3.18 Other conditions with possible links to smoking

 

Last updated: May 2021
Suggested citation: Hurley, S, Winnall, WR, Greenhalgh, EM & Winstanley, MH. 3.18 Other conditions with possible links to smoking. In Greenhalgh, EM, Scollo, MM and Winstanley, MH [editors].  Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2021. Available from  http://www.tobaccoinaustralia.org.au/3-18-other-conditions-with-possible-links-to-smoking

 

This section provides information about the many other conditions (in addition to those discussed in other sections of Chapter 3) that may be associated with smoking. The list of conditions discussed in this section is comprehensive but not exhaustive; because cigarette smoke can adversely affect most, if not all, organs of the body, the list of diseases that may be caused by tobacco is still growing.

Generally, causality between smoking and the conditions discussed in this section has not been established. Before a causal link is confirmed by expert bodies such as the US Surgeon General’s office, a plausible biological mechanism and multiple prospective studies reporting the association are required. These studies need large numbers of subjects, unbiased/prospective design and controlling for confounding factors.

3.18.1 Mental illnesses

People with mood disorders or mental illness have a higher prevalence of smoking than the general population, and account for a large proportion of smokers.1, 2 In Australia, smoking rates among those with mental illness are about twice as high as for people without mental illness. Smokers are more likely than non-smokers to have anxiety,3 depression,3-7, bipolar disorder,8 bruxism (teeth clenching and grinding),9 panic attacks,10, 11 suicide attempts,3, 12 symptoms of psychosis7 and schizophrenia.13-15

The underlying reasons for the relationship between smoking and mental illness are complex, and are described in greater detail in Section 9A.3. This section also summarises research on barriers to quitting (Section 9A.3.4) and interventions for reducing smoking for people with mental illness (Section 9A.3.5).

3.18.2 Neurological diseases

Multiple sclerosis (MS) is a disease in which the myelin sheaths surrounding nerve cells in the brain and spinal cord become damaged and are gradually destroyed, through an autoimmune process. Smoking is considered a risk factor for multiple sclerosis, as well as a number of other autoimmune diseases.16 However, the US Surgeon General’s reports on the health effects of smoking have not reported sufficient evidence for any causative statements regarding smoking and multiple sclerosis.

A 2011 meta-analysis investigating the possible association of smoking and MS pooled data on more than 3,000 cases from 14 studies.17 The study found that smokers had about 50% higher risk of MS than non-smokers. These results were supported by a review of 14 studies, also from 2011.18

Smoking has also been reported to accelerate the clinical progression of MS, and the progression of the typical disease lesions visible on magnetic resonance images.19-22 However, a review article in 2011 looking at smoking and the onset and progression of MS found that while most of the studies on onset supported a positive association, the evidence on progression was more limited and mixed.18 More recently, numerous studies have found that smokers with MS have a higher risk of disease progression or severity, including increased respiratory problems,23 reduced grey matter fraction in the brain,24 worsening disability,25, 26 greater disease severity,27 worse long-term cognitive function28 and higher frequency of relapse.29

The biological mechanisms by which smoking might be causing or worsening MS are unclear. However, evidence from basic research has led to some hypotheses regarding potential mechanisms. Smoke contains nitric oxide, which may play a role in the degradation of nerve tissue.26, 30, 31 Free radicals, cyanates, and carbon monoxide in cigarette smoke may also be toxic to nerve cells.32 Smokers experience long-term inflammation and changes to the regulation of inflammatory cells that may play a role in causing autoimmune diseases such as MS.26 People who smoke have a higher risk of cardiovascular diseases, which also increases their risk of MS progression.26, 33 Further research is necessary to test whether these effects of smoking contribute to the progression of MS.

