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. 2022 Oct;28(10):2045-2055.
doi: 10.1038/s41591-022-01978-x. Epub 2022 Oct 10.

Health effects associated with smoking: a Burden of Proof study

Xiaochen Dai  1   2 , Gabriela F Gil  3 , Marissa B Reitsma  3 , Noah S Ahmad  3 , Jason A Anderson  3 , Catherine Bisignano  3 , Sinclair Carr  3 , Rachel Feldman  3 , Simon I Hay  3   4 , Jiawei He  3   4 , Vincent Iannucci  3 , Hilary R Lawlor  3 , Matthew J Malloy  3 , Laurie B Marczak  3 , Susan A McLaughlin  3 , Larissa Morikawa  3 , Erin C Mullany  3 , Sneha I Nicholson  3 , Erin M O'Connell  3 , Chukwuma Okereke  3 , Reed J D Sorensen  3 , Joanna Whisnant  3 , Aleksandr Y Aravkin  3   5 , Peng Zheng  3   4 , Christopher J L Murray  3   4 , Emmanuela Gakidou  3   4
Affiliations

Health effects associated with smoking: a Burden of Proof study

Xiaochen Dai et al. Nat Med. 2022 Oct.

Abstract

As a leading behavioral risk factor for numerous health outcomes, smoking is a major ongoing public health challenge. Although evidence on the health effects of smoking has been widely reported, few attempts have evaluated the dose-response relationship between smoking and a diverse range of health outcomes systematically and comprehensively. In the present study, we re-estimated the dose-response relationships between current smoking and 36 health outcomes by conducting systematic reviews up to 31 May 2022, employing a meta-analytic method that incorporates between-study heterogeneity into estimates of uncertainty. Among the 36 selected outcomes, 8 had strong-to-very-strong evidence of an association with smoking, 21 had weak-to-moderate evidence of association and 7 had no evidence of association. By overcoming many of the limitations of traditional meta-analyses, our approach provides comprehensive, up-to-date and easy-to-use estimates of the evidence on the health effects of smoking. These estimates provide important information for tobacco control advocates, policy makers, researchers, physicians, smokers and the public.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Smoking and lung cancer.
a, The log(RR) function. b, RR function. c, A modified funnel plot showing the residuals (relative to 0) on the x axis and the estimated s.d. that includes reported s.d. and between-study heterogeneity on the y axis.
Fig. 2
Fig. 2. Smoking and COPD.
a, The log(RR) function. b, RR function. c, A modified funnel plot showing the residuals (relative to 0) on the x axis and the estimated s.d. that includes the reported s.d. and between-study heterogeneity on the y axis.
Fig. 3
Fig. 3. Smoking and type 2 diabetes.
a, The log(RR) function. b, RR function. c, A modified funnel plot showing the residuals (relative to 0) on the x axis and the estimated s.d. that includes the reported s.d. and between-study heterogeneity on the y axis.
Fig. 4
Fig. 4. Smoking and prostate cancer.
a, The log(RR) function. b, RR function. c, A modified funnel plot showing the residuals (relative to 0) on the x axis and the estimated s.d. that includes reported s.d. and between-study heterogeneity on the y axis.
Extended Data Fig. 1
Extended Data Fig. 1. PRISMA 2020 flow diagram for an updated systematic review of the Smoking and Tracheal, bronchus, and lung cancer risk-outcome pair.
The PRISMA flow diagram of an updated systematic review on the relationship between smoking and lung cancer conducted on PubMed to update historical review from previous cycles of the Global Burden of Disease Study. Template is from: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71. For more information, visit: http://www.prisma-statement.org/.
Extended Data Fig. 2
Extended Data Fig. 2. PRISMA 2020 flow diagram for an updated systematic review of the Smoking and Chronic obstructive pulmonary disease risk-outcome pair.
The PRISMA flow diagram of an updated systematic review on the relationship between smoking and chronic obstructive pulmonary disease conducted on PubMed to update historical review from previous cycles of the Global Burden of Disease Study. Template is from: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71. For more information, visit: http://www.prisma-statement.org/.
Extended Data Fig. 3
Extended Data Fig. 3. PRISMA 2020 flow diagram for an updated systematic review of the Smoking and Diabetes mellitus type 2 risk- outcome pair.
The PRISMA flow diagram of an updated systematic review on the relationship between smoking and type 2 diabetes conducted on PubMed to update historical review from previous cycles of the Global Burden of Disease Study. Template is from: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71. For more information, visit: http://www.prisma-statement.org/.
Extended Data Fig. 4
Extended Data Fig. 4. PRISMA 2020 flow diagram for an updated systematic review of the Smoking and Breast cancer risk-outcome pair.
The PRISMA flow diagram of an updated systematic review on the relationship between smoking and breast cancer conducted on PubMed to update historical review from previous cycles of the Global Burden of Disease Study. Template is from: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71. For more information, visit: http://www.prisma-statement.org/.
Extended Data Fig. 5
Extended Data Fig. 5. PRISMA 2020 flow diagram for an updated systematic review of the Smoking and Prostate cancer risk-outcome pair.
The PRISMA flow diagram of an updated systematic review on the relationship between smoking and prostate cancer conducted on PubMed to update historical review from previous cycles of the Global Burden of Disease Study. Template is from: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71. For more information, visit: http://www.prisma-statement.org/.
Extended Data Fig. 6
Extended Data Fig. 6. Smoking and Breast Cancer.
a, log-relative risk function. b, relative risk function. c, A modified funnel plot showing the residuals (relative to 0) on the x-axis and the estimated standard deviation (SD) that includes reported SD and between-study heterogeneity on the y-axis.
See this image and copyright information in PMC

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