Female vulnerability to the effects of smoking on health outcomes in older people

Abstract

Cigarette smoking is among the leading risk factors for mortality and morbidity. While men have a higher smoking prevalence, mechanistic experiments suggest that women are at higher risk for health problems due to smoking. Moreover, the comparison of smoking effects on multiple conditions and mortality for men and women has not yet been done in a population-based group with race/ethnic diversity. We used proportional hazards models and restricted mean survival time to assess differences in smoking effects by sex for multiple health outcomes using data from the U.S. Health and Retirement Study (HRS), a population-representative cohort of individuals aged 50+ (n = 22,708, 1992-2014). Men had experienced more smoking pack-years than women (22.0 vs 15.6 average pack-years). Age of death, onset of lung disorders, heart disease, stroke, and cancer showed dosedependent effects of smoking for both sexes. Among heavy smokers (>28 pack-years) women had higher risk of earlier age of death (HR = 1.3, 95%CI:1.03-1.65) and stroke (HR = 1.37, 95%CI:1.02-1.83). Risk of cancer and heart disease did not differ by sex for smokers. Women had earlier age of onset for lung disorders (HR = 2.83, 95%CI:1.74-4.6), but men risk due to smoking were higher (Smoking-Sex interaction P<0.02) than women. Passive smoke exposure increased risk of earlier heart disease (HR = 1.33, 95%CI:1.07-1.65) and stroke (HR:1.54, 95%CI:1.07-2.22) for non-smokers, mainly in men. Smoking cessation after 15 years partially attenuated the deleterious smoking effects for all health outcomes. In sum, our results suggest that women are more vulnerable to ever smoking for earlier death and risk of stroke, but less vulnerable for lung disorders. From an epidemiological perspective, sex differences in smoking effects are important considerations that could underlie sex differences in health outcomes. These findings also encourage future mechanistic experiments to resolve potential mechanisms of sex-specific cigarette smoke toxicity. Implications This study identifies new sex differences in health outcomes due to smoking exposures. Sex differences in smoking hazards are often missed in epidemiological studies. Specifically,

Sex-Related Differences in Oxidative, Platelet, and Vascular Function in Chronic Users of Heat-not-Burn vs. Traditional Combustion Cigarettes

“…We concluded that smoking HNBCs or TCCs has a similar negative impact on reactive oxygen species (ROS) generation and vascular reactivity, although HNBC smokers display lower levels of markers related to platelet activation. TCCs showed similar detrimental effects in women and men, in contrast with the current knowledge on the impact of traditional smoking on both cardiovascular and pulmonary health, which seems to be more severe in females [24][25][26]. However, the discrepancy found in our results may be partially explained by the lower mean age of the patients enrolled for the study, which is below 40 years, and, consequently, by the relatively few years of smoking habit.…”

“…However, since this was a sex-focused sub-study intended to unveil sex-related differences concerning different smoking habits, we deeply analyzed gender-related differences with respect to redox state, platelet aggregation, and vascular function. In this setting, smoking HNBCs or TCCs showed similar detrimental effects in women and men, in contrast with the current knowledge on the impact of traditional smoking on both cardiovascular and pulmonary health, which seems to be more severe in females [ 24 , 25 , 26 ]. However, the discrepancy found in our results may be partially explained by the lower mean age of the patients enrolled for the study, which is below 40 years, and, consequently, by the relatively few years of smoking habit.…”

Questioning the sex-specific differences in the association of smoking on the survival rate of hospitalized COVID-19 patients

“…Another study pinpointed that smoking men have more emphysematous deterioration of the lungs compared to smoking women [ 25 ]. A significant representative cohort of 22,708 individuals demonstrated that smoking women were more vulnerable for earlier death and risk of stroke as compared to smoking men, but less vulnerable for lung disorders [ 26 ]. Since COVID-19 targets mainly the lungs, smoking-related lung disorders overlap with COVID-19 respiratory comorbidities that include chronic bronchitis, emphysema and chronic obstructive pulmonary disease (COPD) [ 27 , 28 ].…”

“…Taking into consideration that our study was done in a LMIC, our results were consistent with this comprehensive study to indicate a potential sex sensitivity for smoking in COVID-19 cases that is worth noting and investigating in prospective studies. On the other hand, tobacco dosage consumption might have a potential cofounding effect on COVID-19 morbidity and thus, accounting for smoking dosage might underlie the prominent morbidity among male COVID-19 patients since men tend to have higher rates of cigarettes consumption per day as compared to women [ 26 ]. Previous studies have showed that the detected global sex disparities in severity and mortality from COVID-19 could be driven by the higher presence of comorbidities (i.e.…”

Longitudinal Health Behaviour Patterns Among Chinese Adults Aged ≥ 50 Years and Their Associations With Trajectories of Depressive Symptoms Over Time: A Latent Class Analysis

“…More detailed measurement, such as the consideration of smoking intensity (i.e., the amount/frequency of cigarettes/tobacco smoked) or social participation intensity, might yield different patterns [13,51]. Third, heavy smokers are known to have higher risks of earlier death [57], but our study did not include heavy smokers who had died before the age of 50 years or between CHARLS waves. Thus, our ndings might underestimate the in uence of heavy smoking on depressive symptoms.…”