Tobacco smoke exposure and spine fracture risk in US adults: A cross-sectional analysis of the National Health and Nutrition Examination Survey 1999-2010, 2013-2014, 2017-2020
Abstract
Introduction: While tobacco smoke is an established risk factor for multiple pathological conditions, its specific relationship with spine fracture remains inadequately characterized in the scientific literature. This study was designed to assess the potential link between tobacco smoke exposure and spine fracture prevalence among US adults, and to investigate the presence of a dose-response gradient.
Methods: We performed an analytical cross-sectional study utilizing data from the National Health and Nutrition Examination Survey (NHANES) 1999-2010, 2013-2014, 2017-2020. Serum cotinine concentrations were employed as an objective biomarker for tobacco smoke exposure. Multivariable logistic regression models were constructed to quantify the association between smoke exposure and a diagnosis of spine fracture. We performed a rigorous evaluation of the association's consistency through subgroup stratification. Further, we characterized the dose-response relationship using restricted cubic splines (RCS) with threshold effect analysis to detect possible non-linear patterns.
Results: Our final analytical cohort included 31124 eligible participants. After comprehensive covariate adjustment, multivariable analysis revealed a significant positive correlation between tobacco smoke exposure and spine fracture risk. When treated as a continuous variable, a significant positive linear dose-response relationship was observed: the natural log-transformed cotinine concentration maintained a…
How strong is the evidence?
Evidence Hub reads this as a cross-sectional, done in people. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause. Reported size: 31,124 participants or records.
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