Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-26T06:53:10.121Z Has data issue: false hasContentIssue false
  • English
  • Français

Cigarette smoking as a risk factor for schizophrenia or all non-affective psychoses

Published online by Cambridge University Press:  09 March 2020

Michael King Open the ORCID record for Michael King [Opens in a new window] ,
Rebecca Jones ,
Irene Petersen ,
Fiona Hamilton  and
Irwin Nazareth Open the ORCID record for Irwin Nazareth [Opens in a new window]
Michael King*
Affiliation:
Division of Psychiatry, University College London, B Wing, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
Rebecca Jones
Affiliation:
Division of Psychiatry, University College London, B Wing, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
Irene Petersen
Affiliation:
Research Department of Primary Care & Population Health, Institute of Epidemiology and Health Care, University College London, Upper 3rd Floor, Royal Free Campus, Rowland Hill Street, LondonNW3 2PF, UK
Fiona Hamilton
Affiliation:
Research Department of Primary Care & Population Health, Institute of Epidemiology and Health Care, University College London, Upper 3rd Floor, Royal Free Campus, Rowland Hill Street, LondonNW3 2PF, UK
Irwin Nazareth
Affiliation:
Research Department of Primary Care & Population Health, Institute of Epidemiology and Health Care, University College London, Upper 3rd Floor, Royal Free Campus, Rowland Hill Street, LondonNW3 2PF, UK
*
Author for correspondence: Michael King, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Smoking tobacco is regarded as an epiphenomenon in patients with schizophrenia when it may be causal. We aimed to examine whether smoking status is related to the onset of schizophrenia or the broader diagnosis of non-affective psychosis, including schizophrenia.

Methods

We used data from The Health Improvement Network primary care database to identify people aged 15–24 between 1 January 2004 and 31 December 2009. We followed them until the earliest of: first diagnosis of schizophrenia (or psychosis), patient left the practice, practice left THIN, patient died or 31 December 2014.

Results

In men, incidence rates for schizophrenia per 100 000 person years at risk were higher in smoking initiators (non-smoker who became a smoker during the study) than in non-smokers (adjusted IRR 1.94; 95% CI 1.29–2.91) and higher still in smokers (adjusted IRR 3.32; 95% CI 2.67–4.14). Among women, the incidence rate of schizophrenia was higher in smokers than in non-smokers (adjusted IRR 1.50; 95% CI 1.06–2.12), but no higher in smoking initiators than non-smokers. For non-affective psychosis, the pattern was similar for men but more evident in women where psychosis incidence rates were higher in smoking initiators (adjusted IRR 1.90; 95% CI 1.40–2.56) and in smokers (adjusted IRR 2.13; 95% CI 1.76–2.57) than in non-smokers.

Conclusions

We found an important and strong association between smoking and incidence of schizophrenia. Smoking may increase risk through as yet unknown pathways or smoking may share genetic risk with schizophrenia and non-affective psychoses.

