Effects of smoking on disease risk among South Korean adults
Youngmee Kim 1
More details
Hide details
Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea
Department of Pulmonology and Critical Care Medicine, International Health Care Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Won-Kyung Cho   

Department of Pulmonology and Critical Care Medicine, International Health Care Center, Asan Medical Center, University of Ulsan College of Medicine 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
Publish date: 2018-10-02
Tob. Induc. Dis. 2018;16(October):45
Tobacco smoking is currently considered to be the main preventable cause of death and disability worldwide. We examined the magnitude of cigarette smoking effects on major smoking-related diseases, such as chronic obstructive pulmonary disease (COPD), hypertension (HTN) and cardiovascular disease (CVD), among South Korean adults using nationwide and representative survey data.

We used data from the Korea National Health and Nutrition Examination Survey, which was conducted over a 9-year period from 2007 to 2015 by the Korea Centers for Disease Control and Prevention. Multiple logistic regression analyses were performed to assess the associations between smoking status and all outcomes of interest. A total of 24072 participants ≥40 years of age were sampled in the current study.

The study results were as follows: 1) Current and former smoking is associated with lower socioeconomic status; 2) The prevalence of major smoking-related diseases was significantly higher in former and current smokers compared to non-smokers; 3) The odd ratios of developing COPD were 3.49 [95% confidence interval (CI): 2.44–5.00], 2.41 (95% CI: 1.68–3.45) and 3.45 (95% CI: 2.20–5.40) among male current smokers, male ex-smokers and female current smokers, respectively. The odd ratio of developing CVD was 2.01 (95% CI: 1.05–3.86) in male ex-smokers. Otherwise, no significant associations between smoking and other diseases were observed after controlling the sociodemographic and clinical factors; and 4) The risk for COPD tends to be related to the smoking amount and weaning after quitting smoking.

Our study showed that COPD had the strongest association with current and former smoking in both male and female smokers after controlling for all potential confounding factors among major smoking-related diseases.

Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ. 2004;328:1519. doi:10.1136/bmj.38142.554479.AE
U.S. Department of Health and Human Services. The health consequences of smoking-50 years of progress. Published, 2014. Accessed January 7, 2018.
Gilkes A, Ashworth M, Schofield P, et al. Does COPD risk vary by ethnicity? A retrospective cross-sectional study. Int J Chron Obstruct Pulmon Dis. 2016;11:739-746. doi:10.2147/COPD.S96391
Martin A, Badrick E, Mathur R, Hull S. Effect of ethnicity on the prevalence, severity, and management of COPD in general practice. Br J Gen Pract. 2012;62:e76-81. doi:10.3399/bjgp12X625120
USDHHS. Tobacco Use Among U.S. Racial/Ethnic Minority Groups - African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanics: A report of the Surgeon General. Washington, DC: U.S. Government Printing Office; 1998.
Korea Centers for Disease Control and Prevention (KCDC). The work-shop report and guide to the utilization of the data from the Korea National Health and Nutrition Examination Survey. Published, 2017. Accessed January 7, 2018.
Centers for Disease Control and Prevention. National Health Interview Survey. Accessed January 7, 2018.
Pomerleau CS, Pomerleau OF, Snedecor SM, Mehringer AM. Defining a never-smoker: results from the nonsmokers survey. Addict Behav. 2004;29:1149-1154. doi:10.1016/j.addbeh.2004.03.008
Vestbo J, Hurd SS, Agustí AG, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2013;187:347-365. doi:10.1164/rccm.201204-0596PP
Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med. 2001;33:337-343.
World Health Organization. Global Health Observatory data respository. Tobacco use. Data by country. Published, 2015. Accessed January 7, 2018.
Barbeau EM, Krieger N, Soobader MJ. Working class matters: socioeconomic disadvantage, race/ethnicity, gender, and smoking in NHIS 2000. Am J Public Health. 2004;94:269-278.
Silverman EK, Weiss ST, Drazen JM, et al. Gender-related differences in severe, early-onset chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2000;162:2152-2158. doi:10.1164/ajrccm.162.6.2003112
Peters SA, Huxley RR, Woodward M. Do smoking habits differ between women and men in contemporary Western populations? Evidence from half a million people in the UK Biobank study. BMJ Open. 2014;4:e005663. doi:10.1136/bmjopen-2014-005663
Huxley RR, Woodward M. Cigarette smoking as a risk factor for coronary heart disease in women compared with men: a systematic review and meta-analysis of prospective cohort studies. Lancet. 2011;378:1297-1305. doi:10.1016/S0140-6736(11)60781-2
Huxley R, Jamrozik K, Lam T, et al. Impact of smoking and smoking cessation on lung cancer mortality in the Asia-Pacific region. Am J Epidemiol. 2007;165:1280-1286. doi:10.1093/aje/kwm002
Qaseem A, Wilt TJ, Weinberger SE, et al. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society. Ann Intern Med. 2011;155:179-191. doi:10.7326/0003-4819-155-3-201108020-00008
Anthonisen NR, Skeans MA, Wise RA, Manfreda J, Kanner R, Connett J. The effects of a smoking cessation intervention on 14.5-year mortality: a randomized clinical trial. Ann Intern Med. 2005;142:233-239. doi:10.7326/0003-4819-142-4-200502150-00005
Ahmed, AA, Patel K, Nyaku MA, et al. Risk of Heart Failure and Death After Prolonged Smoking Cessation: Role of Amount and Duration of Prior Smoking. Circ Heart Fail. 2015;8:694-701. doi:10.1161/CIRCHEARTFAILURE.114.001885
International Agency for Research on Cancer. Tobacco Control: Reversal of Risk After Quitting Smoking. Vol 11. IARC Handbooks of Cancer Prevention: 2007.
Rennard SI, Vestbo J. COPD: the dangerous underestimate of 15%. Lancet. 2006; 367:1216-1219. doi:10.1016/S0140-6736(06)68516-4
Ito K, Barnes PJ. COPD as a disease of accelerated lung aging. Chest. 2009;135: 173-180. doi:10.1378/chest.08-1419
Caraballo RS, Giovino GA, Pechacek TF, et al. Racial and ethnic differences in serum cotinine levels of cigarette smokers: Third National Health and Nutrition Examination Survey, 1988-1991. JAMA. 1998;280:135-139. doi:10.1001/jama.280.2.135
Wagenknecht LE, Cutter GR, Haley NJ, et al. Racial differences in serum cotinine levels among smokers in the Coronary Artery Risk Development in (Young) Adults study. Am J Public Health. 1990;80:1053-1056. doi:10.2105/ajph.80.9.1053
Perez-Stable EJ, Herrera B, Jacob P 3rd, Benowitz NL. Nicotine metabolism and intake in black and white smokers. JAMA. 1998;280:152-156. doi:10.1001/jama.280.2.152
Smith-Warner SA, Spiegelman D, Yaun SS, et al. Fruits, vegetables and lung cancer: a pooled analysis of cohort studies. Int J Cancer. 2003;107:1001-1011. doi:10.1002/ijc.11490