Table 4.
Adjusted cross-sectional dose-response relationships between smoking and the risk of vasomotor symptoms at baseline (n=14,709; data from ALSWH, SWAN and WHITEHALL)
| VMS (hot flushes and night sweats) (%) |
Model 1 RRR (95% CI) |
Model 2 RRR (95% CI) |
|||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| n | Never | Rarely/Mild | Sometimes/Moderate | Often/Severe | Rarely/Mild | Sometimes/Moderate | Often/Severe | Rarely/Mild | Sometimes/Moderate | Often/Severe | |
| Smoking status (n=14,709) | |||||||||||
| Never smoker | 8259 | 46.3 | 19.4 | 20.9 | 13.4 | – | – | – | – | – | – |
| Former smoker | 4011 | 44.0 | 18.7 | 22.4 | 14.9 | 1.00 (0.94–1.06) | 1.11 (0.98–1.25) | 1.13 (0.98–1.30) | 1.00 (0.99–1.02) | 1.13 (1.06–1.20) | 1.12 (0.98–1.28) |
| Current smoker | 2439 | 36.6 | 18.9 | 24.6 | 19.9 | 1.19 (1.16–1.21) | 1.38 (1.08–1.77) | 1.66 (1.39–1.98) | 1.18 (1.15–1.21) | 1.35 (1.17–1.55) | 1.58 (1.51–1.65) |
| Intensity of smoking (n=14,442) | |||||||||||
| Never smoker | 8259 | 46.3 | 19.4 | 20.9 | 13.4 | – | – | – | – | – | – |
| Former smoker | 4011 | 44.0 | 18.7 | 22.4 | 14.9 | 1.00 (0.94–1.05) | 1.11 (0.98–1.25) | 1.13 (0.98–1.30) | 1.01 (0.99–1.02) | 1.13 (1.06–1.21) | 1.12 (0.98–1.28) |
| Current smoker 1–9 cigarettes/day | 362 | 43.7 | 22.4 | 18.8 | 15.2 | 1.15 (0.96–1.38) | 0.92 (0.69–1.23) | 1.11 (0.76–1.63) | 1.08 (1.07–1.08) | 1.13 (0.77–1.67) | 1.17 (0.94–1.45) |
| Current smoker 10–19 cigarettes/day | 675 | 39.6 | 18.1 | 23.7 | 18.7 | 1.04 (0.76–1.43) | 1.20 (0.88–1.65) | 1.41 (1.00–1.97) | 1.01 (0.77–1.33) | 1.19 (0.93–1.52) | 1.33 (1.04–1.70) |
| Current smoker ≥20 cigarettes/day | 1135 | 32.2 | 18.0 | 27.7 | 22.2 | 1.27 (1.05–1.52) | 1.71 (1.31–2.23) | 2.02 (1.65–2.47) | 1.29 (1.11–1.49) | 1.58 (1.47–1.70) | 1.87 (1.75–1.99) |
| Duration of smoking (n=14,684) | |||||||||||
| Never smoker | 8259 | 46.3 | 19.4 | 20.9 | 13.4 | – | – | – | – | – | – |
| Former smoker | 4011 | 44.0 | 18.7 | 22.4 | 14.9 | 1.00 (0.94–1.05) | 1.11 (0.98–1.25) | 1.13 (0.98–1.30) | 1.01 (0.99–1.02) | 1.13 (1.06–1.21) | 1.12 (0.98–1.28) |
| Current smoker duration <20 years | 103 | 42.7 | 17.5 | 18.5 | 21.4 | 0.93 (0.64–1.35) | 0.90 (0.47–1.71) | 1.57 (1.35–1.82) | 0.93 (0.64–1.34) | 0.84 (0.47–1.48) | 1.45 (1.17–1.79) |
| Current smoker duration 20–29 years | 566 | 44.7 | 17.0 | 23.0 | 15.4 | 0.91 (0.64–1.32) | 1.15 (1.00–1.31) | 1.22 (1.01–1.46) | 0.92 (0.66–1.30) | 1.17 (1.11–1.23) | 1.22 (0.99–1.49) |