Keywords

Onsetprimary careriskschizophreniasmoking
Type
Original Articles
Information
Psychological Medicine , Volume 51 , Issue 8 , June 2021 , pp. 1373 - 1381
Check for updates
Copyright
Copyright © The Author(s) 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aguocha, C. M., Aguocha, J. K., Igwe, M., Uwakwe, R. U., & Onyeama, G. M. (2015). Prevalence and correlates of cigarette smoking among patients with schizophrenia in southeast Nigeria. Acta Psychiatrica Scandinavica, 131(3), 206–212. doi: 10.1111/acps.12334.CrossRefGoogle ScholarPubMed
Akbarian, S., & Kundakovic, M. (2015). CHRNA7 And CHRFAM7A: Psychosis and smoking? Blame the neighbors! American Journal of Psychiatry, 172(11), 1054–1056. doi: 10.1176/appi.ajp.2015.15081018.CrossRefGoogle ScholarPubMed
Arseneault, L., Cannon, M., Witton, J., & Murray, R. M. (2004). Causal association between cannabis and psychosis: Examination of the evidence. The British Journal of Psychiatry, 184(2), 110–117. doi:10.1192/bjp.184.2.110.CrossRefGoogle Scholar
Blak, B. T., Thompson, M., Dattani, H., & Bourke, A. (2011). Generalisability of The Health Improvement Network (THIN) database: Demographics, chronic disease prevalence and mortality rates. Journal of Innovation in Health Informatics, 19(4), 251–255.CrossRefGoogle ScholarPubMed
Broadfield, D. (2017). Drug misuse: Findings from the 2016/2017 crime survey for England and Wales. (11/17). London, UK: Home Office.Google Scholar
Cao, X.-L., Li, Y., Zhong, B.-L., Chiu, H. F. K., Ungvari, G. S., Ng, C. H., & Xiang, Y.-T. (2016). Current cigarette smoking in Chinese female patients with schizophrenia: A meta-analysis. Psychiatry Research, 235, 203–205. doi:http://dx.doi.org/10.1016/j.psychres.2015.11.050.CrossRefGoogle ScholarPubMed
Dave, S., & Petersen, I. (2009). Creating medical and drug code lists to identify cases in primary care databases. Pharmacoepidemiology and Drug Safety, 18(8), 704–707.CrossRefGoogle ScholarPubMed
de Leon, J., & Diaz, F. J. (2005). A meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking behaviors. Schizophrenia Research, 76(2–3), 135–157. doi:http://dx.doi.org/10.1016/j.schres.2005.02.010.CrossRefGoogle ScholarPubMed
Dierker, L., He, J., Kalaydjian, A., Swendsen, J., Degenhardt, L., Glantz, M., … Merikangas, K. (2008). The importance of timing of transitions for risk of regular smoking and nicotine dependence. Annals of Behavioral Medicine, 36(1), 87–92. doi:10.1007/s12160-008-9051-x.CrossRefGoogle ScholarPubMed
Dolan, S. A., Jarman, B., Bajekal, M., Davies, P. M., & Hart, D. (1995). Measuring disadvantage: Changes in the underprivileged area, Townsend, and Carstairs Scores 1981–91. Journal of Epidemiology and Community Health, 49(Suppl 2), S30–S33. doi:10.1136/jech.49.Suppl_2.S30.CrossRefGoogle ScholarPubMed
Fergusson, D. M., Hall, W., Boden, J. M., & Horwood, L. J. (2015). Rethinking cigarette smoking, cannabis use, and psychosis. The Lancet Psychiatry, 2(7), 581–582. doi:https://doi.org/10.1016/S2215-0366(15)00208-4.CrossRefGoogle ScholarPubMed
Fix, B. V., Smith, D., O'Connor, R., Heckman, B. W., Willemsen, M. C., Cummings, M., & Fong, G. (2019). Cannabis use among a nationally representative cross-sectional sample of smokers and non-smokers in the Netherlands: Results from the 2015 ITC Netherlands Gold Magic Survey. BMJ Open, 9(3), E024497. doi:10.1136/bmjopen-2018-024497.CrossRefGoogle ScholarPubMed
Gage, S. H., Hickman, M., & Zammit, S. (2016). Association between cannabis and psychosis: Epidemiologic evidence. Biological Psychiatry, 79(7), 549–556. doi:http://dx.doi.org/10.1016/j.biopsych.2015.08.001.CrossRefGoogle ScholarPubMed
Gage, S. H., Jones, H. J., Taylor, A. E., Burgess, S., Zammit, S., & Munafò, M. R. (2017). Investigating causality in associations between smoking initiation and schizophrenia using Mendelian randomization. Scientific Reports, 7, 40653. doi:10.1038/srep40653 https://www.nature.com/articles/srep40653#supplementary-information.CrossRefGoogle ScholarPubMed
Gurillo, P., Jauhar, S., Murray, R. M., & MacCabe, J. H. (2015). Does tobacco use cause psychosis? Systematic review and meta-analysis. The Lancet Psychiatry, 2(8), 718–725. doi:http://dx.doi.org/10.1016/S2215-0366(15)00152-2.CrossRefGoogle ScholarPubMed
Hardoon, S., Hayes, J. F., Blackburn, R., Petersen, I., Walters, K., Nazareth, I., & Osborn, D. P. J. (2013). Recording of severe mental illness in United Kingdom primary care, 2000-2010. PLoS ONE, 8(12), e82365–e82365. doi:10.1371/journal.pone.0082365.CrossRefGoogle ScholarPubMed
Horsfall, L., Walters, K., & Petersen, I. (2013). Identifying periods of acceptable computer usage in primary care research databases. Pharmacoepidemiology and Drug Safety, 22(1), 64–69. doi:10.1002/pds.3368.CrossRefGoogle ScholarPubMed
Kafali, H. Y., Bildik, T., Bora, E., Yuncu, Z., & Erermis, H. S. (2019). Distinguishing prodromal stage of bipolar disorder and early onset schizophrenia spectrum disorders during adolescence. Psychiatry Research, 275, 315–325. doi:https://doi.org/10.1016/j.psychres.2019.03.051.CrossRefGoogle ScholarPubMed
