Marja Lisa Byhamre1, Marzieh Araghi2, Lars Alfredsson3, Rino Bellocco4,5, Gunnar Engström6, Marie Eriksson7, Maria Rosaria Galanti2,8, Jan-Håkan Jansson9, Anton Lager2,8, Michael Lundberg2, Per-Olof Östergren10, Nancy L Pedersen4, Ylva Trolle Lagerros11,12, Weimin Ye4, Patrik Wennberg1, Cecilia Magnusson2,8. 1. Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden. 2. Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. 3. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. 4. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. 5. Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy. 6. Department of Clinical Sciences, Lund University, Malmö, Sweden. 7. Department of Statistics, Umeå School of Business, Economics, and Statistics, Umeå University, Umeå, Sweden. 8. Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden. 9. Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, Skellefteå, Sweden. 10. Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden. 11. Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden. 12. Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden.
Abstract
BACKGROUND: The health consequences of the use of Swedish snus, including its relationship with mortality, have not been fully established. We investigated the relationship between snus use and all-cause and cause-specific mortality (death due to cardiovascular diseases, cancer diseases and all other reasons, respectively) in a nationwide collaborative pooling project. METHODS: We followed 169 103 never-smoking men from eight Swedish cohort studies, recruited in 1978-2010. Shared frailty models with random effects at the study level were used in order to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of mortality associated with snus use. RESULTS: Exclusive current snus users had an increased risk of all-cause mortality (aHR 1.28, 95% CI 1.20-1.35), cardiovascular mortality (aHR 1.27, 95% CI 1.15-1.41) and other cause mortality (aHR 1.37, 95% CI 1.24-1.52) compared with never-users of tobacco. The risk of cancer mortality was also increased (aHR 1.12, 95% CI 1.00-1.26). These mortality risks increased with duration of snus use, but not with weekly amount. CONCLUSIONS: Snus use among men is associated with increased all-cause mortality, cardiovascular mortality, with death from other causes and possibly with increased cancer mortality.
BACKGROUND: The health consequences of the use of Swedish snus, including its relationship with mortality, have not been fully established. We investigated the relationship between snus use and all-cause and cause-specific mortality (death due to cardiovascular diseases, cancer diseases and all other reasons, respectively) in a nationwide collaborative pooling project. METHODS: We followed 169 103 never-smoking men from eight Swedish cohort studies, recruited in 1978-2010. Shared frailty models with random effects at the study level were used in order to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of mortality associated with snus use. RESULTS: Exclusive current snus users had an increased risk of all-cause mortality (aHR 1.28, 95% CI 1.20-1.35), cardiovascular mortality (aHR 1.27, 95% CI 1.15-1.41) and other cause mortality (aHR 1.37, 95% CI 1.24-1.52) compared with never-users of tobacco. The risk of cancer mortality was also increased (aHR 1.12, 95% CI 1.00-1.26). These mortality risks increased with duration of snus use, but not with weekly amount. CONCLUSIONS: Snus use among men is associated with increased all-cause mortality, cardiovascular mortality, with death from other causes and possibly with increased cancer mortality.
Authors: M Eriksson; L Holmgren; U Janlert; J-H Jansson; D Lundblad; B Stegmayr; S Söderberg; M Eliasson Journal: J Intern Med Date: 2010-12-15 Impact factor: 8.989