| Current smoker duration ≥30 years | 1745 | 33.5 | 19.5 | 25.6 | 21.4 | 1.32 (1.11–1.56) | 1.52 (1.10–2.11) | 1.85 (1.40–2.44) | 1.30 (1.12–1.50) | 1.46 (1.19–1.80) | 1.74 (1.49–2.03) |
| Cumulative dose of smoking (n=14,431) | |||||||||||
| Never smoker | 8259 | 46.3 | 19.4 | 20.9 | 13.4 | – | – | – | – | – | – |
| Former smoker | 4011 | 44.0 | 18.7 | 22.4 | 14.9 | 1.00 (0.94–1.05) | 1.11 (0.98–1.25) | 1.13 (0.98–1.30) | 1.01 (1.00–1.02) | 1.13 (1.06–1.21) | 1.12 (0.98–1.28) |
| Current smoker <10 pack-years | 285 | 44.2 | 21.1 | 16.8 | 17.9 | 1.10 (0.85–1.42) | 0.83 (0.59–1.17) | 1.35 (1.01–1.80) | 1.03 (0.82–1.30) | 1.01 (0.67–1.53) | 1.44 (1.20–1.72) |
| Current smoker 10–19 pack-years | 431 | 40.1 | 20.0 | 22.3 | 17.6 | 1.11 (0.84–1.46) | 1.12 (0.84–1.48) | 1.31 (1.14–1.51) | 1.05 (0.89–1.23) | 1.13 (0.90–1.44) | 1.23 (1.15–1.32) |
| Current smoker 20–29 pack-years | 436 | 40.1 | 16.5 | 26.8 | 16.5 | 0.96 (0.76–1.22) | 1.40 (0.99–1.97) | 1.30 (0.98–1.72) | 0.97 (0.76–1.22) | 1.39 (1.10–1.76) | 1.26 (1.00–1.60) |
| Current smoker 30–39 pack-years | 493 | 32.9 | 19.9 | 26.6 | 20.7 | 1.35 (1.18–1.54) | 1.59 (1.25–2.01) | 1.77 (1.18–2.68) | 1.35 (1.15–1.59) | 1.54 (1.40–1.69) | 1.69 (1.19–2.42) |
| Current smoker ≥40 pack-years | 516 | 28.5 | 17.3 | 28.7 | 25.6 | 1.36 (1.27–1.47) | 1.95 (1.22–3.12) | 2.55 (2.05–3.16) | 1.39 (1.28–1.51) | 1.68 (1.35–2.09) | 2.21 (2.06–2.37) |
| Age initiated smoking (n=14,543) | |||||||||||
| Never smoker | 8259 | 46.3 | 19.4 | 20.9 | 13.4 | – | – | – | – | – | – |
| Former smoker initiated at ≥20 years | 854 | 44.7 | 19.2 | 20.7 | 15.3 | 1.00 (0.78–1.28) | 1.00 (0.87–1.16) | 1.12 (0.91–1.37) | 1.04 (0.86–1.26) | 1.06 (0.98–1.15) | 1.17 (1.07–1.28) |
| Former smoker initiated at 16–19 years | 2149 | 45.5 | 19.3 | 21.3 | 14.0 | 1.00 (0.93–1.08) | 1.03 (0.91–1.16) | 1.04 (0.87–1.25) | 1.01 (0.98–1.05) | 1.05 (0.96–1.15) | 1.06 (0.86–1.30) |
| Former smoker initiated at ≤15 years | 882 | 39.3 | 17.2 | 26.4 | 17.0 | 1.01 (0.81–1.26) | 1.42 (1.17–1.72) | 1.38 (1.19–1.60) | 0.98 (0.80–1.20) | 1.41 (1.21–1.64) | 1.29 (1.15–1.46) |
| Current smoker initiated at ≥20 years | 605 | 40.0 | 17.9 | 22.3 | 19.8 | 1.00 (0.80–1.26) | 1.13 (0.92–1.39) | 1.48 (1.35–1.61) | 1.00 (0.78–1.28) | 1.11 (1.00–1.22) | 1.43 (1.35–1.50) |
| Current smoker initiated at 16–19 years | 1124 | 37.5 | 19.8 | 25.8 | 16.9 | 1.22 (1.12–1.32) | 1.42 (1.16–1.73) | 1.40 (1.21–1.62) | 1.23 (1.11–1.36) | 1.38 (1.27–1.50) | 1.37 (1.32–1.42) |
| Current smoker initiated at ≤15 years | 670 | 31.6 | 17.8 | 25.4 | 25.2 | 1.29 (1.17–1.42) | 1.63 (1.09–2.45) | 2.41 (1.81–3.20) | 1.25 (1.22–1.28) | 1.57 (1.14–2.17) | 2.19 (1.88–2.54) |
