ORIGINAL ARTICLE
Effects of cigaree smoking on rhinologic diseases: Korean National Health and Nutrition Examination Survey 2008-2011 Woo Hyun Lee, MD1 , Seung-No Hong, MD2 , Hong Joong Kim, MD2 , Soyeon Ahn, PhD3 , Chae-Seo Rhee, MD2 , Chul Hee Lee, MD2 and Jeong-Whun Kim, MD2
Background: Several studies have shown a relationship between cigaree smoking and general diseases of the nose in a large Asian population. The current study was conducted to beer understand the effect of cigaree smoke exposure on rhinologic diseases in Koreans. Methods: Data were obtained from the 2008-2011 Korea National Health and Nutrition Examination Survey, a cross-sectional survey of the noninstitutionalized population in Korea. Of the 37,753 people surveyed, 11,589 adult participants had completed questionnaires on rhinologic symptoms and smoking behaviors, had undergone nasal endoscopy, and had provided urine collection were enrolled. Rhinologic diseases investigated in this study included subjective olfactory dysfunction, rhinitis symptoms, chronic rhinosinusitis (CRS), and nasal septal deviation with obstructive symptoms. The relationship between disease and cigaree smoking was evaluated using multivariate regression analyses. Results: In South Korea, the weighted prevalence of subjective olfactory dysfunction, rhinitis symptoms, CRS, and nasal septal deviation with obstructive symptoms was 4.6%, 27.2%, 6.2%, and 4.0%, respectively. The only disease signif-
T
he hazardous health effects of smoking are widely accepted, but a large number of people still smoke. Most
1 Department
of Otolaryngology, National Police Hospital, Seoul, South Korea; 2 Department of Otorhinolaryngology–Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea; 3 Medical Research Collaborating Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea Correspondence to: Jeong-Whun Kim, MD, PhD, Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 464-707, South Korea; e-mail: [email protected]; [email protected] Potential conflict of interest: None provided. Received: 26 January 2015; Revised: 14 April 2015; Accepted: 17 April 2015 DOI: 10.1002/alr.21553 View this article online at wileyonlinelibrary.com.
937
International Forum of Allergy & Rhinology, Vol. 5, No. 10, October 2015
icantly associated with active smoking was CRS in participants 40 years of age and older aer adjusting for age, sex, residency, house income, education, and occupation (adjusted odds ratio = 1.427, 95% confidence interval = 1.050 to 1.938). For each year of active smoking, CRS prevalence increased by 1.5%. None of the rhinologic diseases examined were associated with passive smoking. Conclusion: Our study showed that CRS seems to be associated with active smoking in older participants. Considering the relatively high prevalence of CRS in Korea, further longitudinal researches for their association and preC 2015 ARS-AAOA, LLC. vention are required.
Key Words: smoking; olfaction disorders; rhinitis; sinusitis; nasal septal deviation; health survey
How to Cite this Article: Lee WH, Hong SN, Kim HJ, et al. Effects of cigaree smoking on rhinologic diseases: Korean National Health and Nutrition Examination Survey 2008-2011. Int Forum Allergy Rhinol. 2015;5:937–943.
scientific evidence on the effects of smoking on the sinonasal tract has been shown in Western populations. From these studies, the association between cigarette smoke and numerous serious health problems, particularly of the respiratory system, is obvious. The prevalence of lung cancer and chronic obstructive pulmonary disease increases with the amount of smoking amount,1 and cigarette smoke exposure is as a known risk factor for asthma.2 The harmful effects of cigarette smoke on the upper airway are also well known, but the literature has been inconclusive on the association between cigarette smoke exposure and rhinologic disease. Some studies have reported an association between smoking and abnormal olfactory function, sinusitis, and rhinitis,3, 4 but other studies have reported no effect,5 or even a protective effect6 on olfaction and rhinitis. Although rhinologic diseases are generally not lifethreatening, they cause a socioeconomic burden from the
Lee et al.