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative condition; a type of motor neurone disease. ALS leads to a dramatic loss of motor function that is usually rapid and lethal. A 2010 meta-analysis of 15 case–control and five cohort studies found that smoking increased the risk of ALS in women, but not in men.34 However a 2011 pooled analysis of data from more than half a million men and more than half a million women enrolled in five prospective cohort studies in the US found that smoking increases the risk of ALS by about 40% for both men and women.35 This large study therefore strongly supports the existence of an association between smoking and ALS. The risk in smokers increased with decreasing age at smoking initiation. Smoking has also been reported to decrease survival rates in women with ALS.36 Although smokers have a higher risk of ALS, the question of whether smoking is causative for ALS remains unanswered. Two studies that have assessed this association by reducing the effects of confounding have had conflicting conclusions.37, 38

There is increasing evidence for an association between smoking and hearing loss. A case–control study in the US, which included more than 3,000 cases, found only a very small, marginally statistically significant increase in risk associated with smoking.39 A prospective study of over 50,000 Japanese people found that smokers had a 1.6-fold increased risk of hearing loss, especially at the high frequency, in a dose-response manner. Smoking cessation reduced this excess risk.40 During the Nurses’ Health study II, 2,760 cases of hearing loss were reported. Compared with never smokers in this study, the risk of hearing loss for past smokers with 20 or more pack-years of smoking was 1.30-fold higher, and the risk for current smokers was 1.21-fold higher. Similar to the Japanese cohort, the excess risk decreased with smoking cessation.41 A 2020 systematic review found that smoking sensorineural hearing loss that is more pronounced in the long term and at high frequencies.42 Smoking, therefore, may be a causal factor in hearing loss, but future research is necessary to make this conclusion.

Smoking may be a precipitating factor for migraine43, 44 and smokers may be at increased risk of developing cranial autonomic symptoms (for example, facial sweating) during an attack.45 However, there is some doubt as to whether smoking is a cause of migraines.46

An analysis of the Nurses’ Health Study II in the US reported an increased risk of seizures associated with smoking.47

3.18.3 Kidney disease

Smoking has physiological effects on the kidneys. It has been reported to increase the glomerular filtration rate,48, 49 possibly by relaxing renal arteries.48 An increased glomerular filtration rate is a sign of kidney disease. There is evidence that smoking increases the risk of developing chronic kidney disease. For example, a 10-year follow-up study of more than 100,000 Japanese people found that smoking increased the risk of developing proteinuria and renal dysfunction.50 In a prospective study of Japanese people, current smokers had a 1.39-fold increased risk of new-onset of chronic kidney disease. This association was stronger for younger smokers.51 Similar results were found in a Korean study.52 The association of smoking with end-stage kidney disease (ESKD) was examined in a retrospective study of over 23 million people using data from the Korean National Health Insurance Service.53 Current smokers had a significant 1.39-fold increased risk of developing ESKD compared to non-smokers. The risk of ESKD increased with the smoking duration, number of cigarettes smoked and the pack-years.53

A case–control study in Syria found that smokers had a higher risk of hypertensive nephropathy and diabetic nephropathy, but the risk of other types of chronic kidney disease were not increased by smoking.54 A systematic review that included nine studies of smokers found that smokers were more likely to get kidney stone disease than non-smokers.55 

3.18.4 Other conditions

Numerous studies have indicated that smokers are more likely to suffer gout, a type of inflammatory arthritis. However, there is currently little evidence that smoking is a cause of gout.56

Smokers are also 1.49-fold more likely to have suffered from major bleeding compared to non-smokers. This includes intracranial bleeding, airway bleeding, gastrointestinal bleeding and urinary bleeding.57

A study from Japan has found that women who are current or ex-smokers are more likely to suffer from overactive bladder.58  

 

Relevant news and research

For recent news items and research on this topic, click  here.( Last updated May 2023)
 

References

 

1. Leonard S, Adler LE, Benhammou K, Berger R, Breese CR, et al. Smoking and mental illness. Pharmacology, Biochemistry and Behavior, 2001; 70(4):561-70. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11796154

2. Prochaska JJ, Das S, and Young-Wolff KC. Smoking, mental illness, and public health. Annual Review of Public Health, 2017; 38:165-85. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27992725

3. Pedersen W and von Soest T. Smoking, nicotine dependence and mental health among young adults: a 13-year population-based longitudinal study. Addiction, 2009; 104(1):129-37. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19133898

4. Flensborg-Madsen T, von Scholten MB, Flachs EM, Mortensen EL, Prescott E, et al. Tobacco smoking as a risk factor for depression. A 26-year population-based follow-up study. Journal of Psychiatric Research, 2011; 45(2):143-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20630542

5. Bainter T, Selya AS, and Oancea SC. A key indicator of nicotine dependence is associated with greater depression symptoms, after accounting for smoking behavior. PLoS ONE, 2020; 15(5):e0233656. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32442211

