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a Department of
Medicine, Faculty of Medicine and Health Science, University of
Auckland, Auckland, New Zealand, b Department of Community
Health
Correspondence to: Ruth Bonita, University Geriatric Unit, North Shore Hospital, Private Bag 93-503, Takapuna, Auckland 9, New Zealand; r.bonita{at}auckland.ac.nz
Received 29 May 1998 and in revised form 18 February 1999;
Accepted 10 March
1999.
OBJECTIVE
To estimate
the relative risk of stroke associated with exposure to environmental
tobacco smoke (ETS, passive smoking) and to estimate the risk of stroke
associated with current smoking (active smoking) using the traditional
baseline group (never-smokers) and a baseline group that includes
lifelong non-smokers and long-term (>10 years) ex-smokers who have not
been exposed to ETS.
DESIGN AND
SETTINGPopulation-based case-control study in
residents of Auckland, New Zealand.
SUBJECTSCases were
obtained from the Auckland stroke study, a population-based register of
acute stroke. Controls were obtained from a cross-sectional survey of
major cardiovascular risk factors measured in the same population. A
standard questionaire was administered to patients and controls by
trained nurse interviewers.
RESULTSInformation
was available for 521 patients with first-ever acute stroke and 1851 community controls aged 35-74 years. After adjusting for potential
confounders (age, sex, history of hypertension, heart disease, and
diabetes) using logistic regression, exposure to ETS among non-smokers
and long-term ex-smokers was associated with a significantly increased
risk of stroke (odds ratio (OR) = 1.82; 95% confidence interval (95%
CI) = 1.34 to 2.49). The risk was significant in men (OR = 2.10; 95%
CI = 1.33 to 3.32) and women (OR = 1.66; 95% CI = 1.07 to 2.57).
Active smokers had a fourfold risk of stroke compared with people who
reported they had never smoked cigarettes (OR = 4.14; 95% CI = 3.04 to 5.63); the risk increased when active smokers were compared with
people who had never smoked or had quit smoking more than 10 years
earlier and who were not exposed to ETS (OR = 6.33; 95% CI = 4.50 to
8.91).
CONCLUSIONSThis study
is one of the few to investigate the association between passive
smoking and the risk of acute stroke. We found a significantly
increased risk of stroke in men and in women. This study also confirms
the higher risk of stroke in men and women who smoke cigarettes
compared with non-smokers. The stroke risk increases further when those
who have been exposed to ETS are excluded from the non-smoking
reference group. These findings also suggest that studies investigating
the adverse effects of smoking will underestimate the risk if exposure
to ETS is not taken into account.
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