Kunii, Y., Zhang, W., Xu, Q., Hyde, T. M., McFadden, W., Shin, J. H., … Lipska, B. K. (2015). CHRNA7 And CHRFAM7A mRNAs: Co-localized and their expression levels altered in the postmortem dorsolateral prefrontal cortex in major psychiatric disorders. American Journal of Psychiatry, 172(11), 1122–1130. doi:10.1176/appi.ajp.2015.14080978.CrossRefGoogle ScholarPubMed
Large, M., & MacCabe, J. H. (2015). Tobacco and psychosis: Not quite a smoking gun. Australian and New Zealand Journal of Psychiatry, 49(10), 859–860. doi:10.1177/0004867415598013.CrossRefGoogle ScholarPubMed
Li, Y., Hou, C.-L., Ma, X.-R., Zang, Y., Jia, F.-J., Zhong, B.-L., … Xiang, Y.-T. (2016). Smoking and its associations with sociodemographic and clinical characteristics and quality of life in patients with schizophrenia treated in primary care in China. General Hospital Psychiatry, 38, 79–83. doi:http://dx.doi.org/10.1016/j.genhosppsych.2015.10.003.CrossRefGoogle ScholarPubMed
Liu, X.-A., & Kenny, P. J. (2017). Α5 nicotinic receptors link smoking to schizophrenia. Nature Medicine, 23, 277. doi:10.1038/nm.4300.CrossRefGoogle Scholar
Maguire, A., Blak, B. T., & Thompson, M. (2009). The importance of defining periods of complete mortality reporting for research using automated data from primary care. Pharmacoepidemiology and Drug Safety, 18(1), 76–83. doi:10.1002/pds.1688.CrossRefGoogle ScholarPubMed
Marconi, A., Di Forti, M., Lewis, C. M., Murray, R. M., & Vassos, E. (2016). Meta-analysis of the association between the level of cannabis use and risk of psychosis. Schizophrenia Bulletin, 42(5), 1262–1269. doi:10.1093/schbul/sbw003.CrossRefGoogle ScholarPubMed
Marston, L., Carpenter, J. R., Walters, K. R., Morris, R. W., Nazareth, I., White, I. R., & Petersen, I. (2014). Smoker, ex-smoker or non-smoker? The validity of routinely recorded smoking status in UK primary care: A cross-sectional study. BMJ Open, 4(4), e004958. doi:10.1136/bmjopen-2014-004958.CrossRefGoogle ScholarPubMed
McGrath, J. J., Alati, R., Clavarino, A., Williams, G. M., Bor, W., Najman, J. M., … Scott, J. G. (2015). Age at first tobacco use and risk of subsequent psychosis-related outcomes: A birth cohort study. Australian and New Zealand Journal of Psychiatry, 50(6), 577–583. doi:10.1177/0004867415587341.CrossRefGoogle ScholarPubMed
Munafò, M. R., Larsson Lönn, S., Sundquist, J., Sundquist, K., & Kendler, K. (2016). Snus use and risk of schizophrenia and non-affective psychosis. Drug and Alcohol Dependence, 164, 179–182. doi:http://dx.doi.org/10.1016/j.drugalcdep.2016.04.035.CrossRefGoogle ScholarPubMed
Murray, R. M., Bhavsar, V., Tripoli, G., & Howes, O. (2017). 30 Years on: How the neurodevelopmental hypothesis of schizophrenia morphed into the developmental risk factor model of psychosis. Schizophrenia Bulletin, 43(6), 1190–1196. doi:10.1093/schbul/sbx121.CrossRefGoogle Scholar
Office, H. (2018). Drug misuse: findings from the 2017 to 2018 CSEW. Appendix table 3.02. Retrieved from https://www.gov.uk/government/statistics/drug-misuse-findings-from-the-2017-to-2018-csew.Google Scholar
Reginsson, G. W., Ingason, A., Euesden, J., Bjornsdottir, G., Olafsson, S., Sigurdsson, E., … Stefansson, K. (2018). Polygenic risk scores for schizophrenia and bipolar disorder associate with addiction. Addiction Biology, 23(1), 485–492. doi:10.1111/adb.12496.CrossRefGoogle ScholarPubMed
Schneeweiss, S. (2006). Sensitivity analysis and external adjustment for unmeasured confounders in epidemiologic database studies of therapeutics. Pharmacoepidemiology and Drug Safety, 15(5), 291–303. doi:10.1002/pds.1200.CrossRefGoogle ScholarPubMed
Taggar, J. S., Coleman, T., Lewis, S., & Szatkowski, L. (2012). The impact of the Quality and Outcomes Framework (QOF) on the recording of smoking targets in primary care medical records: Cross-sectional analyses from The Health Improvement Network (THIN) database. BMC Public Health, 12(1), 1–11. doi:10.1186/1471-2458-12-329.CrossRefGoogle ScholarPubMed
West, R. (2017). Tobacco smoking: Health impact, prevalence, correlates and interventions. Psychology & Health, 32(8), 1018–1036. doi:10.1080/08870446.2017.1325890.CrossRefGoogle ScholarPubMed
Whitton, A., Green, A., Pizzagalli, D., Williams, J., & Brunette, M. (2018). S244. Potent dopamine D2 receptor antagonists block the reward-enhancing effects of nicotine in smokers with schizophrenia. Biological Psychiatry, 83(9, Supplement), S443. doi:https://doi.org/10.1016/j.biopsych.2018.02.1136.CrossRefGoogle Scholar
Winterer, G. (2010). Why do patients with schizophrenia smoke? Current Opinion in Psychiatry, 23(2), 112–119. doi:10.1097/YCO.0b013e3283366643.CrossRefGoogle ScholarPubMed
Wootton, R. E., Richmond, R. C., Stuijfzand, B. G., Lawn, R. B., Sallis, H. M., Taylor, G. M. J., … Munafo, M. R. (2018). Causal effects of lifetime smoking on risk for depression and schizophrenia: Evidence from a Mendelian randomisation study. bioRxiv, 381301. doi:10.1101/381301.Google Scholar