relatively high cost of treatment because so many people suffer from them. Scientific evidence is needed to establish a health policy and to educate patients on the deleterious effects of smoking on the sinonasal tract. However, studies showing the relationship between smoking and rhinologic diseases (eg, olfactory dysfunction, rhinitis, chronic rhinosinusitis [CRS], and nasal septal deviation with obstructive symptoms) are lacking in East Asian populations. The current study was conducted to identify the effects of smoking on rhinologic diseases in a large population representing the whole nation of South Korea. Data were obtained from the Korean National Health and Nutrition Examination Survey (KNHANES), a governmentdriven survey performed by the Korea Center for Disease Control and Prevention (KCDC). The current study was performed in collaboration with the Korean Society of Otorhinolaryngology–Head and Neck Surgery.
Subjects and methods Study populations We used 2008-2011 KNHANES data to identify eligible people.7 A total of 46,777 individuals of 16,800 households were asked to participate in the KNHANES between 2008 and 2011. Participants were randomly selected from a panel to represent the whole nation of South Korea. The panel was extracted using a multistage clustered and stratified random sampling method based on national census data. Among the 46,777 individuals selected, 37,753 (80.7%) agreed to participate in the survey. The survey team consisted of 1 ear, nose, and throat (ENT) resident, 3 nurses, 2 trained interviewers, and 1 coordinator. All questionnaires, nasal endoscopic examinations, and blood and urine collection were performed during a single visit. Analyses were conducted for 11,589 adult participants who had completed questionnaires on both rhinologic symptoms and smoking behaviors, had undergone nasal endoscopy, and had provided urinary samples. General characteristics of the 11,589 participants are summarized in Table 1. Mean subject age was 47.8 ± 15.9 years and 52.5% of subjects were females. Written informed consent was obtained from all participants prior to performing any study examinations or procedures. The study protocol was reviewed and approved by Seoul National University Bundang Hospital Institutional Review Board.
Rhinologic examination A total of 248 residents belonging to the Korean Society of Otorhinolaryngology were trained for the survey, specifically to perform nasal endoscopy and interview subjects on rhinologic disease history. Endoscopic examination was performed on each nasal cavity using a 4 mm 0-degree rigid endoscope from the nostril to the choana via the middle meatus before and after vasoconstriction using a nasal decongestant. Subjective olfactory dysfunction was identified by a positive answer to the question,
TABLE 1. General characteristics of participants who completed rhinologic questionnaires, underwent urine cotinine level test, and underwent rhinologic examination Characteristics
Missing values
Age (years), mean ± SD
47.8 ± 15.9
Gender, n (%)
0 0
Female
6083 (52.5%)
Male
5506 (47.5%)
Residency, n (%)
0
Urban
8787 (75.8%)
Rural
2802 (24.2%)
Household income, n (%)
175 (1.5%)
ࣙ50% of participants
6342 (54.7%)
20 ng/mL.9, 10 All other subjects were categorized as nonsmokers.
