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Last updated: February 2024
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; 2024. Available from https://www.tobaccoinaustralia.org.au/chapter-3-health-effects/3-18-other-conditions-with-possible-links-to-smoking
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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.3 Smokers are more likely than non-smokers to have anxiety,4 depression,4-8 , bipolar disorder,9 bruxism (teeth clenching and grinding),10 panic attacks,11,12 suicide attempts,4 ,13 symptoms of psychosis8 and schizophrenia.14-16
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 is an autoimmune disease of the central nervous system. For information about the relationship between smoking and multiple sclerosis, see section 3.17.7.
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.17 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.18 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.19 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.20,21
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.22 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.23 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.24 A 2020 systematic review found that smoking sensorineural hearing loss that is more pronounced in the long term and at high frequencies.25 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 migraine26,27 and smokers may be at increased risk of developing cranial autonomic symptoms (for example, facial sweating) during an attack.28 However, there is some doubt as to whether smoking is a cause of migraines.29
An analysis of the Nurses’ Health Study II in the US reported an increased risk of seizures associated with smoking.30
3.18.3 Kidney disease
Smoking has physiological effects on the kidneys. It has been reported to increase the glomerular filtration rate,31,32 possibly by relaxing renal arteries.31 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.33 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.34 Similar results were found in a Korean study.35 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.36 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.36
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.37 A systematic review that included nine studies of smokers found that smokers were more likely to get kidney stone disease than non-smokers.38
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.39
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.40
A study from Japan has found that women who are current or ex-smokers are more likely to suffer from overactive bladder.41
Relevant news and research
For recent news items and research on this topic, click here. ( Last updated March 2024)
References
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20. 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
21. 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
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41. 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