6. Gentile A, Bianco A, Nordstrm A, and Nordstrm P. Use of alcohol, drugs, inhalants, and smoking tobacco and the long-term risk of depression in men: A nationwide Swedish cohort study from 1969-2017. Drug and Alcohol Dependence, 2021; 221:108553. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33548898

7. Rognli EB, Bramness JG, and von Soest T. Smoking in early adulthood is prospectively associated with prescriptions of antipsychotics, mood stabilizers, antidepressants and anxiolytics. Psychological Medicine, 2021:1-10. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33583454

8. Minichino A, Bersani FS, Calo WK, Spagnoli F, Francesconi M, et al. Smoking behaviour and mental health disorders--mutual influences and implications for therapy. International Journal of Environmental Research and Public Health, 2013; 10(10):4790-811. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24157506

9. Rintakoski K, Ahlberg J, Hublin C, Broms U, Madden PA, et al. Bruxism is associated with nicotine dependence: a nationwide Finnish twin cohort study. Nicotine and Tobacco Research, 2010; 12(12):1254-60. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21041838

10. Cosci F, Knuts IJ, Abrams K, Griez EJ, and Schruers KR. Cigarette smoking and panic: a critical review of the literature. Journal of Clinical Psychiatry, 2010; 71(5):606-15. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19961810

11. Abrams K, Zvolensky MJ, Dorflinger L, Galatis A, Blank M, et al. Fear reactivity to bodily sensations among heavy smokers and nonsmokers. Experimental and Clinical Psychopharmacology, 2008; 16(3):230–9. Available from: https://pubmed.ncbi.nlm.nih.gov/18540783/

12. Riala K, Taanila A, Hakko H, and Räsänen P. Longitudinal smoking habits as risk factors for early-onset and repetitive suicide attempts: the Northern Finland 1966 Birth Cohort Study. Annals of Epidemiology, 2009; 19(5):329-35. Available from: https://pubmed.ncbi.nlm.nih.gov/19230708/

13. de Leon J and Diaz FJ. A meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking behaviors. Schizophrenia Research, 2005; 76(2-3):135-57. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15949648

14. Liu H, Luo Q, Du W, Li X, Zhang Z, et al. Cigarette smoking and schizophrenia independently and reversibly altered intrinsic brain activity. Brain Imaging and Behavior, 2018; 12(5):1457-65. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29297153

15. Scott JG, Matuschka L, Niemela S, Miettunen J, Emmerson B, et al. Evidence of a causal relationship between smoking tobacco and schizophrenia spectrum disorders. Frontiers in Psychiatry, 2018; 9:607. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30515111

16. US Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. Available from: http://www.surgeongeneral.gov/library/reports/50-years-of-progress/full-report.pdf.

17. Handel AE, Williamson AJ, Disanto G, Dobson R, Giovannoni G, et al. Smoking and multiple sclerosis: an updated meta-analysis. PLoS ONE, 2011; 6(1):e16149. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21249154

18. Jafari N and Hintzen RQ. The association between cigarette smoking and multiple sclerosis. Journal of the neurological sciences, 2011; 311(1):78-85. Available from: http://www.jns-journal.com/article/S0022-510X(11)00553-3/abstract

19. Di Pauli F, Reindl M, Ehling R, Schautzer F, Gneiss C, et al. Smoking is a risk factor for early conversion to clinically definite multiple sclerosis. Multiple Sclerosis, 2008; 14(8):1026-30. Available from: https://pubmed.ncbi.nlm.nih.gov/18632775/

20. Healy BC, Ali EN, Guttmann CR, Chitnis T, Glanz BI, et al. Smoking and disease progression in multiple sclerosis. Archives of Neurology, 2009; 66(7):858-64. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19597087

21. Pittas F, Ponsonby A, van der Mei I, Taylor B, Blizzard L, et al. Smoking is associated with progressive disease course and increased progression in clinical disability in a prospective cohort of people with multiple sclerosis. Journal of Neurology, 2009; 256(4):577-85. Available from: https://pubmed.ncbi.nlm.nih.gov/19365595/

22. Zivadinov R, Weinstock-Guttman B, Hashmi K, Abdelrahman N, Stosic M, et al. Smoking is associated with increased lesion volumes and brain atrophy in multiple sclerosis. Neurology, 2009; 73(7):504-10. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19687451

