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Smoking and smoking cessation in relation to risk of diabetes in Chinese men and women: a 9-year prospective study of 0·5 million people.
Lancet Public Health 2018; 3(4):e167-e176LP

Abstract

BACKGROUND

In developed countries, smoking is associated with increased risk of diabetes. Little is known about the association in China, where cigarette consumption has increased (first in urban, then in rural areas) relatively recently. Moreover, uncertainty remains about the effect of smoking cessation on diabetes in China and elsewhere. We aimed to assess the associations of smoking and smoking cessation with risk of incident diabetes among Chinese adults.

METHODS

The prospective China Kadoorie Biobank enrolled 512 891 adults (59% women) aged 30-79 years during 2004-08 from ten diverse areas (five urban and five rural) across China. Participants were interviewed at study assessment clinics, underwent physical measurements, and had a non-fasting blood sample taken. Participants were separated into four categories according to smoking history: never-smokers, ever-regular smokers, ex-smokers, and occasional smokers. Incident diabetes cases were identified through linkage with diabetes surveillance systems, the national health insurance system, and death registries. All analyses were done separately in men and women and Cox regression was used to yield adjusted hazards ratios (HRs) for diabetes associated with smoking.

FINDINGS

68% (n=134 975) of men ever smoked regularly compared with 3% (n=7811) of women. During 9 years' follow-up, 13 652 new-onset diabetes cases were recorded among 482 589 participants without previous diabetes. Among urban men, smokers had an adjusted HR of 1·18 (95% CI 1·12-1·25) for diabetes. HRs increased with younger age at first smoking regularly (1·12, 1·20, and 1·27 at ≥25 years, 20-24 years, and <20 years, respectively; p for trend=0·00073) and with greater amount smoked (1·11, 1·15, 1·42, and 1·63 for <20, 20-29, 30-39 and ≥40 cigarettes per day; p for trend<0·0001). Among rural men, similar, albeit more modest, associations were seen. Overall, HRs were more extreme at higher levels of adiposity. Among men who stopped by choice, there was no excess risk within 5 years of cessation, contrasting with those who stopped because of illness (0·92 [0·75-1·12] vs 1·42 [1·23-1·63]). Among the few women who ever smoked regularly, the excess risk of diabetes was significant (1·33 [1·20-1·47]).

INTERPRETATION

Among Chinese adults, smoking was associated with increased risk of diabetes, with no significant excess risk following voluntary smoking cessation.

FUNDING

Wellcome Trust, Medical Research Council, British Heart Foundation, Cancer Research UK, Kadoorie Charitable Foundation, Ministry of Science and Technology, National Natural Science Foundation of China, and China Scholarship Council.

Authors+Show Affiliations

Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China.Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.Chinese Academy of Medical Sciences, Beijing, China.Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.Chinese Academy of Medical Sciences, Beijing, China.Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China.Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China.Shibei Centre for Disease Control and Prevention, Qingdao, China.Qingdao Centre for Disease Control and Prevention, Qingdao, China.National Center for Food Safety Risk Assessment, Beijing, China.Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.Chinese Academy of Medical Sciences, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China.Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK. Electronic address: zhengming.chen@ctsu.ox.ac.uk.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29548855

