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Age at smoking initiation and smoking cessation influence the incidence of stroke in China: a 10-year follow-up study

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Abstract

Our study aimed to explore the correlation between age at smoking initiation and smoking cessation for the risk for stroke in China. We investigated 50,174 participants from one of the urban areas of China Kadoorie Biobank (CKB) Study. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) for association between smoking and incidence of stroke were estimated using Cox regression model. During a median of 10.7 years of follow-up, 4370 total stroke cases were documented. Among men, comparing current smokers to never smokers, the HR of total stroke for current smokers was 1.279 (95% CI, 1.134–1.443) for total stroke. The HRs of total stroke were 1.344 (1.151–1.570) for those started smoking at age less than 20 years, 1.254 (1.090–1.443) for those started smoking at age 20–30 years, and 1.205 (1.012–1.435) for those started smoking at age 30 year and above, with a dose-response relation (P for trend, 0.004). Comparing former smokers to current smokers, in the low pack-year group, those stopped smoking at age less than 65 years had a 18.2% decreased risk for total stroke (0.818; 0.673–0.994). The decreased risk was not found in those stopped smoking at age 65 years and above. Similar results were observed in the high pack-year group. In conclusion, we found that current smokers had a higher stroke risk than never smokers, and the risk increased with a younger age at smoking initiation. Smoking cessation can reduce the risk for stroke, especially could benefit from cessation at a younger age.

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Acknowledgements

We thank Chinese Center for Disease Control and Prevention, Chinese Ministry of Health, National Health and Family Planning Commission of China, and 10 provincial/regional Health Administrative Departments. The most important acknowledgement is to the participants in the study and the members of the survey teams in each of the 10 regional centers, as well as to the project development and management teams based at Beijing, Oxford and the 10 regional centers.

Funding

This work was supported by grants (82192900, 81390540, 91846303) from the National Natural Science Foundation of China, by grants (2016YFC0900500) from the National Key Research and Development Program of China, grants from the Kadoorie Charitable Foundation in Hong Kong and grants (202922/Z/16/Z, 088158/Z/09/Z, 104085/Z/14/Z) from Wellcome Trust in the UK.

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  1. Tian Liang, Changping Xie, and Bangjun Lv are first co-authors.

Authors and Affiliations

  1. School of Public Health of Guangxi Medical University, Nanning, Guangxi, 530021, China

    Tian Liang, Li Su, Jianxiong Long, Shengying Liu & Xiaolan Huang

  2. Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi, 545007, China

    Changping Xie, Bangjun Lv, Rong Pan & Jian Lan

  3. Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, 100191, China

    Pei Pei

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Liang, T., Xie, C., Lv, B. et al. Age at smoking initiation and smoking cessation influence the incidence of stroke in China: a 10-year follow-up study. J Thromb Thrombolysis 56, 175–187 (2023). https://doi.org/10.1007/s11239-023-02812-y

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