Decreased cigarette smoking may partially explain the increased prevalence of antinuclear antibodies in the United States
Abstract
Introduction: Despite well-known harmful health effects of smoking, research supports an inverse association with some autoimmune diseases. High-titer antinuclear antibodies (ANA) are associated with autoimmune diseases, and ANA prevalence in the US increased between 1988 and 2012. Tobacco smoking decreased during those years while vaping of electronic cigarettes (e-cigarettes) increased after their introduction in 2007. Carbon monoxide (CO) may ameliorate autoimmunity, and e-cigarettes deliver much less CO than regular cigarettes. We explored interdependencies among ANA, smoking, and time. Methods: We analyzed cross-sectional data on ANA and the primary nicotine metabolite, cotinine, in 13,288 participants ≥12 years old from three time periods (1988-1991, 1999-2004, 2011-2012) of the US National Health and Nutrition Examination Survey. Smoking exposure (none, passive, active) was inferred from serum cotinine. We used logistic regression to analyze ANA prevalence, adjusted for sex, age, and race/ethnicity. Results: Over the study periods, ANA prevalence was highest (13.3-19.2%) for nonsmokers but non-trending; lower (11.1-15.5%) for "passive" smokers but steadily increasing; and even lower for active smokers but increasing from 7.4% in 1999-2004 to 13.3% in 2011-2012. The increases in ANA among passive and active smokers were mainly in adolescents (ages 12-19 years). Smokers had reduced odds of ANA in 1999-2004, with an odds ratio (OR) of 0.65 and a 95% confidence interval…
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