23. Aktan R, Ozalevli S, and Ozakbas S. Effects of cigarette smoking on respiratory problems and functional levels in multiple sclerosis patients. Multiple Sclerosis and Related Disorders, 2018; 25:271-5. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30153625

24. Graetz C, Groger A, Luessi F, Salmen A, Zoller D, et al. Association of smoking but not HLA-DRB1*15:01, APOE or body mass index with brain atrophy in early multiple sclerosis. Multiple Sclerosis, 2019; 25(5):661-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29532745

25. Heydarpour P, Manouchehrinia A, Beiki O, Mousavi SE, Abdolalizadeh A, et al. Smoking and worsening disability in multiple sclerosis: A meta-analysis. Acta Neurologica Scandinavica, 2018; 138(1):62-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29542102

26. Hedstrom AK. Smoking and disability progression in multiple sclerosis. Expert Review of Neurotherapeutics, 2020; 20(8):739-41. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32208034

27. Ivashynka A, Copetti M, Naldi P, D'Alfonso S, and Leone MA. The impact of lifetime alcohol and cigarette smoking loads on multiple sclerosis severity. Frontiers in Neurology, 2019; 10:866. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31456737

28. Cortese M, Munger KL, Martinez-Lapiscina EH, Barro C, Edan G, et al. Vitamin D, smoking, EBV, and long-term cognitive performance in MS: 11-year follow-up of BENEFIT. Neurology, 2020; 94(18):e1950-e60. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32300060

29. Jasielski P, Piedel F, Rocka A, Petit V, and Rejdak K. Smoking as a risk factor of onset and relapse of Multiple Sclerosis - a review. Neurologia i Neurochirurgia Polska, 2020; 54(3):243-51. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32285433

30. Smith KJ, Kapoor R, Hall SM, and Davies M. Electrically active axons degenerate when exposed to nitric oxide. Annals of Neurology, 2001; 49(4):470-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11310624

31. Rejdak K, Eikelenboom MJ, Petzold A, Thompson EJ, Stelmasiak Z, et al. CSF nitric oxide metabolites are associated with activity and progression of multiple sclerosis. Neurology, 2004; 63(8):1439-45. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15505162

32. Rosso M and Chitnis T. Association between cigarette smoking and multiple sclerosis: A review. JAMA Neurology, 2020; 77(2):245-53. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31841592

33. Marrie RA, Rudick R, Horwitz R, Cutter G, Tyry T, et al. Vascular comorbidity is associated with more rapid disability progression in multiple sclerosis. Neurology, 2010; 74(13):1041-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20350978

34. Alonso A, Logroscino G, and Hernan MA. Smoking and the risk of amyotrophic lateral sclerosis: a systematic review and meta-analysis. Journal of Neurology, Neurosurgery and Psychiatry, 2010; 81(11):1249-52. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20639382

35. Wang H, O'Reilly EJ, Weisskopf MG, Logroscino G, McCullough ML, et al. Smoking and risk of amyotrophic lateral sclerosis: a pooled analysis of 5 prospective cohorts. Archives of Neurology, 2011; 68(2):207-13. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21320987

36. Alonso A, Logroscino G, Jick SS, and Hernan MA. Association of smoking with amyotrophic lateral sclerosis risk and survival in men and women: a prospective study. BMC Neurology, 2010; 10(1):6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20074360

37. Opie-Martin S, Wootton RE, Budu-Aggrey A, Shatunov A, Jones AR, et al. Relationship between smoking and ALS: Mendelian randomisation interrogation of causality. Journal of Neurology, Neurosurgery and Psychiatry, 2020; 91(12):1312-5. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32848012

38. Zhan Y and Fang F. Smoking and amyotrophic lateral sclerosis: A mendelian randomization study. Annals of Neurology, 2019; 85(4):482-4. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30786056

39. Shargorodsky J, Curhan SG, Eavey R, and Curhan GC. A prospective study of cardiovascular risk factors and incident hearing loss in men. Laryngoscope, 2010; 120(9):1887-91. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20715090

40. Hu H, Sasaki N, Ogasawara T, Nagahama S, Akter S, et al. Smoking, smoking cessation, and the risk of hearing loss: Japan Epidemiology Collaboration on Occupational Health Study. Nicotine and Tobacco Research, 2019; 21(4):481-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29547985

