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Int J Epidemiol. 2017 Jun 1;46(3):872-880. doi: 10.1093/ije/dyw294.

Moist smokeless tobacco (Snus) use and risk of Parkinson's disease.

Author information

1
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
2
Department of Psychology, University of Southern California, Los Angeles, CA, USA.
3
Epidemiology and Global Health, Department of Public Health and Clinical Medicine.
4
Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden.
5
Department of Medicine, Clinical Epidemiology Unit.
6
Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden.
7
Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
8
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
9
Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
10
Department of Public Health and Clinical Medicine, Skellefteå Research Unit.
11
Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden.
12
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
13
Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden.
14
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.

Abstract

Background:

Cigarette smoking is associated with a lower risk of Parkinson's disease. It is unclear what constituent of tobacco smoke may lower the risk. Use of Swedish moist smokeless tobacco (snus) can serve as a model to disentangle what constituent of tobacco smoke may lower the risk. The aim of this study was to determine whether snus use was associated with a lower risk of Parkinson's disease.

Methods:

Individual participant data were collected from seven prospective cohort studies, including 348 601 men. We used survival analysis with multivariable Cox regression to estimate study-specific relative risk of Parkinson's disease due to snus use, and random-effects models to pool estimates in a meta-analysis. The primary analyses were restricted to never-smokers to eliminate the potential confounding effect of tobacco smoking.

Results:

During a mean follow-up time of 16.1 years, 1199 incident Parkinson's disease cases were identified. Among men who never smoked, ever-snus users had about 60% lower Parkinson's disease risk compared with never-snus users [pooled hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.28-0.61]. The inverse association between snus use and Parkinson's disease risk was more pronounced in current (pooled HR 0.38, 95% CI 0.23-0.63), moderate-heavy amount (pooled HR 0.41, 95% CI 0.19-0.90) and long-term snus users (pooled HR 0.44, 95% CI 0.24-0.83).

Conclusions:

Non-smoking men who used snus had a substantially lower risk of Parkinson's disease. Results also indicated an inverse dose-response relationship between snus use and Parkinson's disease risk. Our findings suggest that nicotine or other components of tobacco leaves may influence the development of Parkinson's disease.

KEYWORDS:

Parkinson’s disease; epidemiology; individual participant data; nicotine; risk factors

PMID:
27940486
DOI:
10.1093/ije/dyw294
[Indexed for MEDLINE]

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