Citation

Liu, Xin, et al. "Smoking and Smoking Cessation in Relation to Risk of Diabetes in Chinese Men and Women: a 9-year Prospective Study of 0·5 Million People." The Lancet. Public Health, vol. 3, no. 4, 2018, pp. e167-e176.
Liu X, Bragg F, Yang L, et al. Smoking and smoking cessation in relation to risk of diabetes in Chinese men and women: a 9-year prospective study of 0·5 million people. Lancet Public Health. 2018;3(4):e167-e176.
Liu, X., Bragg, F., Yang, L., Kartsonaki, C., Guo, Y., Du, H., ... Chen, Z. (2018). Smoking and smoking cessation in relation to risk of diabetes in Chinese men and women: a 9-year prospective study of 0·5 million people. The Lancet. Public Health, 3(4), pp. e167-e176. doi:10.1016/S2468-2667(18)30026-4.
Liu X, et al. Smoking and Smoking Cessation in Relation to Risk of Diabetes in Chinese Men and Women: a 9-year Prospective Study of 0·5 Million People. Lancet Public Health. 2018;3(4):e167-e176. PubMed PMID: 29548855.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Smoking and smoking cessation in relation to risk of diabetes in Chinese men and women: a 9-year prospective study of 0·5 million people. AU - Liu,Xin, AU - Bragg,Fiona, AU - Yang,Ling, AU - Kartsonaki,Christiana, AU - Guo,Yu, AU - Du,Huaidong, AU - Bian,Zheng, AU - Chen,Yiping, AU - Yu,Canqing, AU - Lv,Jun, AU - Wang,Kang, AU - Zhang,Hua, AU - Chen,Junshi, AU - Clarke,Robert, AU - Collins,Rory, AU - Peto,Richard, AU - Li,Liming, AU - Chen,Zhengming, AU - ,, Y1 - 2018/03/13/ PY - 2017/12/11/received PY - 2018/01/29/revised PY - 2018/02/05/accepted PY - 2018/3/20/pubmed PY - 2019/3/13/medline PY - 2018/3/18/entrez SP - e167 EP - e176 JF - The Lancet. Public health JO - Lancet Public Health VL - 3 IS - 4 N2 - BACKGROUND: In developed countries, smoking is associated with increased risk of diabetes. Little is known about the association in China, where cigarette consumption has increased (first in urban, then in rural areas) relatively recently. Moreover, uncertainty remains about the effect of smoking cessation on diabetes in China and elsewhere. We aimed to assess the associations of smoking and smoking cessation with risk of incident diabetes among Chinese adults. METHODS: The prospective China Kadoorie Biobank enrolled 512 891 adults (59% women) aged 30-79 years during 2004-08 from ten diverse areas (five urban and five rural) across China. Participants were interviewed at study assessment clinics, underwent physical measurements, and had a non-fasting blood sample taken. Participants were separated into four categories according to smoking history: never-smokers, ever-regular smokers, ex-smokers, and occasional smokers. Incident diabetes cases were identified through linkage with diabetes surveillance systems, the national health insurance system, and death registries. All analyses were done separately in men and women and Cox regression was used to yield adjusted hazards ratios (HRs) for diabetes associated with smoking. FINDINGS: 68% (n=134 975) of men ever smoked regularly compared with 3% (n=7811) of women. During 9 years' follow-up, 13 652 new-onset diabetes cases were recorded among 482 589 participants without previous diabetes. Among urban men, smokers had an adjusted HR of 1·18 (95% CI 1·12-1·25) for diabetes. HRs increased with younger age at first smoking regularly (1·12, 1·20, and 1·27 at ≥25 years, 20-24 years, and <20 years, respectively; p for trend=0·00073) and with greater amount smoked (1·11, 1·15, 1·42, and 1·63 for <20, 20-29, 30-39 and ≥40 cigarettes per day; p for trend<0·0001). Among rural men, similar, albeit more modest, associations were seen. Overall, HRs were more extreme at higher levels of adiposity. Among men who stopped by choice, there was no excess risk within 5 years of cessation, contrasting with those who stopped because of illness (0·92 [0·75-1·12] vs 1·42 [1·23-1·63]). Among the few women who ever smoked regularly, the excess risk of diabetes was significant (1·33 [1·20-1·47]). INTERPRETATION: Among Chinese adults, smoking was associated with increased risk of diabetes, with no significant excess risk following voluntary smoking cessation. FUNDING: Wellcome Trust, Medical Research Council, British Heart Foundation, Cancer Research UK, Kadoorie Charitable Foundation, Ministry of Science and Technology, National Natural Science Foundation of China, and China Scholarship Council. SN - 2468-2667 UR - https://www.unboundmedicine.com/medline/citation/29548855/Smoking_and_smoking_cessation_in_relation_to_risk_of_diabetes_in_Chinese_men_and_women:_a_9_year_prospective_study_of_0·5_million_people_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2468-2667(18)30026-4 DB - PRIME DP - Unbound Medicine ER -