Statistical analyses A commercially-available statistical software package that enabled complex weighting SPSS (version 18.0; SPSS Inc, Chicago, IL) was used for all statistical analyses. The KNHANES sampling weight variables were used, along with masked variance primary sampling unit and stratum variables. This adjustment allowed estimation of the entire noninstitutionalized Korean population from the study sample. Participant general characteristics were summarized as the unweighted number of observations for categorical variables. Missing data were considered to be missing completely at random. Smoking behaviors of active smokers are estimated as weighted variables ± standard errors. Prevalence of rhinologic diseases is presented as the unweighted number of observations and weighted percentages ± standard errors for each variable. The chi-square test was used to analyze the differences in the prevalence of rhinologic diseases across genders. Logistic regression analyses were performed to elucidate the association between rhinologic diseases and smoking status. Crude odds ratios (OR) and their 95% confidence intervals (CIs) were calculated. Multiple logistic regression models were created and included variables with subject general characteristics to estimate their adjusted ORs and 95% CIs. A p value of
Effects of cigaree smoking on rhinologic diseases: Korean National Health and Nutrition Examination Survey 2008-2011 Woo Hyun Lee, MD1 , Seung-No Hong, MD2 , Hong Joong Kim, MD2 , Soyeon Ahn, PhD3 , Chae-Seo Rhee, MD2 , Chul Hee Lee, MD2 and Jeong-Whun Kim, MD2
Background: Several studies have shown a relationship between cigaree smoking and general diseases of the nose in a large Asian population. The current study was conducted to beer understand the effect of cigaree smoke exposure on rhinologic diseases in Koreans. Methods: Data were obtained from the 2008-2011 Korea National Health and Nutrition Examination Survey, a cross-sectional survey of the noninstitutionalized population in Korea. Of the 37,753 people surveyed, 11,589 adult participants had completed questionnaires on rhinologic symptoms and smoking behaviors, had undergone nasal endoscopy, and had provided urine collection were enrolled. Rhinologic diseases investigated in this study included subjective olfactory dysfunction, rhinitis symptoms, chronic rhinosinusitis (CRS), and nasal septal deviation with obstructive symptoms. The relationship between disease and cigaree smoking was evaluated using multivariate regression analyses. Results: In South Korea, the weighted prevalence of subjective olfactory dysfunction, rhinitis symptoms, CRS, and nasal septal deviation with obstructive symptoms was 4.6%, 27.2%, 6.2%, and 4.0%, respectively. The only disease signif-
T
he hazardous health effects of smoking are widely accepted, but a large number of people still smoke. Most
1 Department
of Otolaryngology, National Police Hospital, Seoul, South Korea; 2 Department of Otorhinolaryngology–Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea; 3 Medical Research Collaborating Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea Correspondence to: Jeong-Whun Kim, MD, PhD, Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 464-707, South Korea; e-mail: [email protected]; [email protected] Potential conflict of interest: None provided. Received: 26 January 2015; Revised: 14 April 2015; Accepted: 17 April 2015 DOI: 10.1002/alr.21553 View this article online at wileyonlinelibrary.com.
937
International Forum of Allergy & Rhinology, Vol. 5, No. 10, October 2015
icantly associated with active smoking was CRS in participants 40 years of age and older aer adjusting for age, sex, residency, house income, education, and occupation (adjusted odds ratio = 1.427, 95% confidence interval = 1.050 to 1.938). For each year of active smoking, CRS prevalence increased by 1.5%. None of the rhinologic diseases examined were associated with passive smoking. Conclusion: Our study showed that CRS seems to be associated with active smoking in older participants. Considering the relatively high prevalence of CRS in Korea, further longitudinal researches for their association and preC 2015 ARS-AAOA, LLC. vention are required.
Key Words: smoking; olfaction disorders; rhinitis; sinusitis; nasal septal deviation; health survey
How to Cite this Article: Lee WH, Hong SN, Kim HJ, et al. Effects of cigaree smoking on rhinologic diseases: Korean National Health and Nutrition Examination Survey 2008-2011. Int Forum Allergy Rhinol. 2015;5:937–943.
scientific evidence on the effects of smoking on the sinonasal tract has been shown in Western populations. From these studies, the association between cigarette smoke and numerous serious health problems, particularly of the respiratory system, is obvious. The prevalence of lung cancer and chronic obstructive pulmonary disease increases with the amount of smoking amount,1 and cigarette smoke exposure is as a known risk factor for asthma.2 The harmful effects of cigarette smoke on the upper airway are also well known, but the literature has been inconclusive on the association between cigarette smoke exposure and rhinologic disease. Some studies have reported an association between smoking and abnormal olfactory function, sinusitis, and rhinitis,3, 4 but other studies have reported no effect,5 or even a protective effect6 on olfaction and rhinitis. Although rhinologic diseases are generally not lifethreatening, they cause a socioeconomic burden from the
Lee et al.