41. Lin BM, Wang M, Stankovic KM, Eavey R, McKenna MJ, et al. Cigarette smoking, smoking cessation, and risk of hearing loss in women. American Journal of Medicine, 2020; 133(10):1180-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32387319

42. Patel S, Wooles N, and Martin T. A systematic review of the impact of cigarettes and electronic cigarettes in otology. Journal of Laryngology and Otology, 2020:1-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33272335

43. Lopez-Mesonero L, Marquez S, Parra P, Gamez-Leyva G, Munoz P, et al. Smoking as a precipitating factor for migraine: a survey in medical students. Journal of Headache and Pain, 2009; 10(2):101-3. Available from: https://pubmed.ncbi.nlm.nih.gov/19184325/

44. Straube A, Pfaffenrath V, Ladwig KH, Meisinger C, Hoffmann W, et al. Prevalence of chronic migraine and medication overuse headache in Germany--the German DMKG headache study. Cephalalgia, 2010; 30(2):207-13. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19489879

45. Hershey AD and Lipton RB. Lifestyles of the young and migrainous. Neurology, 2010; 75(8):680-1. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20720190

46. Johnsen MB, Winsvold BS, Borte S, Vie GA, Pedersen LM, et al. The causal role of smoking on the risk of headache. A Mendelian randomization analysis in the HUNT study. European Journal of Neurology, 2018; 25(9):1148-e102. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29747220

47. Dworetzky BA, Bromfield EB, Townsend MK, and Kang JH. A prospective study of smoking, caffeine, and alcohol as risk factors for seizures or epilepsy in young adult women: data from the Nurses' Health Study II. Epilepsia, 2010; 51(2):198-205. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19694796

48. Halmai R, Szijarto IA, Feher E, Fesus G, Molnar GA, et al. Cigarette smoke elicits relaxation of renal arteries. European Journal of Clinical Investigation, 2011; 41(2):195-202. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20955211

49. Yoon HJ, Park M, Yoon H, Son KY, Cho B, et al. The differential effect of cigarette smoking on glomerular filtration rate and proteinuria in an apparently healthy population. Hypertension Research, 2009; 32(3):214-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19262485

50. Yamagata K, Ishida K, Sairenchi T, Takahashi H, Ohba S, et al. Risk factors for chronic kidney disease in a community-based population: a 10-year follow-up study. Kidney International, 2007; 71(2):159-66. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17136030

51. Ito K, Maeda T, Tada K, Takahashi K, Yasuno T, et al. The role of cigarette smoking on new-onset of chronic kidney disease in a Japanese population without prior chronic kidney disease: Iki epidemiological study of atherosclerosis and chronic kidney disease (ISSA-CKD). Clinical and Experimental Nephrology, 2020; 24(10):919-26. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32577942

52. Jo W, Lee S, Joo YS, Nam KH, Yun HR, et al. Association of smoking with incident CKD risk in the general population: A community-based cohort study. PLoS ONE, 2020; 15(8):e0238111. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32853266

53. Choi HS, Han KD, Oh TR, Kim CS, Bae EH, et al. Smoking and risk of incident end-stage kidney disease in general population: A nationwide population-based cohort study from Korea. Scientific Reports, 2019; 9(1):19511. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31862942

54. Yacoub R, Habib H, Lahdo A, Al Ali R, Varjabedian L, et al. Association between smoking and chronic kidney disease: a case control study. BMC Public Health, 2010; 10(1):731. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21108832

55. Jones P, Karim Sulaiman S, Gamage KN, Tokas T, Jamnadass E, et al. Do lifestyle factors including smoking, alcohol, and exercise impact your risk of developing kidney stone disease? Outcomes of a systematic review. Journal of Endourology, 2021; 35(1):1-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32808537

56. Lee YH. Assessing the causal association between smoking behavior and risk of gout using a Mendelian randomization study. Clinical Rheumatology, 2018; 37(11):3099-105. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30003442

57. Langsted A and Nordestgaard BG. Smoking is associated with increased risk of major bleeding: a prospective cohort study. Thrombosis and Haemostasis, 2019; 119(1):39-47. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30597498

58. Kawahara T, Ito H, Yao M, and Uemura H. Impact of smoking habit on overactive bladder symptoms and incontinence in women. International Journal of Urology, 2020; 27(12):1078-86. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32875688