Association of urinary cotinine-verified smoking status with hyperuricemia: Analysis of population-based nationally representative data
Yunkyung Kim 1,   Jihun Kang 2, 3  
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Department of Rheumatology, Kosin University Gospel Hospital, Kosin University, Busan, Republic of Korea
Department of Family Medicine, Kosin University Gospel Hospital, Kosin University, Busan, Republic of Korea
Central Institute for Medical Research, Kosin University Gospel Hospital, Busan, Republic of Korea
Jihun Kang   

Department of Family Medicine, Kosin University Gospel Hospital, Kosin University, 262, Gamcheon-ro, Seo-gu, Busan 49267, Republic of Korea
Publication date: 2020-10-06
Tob. Induc. Dis. 2020;18(October):84
Smoking status based solely on self-reporting is unreliable and might be inaccurate, particularly among women. This study investigated the association between urinary cotinine-verified smoking status and hyperuricemia in a nationwide Korean population.

This study included 5,329 participants aged ≥19 years with information on smoking status, urine cotinine levels and serum uric acid. We determined smoking status according to self-reports and urinary cotinine levels. Multivariate linear regression analysis was used to measure the association between smoking exposure and serum uric acid levels. The effects of smoking on hyperuricemia were evaluated by multivariate logistic regression analysis.

Biochemically-verified active and passive smokers comprised 22% (38.7% of men and 8.8% of women) and 12.3% (11.9% of men and 12.6% of women) of the study population, respectively. While reclassification rate of active smokers was 1.4% in men, 31.8% of cotinine-verified female active smokers were self-reported never smokers. Higher uric acid levels were observed with increased tobacco exposure among women (P trend = 0.007) but not among men. After adjusting for confounders, the risk of hyperuricemia increased with tobacco exposure only in women (P trend = 0.016).

Cotinine-verified smoking status was associated with increased serum uric acid and hyperuricemia in a dose-response manner only in women. This study might provide evidence to support the importance of smoking cessation in women with gout and further studies are necessary to elucidate the underlying mechanism of the observed association.

The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MEST) (No. 2019R1G1A1099627). This study was also supported by a grant from Kosin University College of Medicine (Kosin-19-01).
YK conceived and designed the study, collected, analyzed, and interpreted the data and wrote and revised the report. JK conceived and designed the study, collected, analyzed, and interpreted the data, and provided important intellectual context and critical revisions for the manuscript. Both authors have approved the final version for publication and accepted the responsibility for the accuracy and integrity of the data and analysis. A STROBE statement with a checklist of items that should be included in reports of cross-sectional studies has been included in the Supplementary file.
Not commissioned; externally peer reviewed.
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