relatively high cost of treatment because so many people suffer from them. Scientific evidence is needed to establish a health policy and to educate patients on the deleterious effects of smoking on the sinonasal tract. However, studies showing the relationship between smoking and rhinologic diseases (eg, olfactory dysfunction, rhinitis, chronic rhinosinusitis [CRS], and nasal septal deviation with obstructive symptoms) are lacking in East Asian populations. The current study was conducted to identify the effects of smoking on rhinologic diseases in a large population representing the whole nation of South Korea. Data were obtained from the Korean National Health and Nutrition Examination Survey (KNHANES), a governmentdriven survey performed by the Korea Center for Disease Control and Prevention (KCDC). The current study was performed in collaboration with the Korean Society of Otorhinolaryngology–Head and Neck Surgery.
Subjects and methods Study populations We used 2008-2011 KNHANES data to identify eligible people.7 A total of 46,777 individuals of 16,800 households were asked to participate in the KNHANES between 2008 and 2011. Participants were randomly selected from a panel to represent the whole nation of South Korea. The panel was extracted using a multistage clustered and stratified random sampling method based on national census data. Among the 46,777 individuals selected, 37,753 (80.7%) agreed to participate in the survey. The survey team consisted of 1 ear, nose, and throat (ENT) resident, 3 nurses, 2 trained interviewers, and 1 coordinator. All questionnaires, nasal endoscopic examinations, and blood and urine collection were performed during a single visit. Analyses were conducted for 11,589 adult participants who had completed questionnaires on both rhinologic symptoms and smoking behaviors, had undergone nasal endoscopy, and had provided urinary samples. General characteristics of the 11,589 participants are summarized in Table 1. Mean subject age was 47.8 ± 15.9 years and 52.5% of subjects were females. Written informed consent was obtained from all participants prior to performing any study examinations or procedures. The study protocol was reviewed and approved by Seoul National University Bundang Hospital Institutional Review Board.
Rhinologic examination A total of 248 residents belonging to the Korean Society of Otorhinolaryngology were trained for the survey, specifically to perform nasal endoscopy and interview subjects on rhinologic disease history. Endoscopic examination was performed on each nasal cavity using a 4 mm 0-degree rigid endoscope from the nostril to the choana via the middle meatus before and after vasoconstriction using a nasal decongestant. Subjective olfactory dysfunction was identified by a positive answer to the question,
TABLE 1. General characteristics of participants who completed rhinologic questionnaires, underwent urine cotinine level test, and underwent rhinologic examination Characteristics
Missing values
Age (years), mean ± SD
47.8 ± 15.9
Gender, n (%)
0 0
Female
6083 (52.5%)
Male
5506 (47.5%)
Residency, n (%)
0
Urban
8787 (75.8%)
Rural
2802 (24.2%)
Household income, n (%)
175 (1.5%)
ࣙ50% of participants
6342 (54.7%)
20 ng/mL.9, 10 All other subjects were categorized as nonsmokers.
Statistical analyses A commercially-available statistical software package that enabled complex weighting SPSS (version 18.0; SPSS Inc, Chicago, IL) was used for all statistical analyses. The KNHANES sampling weight variables were used, along with masked variance primary sampling unit and stratum variables. This adjustment allowed estimation of the entire noninstitutionalized Korean population from the study sample. Participant general characteristics were summarized as the unweighted number of observations for categorical variables. Missing data were considered to be missing completely at random. Smoking behaviors of active smokers are estimated as weighted variables ± standard errors. Prevalence of rhinologic diseases is presented as the unweighted number of observations and weighted percentages ± standard errors for each variable. The chi-square test was used to analyze the differences in the prevalence of rhinologic diseases across genders. Logistic regression analyses were performed to elucidate the association between rhinologic diseases and smoking status. Crude odds ratios (OR) and their 95% confidence intervals (CIs) were calculated. Multiple logistic regression models were created and included variables with subject general characteristics to estimate their adjusted ORs and 95% CIs. A p value of
