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. 2024 Jul;59(7):1129-1141.
doi: 10.1007/s00127-023-02596-9. Epub 2023 Dec 16.

Early-onset alcohol, tobacco, and illicit drug use with age at onset of hypertension: a survival analysis

Kesheng Wang  1 , Saima Shafique  2   3 , Nianyang Wang  4 , Suzy Mascaro Walter  2 , Xin Xie  5 , Ubolrat Piamjariyakul  3 , Erin L Winstanley  6   7
Affiliations

Early-onset alcohol, tobacco, and illicit drug use with age at onset of hypertension: a survival analysis

Kesheng Wang et al. Soc Psychiatry Psychiatr Epidemiol. 2024 Jul.

Abstract

Purpose: To examine the associations of age when first substance use and early-onset substance use before age 18 with age at onset (AAO) of hypertension.

Methods: This study included 19,270 individuals with AAO of hypertension from the 2015-2019 National Survey on Drug Use and Health. Age when first use of 10 substance use variables included alcohol, daily cigarettes, cigars, smokeless tobacco, marijuana, cocaine, hallucinogens, lysergic acid diethylamide (LSD), inhalants, and methamphetamine use. The outcome was AAO of hypertension and variable cluster analysis was used to classify the exposures and outcome. Substance use status was classified into three categories: early-onset substance use (first used substance before age 18), late-onset substance use (first used substance after age 18), and never used.

Results: The mean AAO of hypertension was 42.7 years. Age when first use of 10 substance use variables had significant correlations with AAO of hypertension (all p values < 0.001). Individuals with early-onset alcohol, cigars, smokeless tobacco, marijuana, hallucinogens, inhalants, cocaine, LSD, and methamphetamine use revealed significantly earlier onset of hypertension than those never used. Compared with never used substances, the Cox regression model showed that early-onset alcohol, smokeless tobacco, marijuana, inhalants, and methamphetamine use had an increased risk of AAO of hypertension [hazard ratio (HR) (95%CI) = 1.22 (1.13, 1.31), 1.36 (1.24, 1.49), 1.85 (1.75, 1.95), 1.41 (1.30, 1.52), and 1.27 (1.07,1.50), respectively].

Conclusion: These findings suggest that intervention strategies or programs focusing on preventing early-onset substance use before age 18 may delay the onset of adult hypertension.

Keywords: Age at onset; Cox regression; Early-onset substance use; Hypertension; Survival analysis; Variable cluster analysis.

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