672,858 were classified as nonsmokers, 34,143 as quitters, and 206,804 as current smokers. Among quitters, 2,372 (6.9%) individuals had weight loss, and 7,816 (22.9%) had weight gain over 2 years. About 23,952 (70.2%) individuals maintained their weight over 2 years. The overall risk of vertebral fractures was significantly higher in quitters (adjusted HR [aHR]=1.110, 95% confidence interval [CI] 1.013-1-216) than in nonsmokers, but it was lower than in current smokers (aHR=1.197, 95%CI 1.143-1.253), regardless of weight change after smoking cessation. However, individuals who experienced weight loss after smoking cessation exhibited a notably higher risk of vertebral fractures than current smokers (aHR=1.321, 95%CI 1.004-1.461). In the female population, weight gain after smoking cessation was associated with a higher risk of vertebral fractures (aHR = 1.470, 95%CI 1.002-2.587) than in current female smokers.
CONCLUSIONS: Maintaining weight after smoking cessation may mitigate the risk of vertebral fractures. Weight loss after smoking cessation adversely affects the protective effects of smoking cessation on vertebral fractures in the general population.