China With The Onset Of Type 2 Diabetes Relations Prospectie Study Of Adult Cigarette Smoking And The Relationship Between Smoking And Suicide Death Meta Analysis Of Prospective Cohort Study

Objective:We examined sex-specific relationships of smoking with risk of type2diabetes mellitus (T2DM) in the Chinese adult population.Methods:Data on cigarette smoking from two study cohorts were obtained at baseline examinations in1998and during2000-2001, separately. A total of27020Chinese adults who were aged35to74years at their baseline examination were followed up in2007-2008, with a response rate of79.78%. After excluding those with diabetes, coronary heart disease and stroke at baseline and those with incomplete cigarette smoking information,7695men and8524women were included in the study. Incident diabetes was ascertained by fasting glucose assays (FBG>126mg/dl), self-report of physician diagnosis, current use of hypoglycemic medications or death certificate listing diabetes as an underlying or contributing cause of death. Cox proportional hazards models were used to evaluate the multivariate-adjusted relationship of cigarette smoking with the incidence of T2DM.Results:During an average of8.1years follow-up, a total of1075T2DM events (524men and551women) were observed. The multivariate-adjusted hazard ratio (HR,[95%confidence interval,95%C1]) of T2DM associated with current smoking was1.24(1.007-1.54) in men and1.90(1.30-2.77) in women, respectively. The corresponding population attributable risk percent was12.61%in men and3.23%in women. For men, compared with never-smokers, the multivariate-adjusted HR(95%CI) for T2DM was1.26(0.94-1.68) for former smokers,1.03(0.80-1.34) for persons who smoked1to19cigarettes/d,1.42(1.13-1.79) for those who smoked20or more cigarettes/d (P for trend for current smokers only=0.003); and the multivariate-adjusted HR (95%CI) of T2DM was0.99(0.77-1.27),1.42(1.10-1.82) and1.79(1.26-2.54) for those who smoked0.1-20,20.1-40, and>40pack-years, respectively (P for trend for current smokers <0.001). While in women, contrast to never-smokers, the multivariate-adjusted HR of T2DM (95%CI) was0.88(0.41-1.89),1.60(0.98-2.63) and2.52(1.44-4.42) for former smokers, persons who smoked1-9cigarettes Id, and those who smoked≥10cigarettes/d; and1.57(0.96-2.57) and2.76(1.57-4.85) for those who smoked0.1-10, and>10.1pack-years, respectively (both p for trends for current smokers only<0.001).Conclusion:Our study demonstrates that cigarette smoking is independently associated with increased risk of T2DM among adult men and women in China, consistent with a dose-response relationship. Objective:Epidemiologic studies have reported conflicting results relating smoking to suicide risk. We conducted a meta-analysis of prospective cohort studies to evaluate the association of cigarette smoking with completed suicide.Methods:Eligible prospective cohort studies were identified from PubMed and EMbase databases (from1966to May2011) and the reference lists of retrieved articles. Two authors independently extracted data and assessed study quality using the Newcastle-Ottawa Scale. Study-specific risk estimates were pooled using random-effects model and generalized least-squares trend estimation was used to assess dose-response relationship.Results:Fifteen prospective cohort studies involving2,395cases among1,369,807participants were included in the meta-analysis. Our data suggested that cigarette smoking significantly increased the risk of completed suicide. Compared with never smokers, the pooled RR was1.28(95%CI:1.001-1.641) for former smokers, and1.81(95%CI:1.50-2.19) for current smokers, respectively. Subgroup analyses showed that the increased suicide risk among current smokers appeared to be consistent, although there was heterogeneity among studies of current smoking (p<0.001). Significant dose-response relationship was found between smoking and suicide, and the risk of suicide was increased by24%for each increment of10cigarettes smoked per day (RR,1.24;95%CI:1.20-1.28).Conclusions:Our meta-analysis robustly demonstrates that cigarette smoking is associated with an increased risk of completed suicide, consistent with a dose-response relationship. This conclusion has an important public health message for countries with high smoking prevalence and high suicide rate such as China.