| Age at quitting smoking (n=10,034)a | |||||||||||
| Never smoker | 5800 | 42.5 | 16.7 | 26.0 | 14.8 | – | – | – | – | – | – |
| Current smoker | 1764 | 33.5 | 16.5 | 28.6 | 21.5 | 1.19 (1.02–1.40) | 1.26 (1.10–1.45) | 1.58 (1.35–1.85) | 1.19 (1.01–1.39) | 1.26 (1.10–1.45) | 1.54 (1.31–1.81) |
| Former smoker quit at <30 years | 807 | 46.1 | 15.0 | 25.5 | 13.4 | 0.85 (0.69–1.06) | 0.95 (0.79–1.15) | 0.91 (0.71–1.15) | 0.85 (0.68–1.06) | 0.96 (0.80–1.16) | 0.90 (0.71–1.15) |
| Former smoker quit at 30–39 years | 834 | 40.3 | 17.6 | 28.4 | 13.7 | 1.11 (0.90–1.37) | 1.14 (0.95–1.37) | 0.97 (0.77–1.22) | 1.10 (0.89–1.35) | 1.13 (0.94–1.36) | 0.94 (0.74–1.18) |
| Former smoker quit at ≥40 years | 829 | 32.7 | 16.2 | 31.1 | 20.0 | 1.18 (0.94–1.47) | 1.40 (1.16–1.68) | 1.50 (1.21–1.86) | 1.14 (0.91–1.43) | 1.34 (1.11–1.62) | 1.37 (1.10–1.71) |
| Years since quitting smoking (n=10,031)a | |||||||||||
| Never smoker | 5800 | 42.5 | 16.7 | 26.0 | 14.8 | – | – | – | – | – | – |
| Current smoker | 1764 | 33.5 | 16.5 | 28.6 | 21.5 | 1.19 (1.02–1.40) | 1.26 (1.10–1.45) | 1.58 (1.35–1.85) | 1.18 (1.01–1.39) | 1.26 (1.10–1.45) | 1.54 (1.31–1.81) |
| Former smoker quit 1–5 years | 445 | 31.2 | 14.8 | 33.7 | 20.2 | 1.11 (0.82–1.51) | 1.54 (1.21–1.97) | 1.52 (1.14–2.03) | 1.06 (0.78–1.44) | 1.47 (1.15–1.88) | 1.37 (1.03–1.83) |
| Former smoker quit 6–14 years | 739 | 37.5 | 18.1 | 28.2 | 16.2 | 1.22 (0.98–1.53) | 1.20 (0.99–1.46) | 1.21 (0.96–1.53) | 1.20 (0.96–1.50) | 1.17 (0.96–1.43) | 1.14 (0.90–1.45) |
| Former smoker quit 15–19 years | 450 | 42.2 | 15.8 | 29.3 | 12.7 | 0.96 (0.73–1.28) | 1.17 (0.92–1.48) | 0.91 (0.66–1.25) | 0.96 (0.72–1.28) | 1.18 (0.93–1.50) | 0.89 (0.65–1.23) |
| Former smoker quit ≥20 years | 833 | 44.8 | 15.6 | 25.2 | 14.4 | 0.90 (0.72–1.11) | 0.93 (0.77–1.12) | 0.94 (0.75–1.19) | 0.89 (0.72–1.10) | 0.94 (0.78–1.13) | 0.93 (0.74–1.17) |
Data are presented as percentage (%) or relative risk ratio (RRR) and their 95% confidence intervals (95% CI) using multinomial logistic regression with a generalised logit link. SURVEYLOGISTIC procedure in SAS was used to incorporate the study cluster into the analyses.
Model 1 included menopausal status and use of menopausal hormone therapy at baseline.
Model 2 additionally included race/ethnicity/region, education, and BMI at baseline.
ALSWH, Australian Longitudinal Study on Women’s Health; SWAN, Study of Women’s Health Across the Nation; WHITEHALL, Whitehall II Study.
a
The analysis was only based on data from the ALSWH study.