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Smoking and Parkinson's disease

An age-dependent risk effect?

From the INSERM U 360 Recherches Epidémiologiques en Neurologie et Psychopathologie (Drs. Tzourio and Alpérovitch), Hôpital de la Salpêtrière, Paris, France; the Departments of Health Sciences Research and Neurology (Dr. Rocca), Mayo Clinic and Mayo Foundation, Rochester, MN; the Department of Epidemiology & Biostatistics (Dr. Breteler), Erasmus University Medical School, Rotterdam, the Netherlands; Targeted Project on Aging (Dr. Baldereschi), National Research Council, Florence, Italy; the Department of Neurology (Dr. Dartigues), Pellegrin Hospital, University of Bordeaux II, France; the Department of Neurology (Dr. Lopez-Pousa), University Hospital, Girona, Spain; and the Department of Neurology (Dr. Manubens-Bertran), University of Navarra, Pamplona, Spain.

Address correspondence and reprint requests to Dr. Christophe Tzourio, INSERM U360, Hôpital de la Salpêtrière, 75651 Paris cedex 13, France.

We studied the association between smoking and Parkinson's disease (PD) through a case-control study. Several studies have shown an inverse association between smoking and PD. This association has been interpreted as spurious by some investigators, and as real and causal by others. Several other studies did not confirm the inverse association. We included 193 prevalent cases of PD ascertained in five European prevalence surveys that followed a two-phase design of screening and clinical examination. Each case was matched by center, age (±2 years), and gender to three control subjects drawn from the same populations (N = 579). Information on smoking was obtained through direct or proxy interview. Overall, there was no association between ever smoking and PD (odds ratio = 1.1; p= 0.6). Analyses stratified by age showed that ever smoking was associated with a decreased risk of PD in the younger individuals (odds ratio = 0.4; p = 0.03) and with a significant trend of increasing risk with advancing age (p = 0.003). The risk of PD in relation to smoking is strongly modified by age; smoking may be protective in the younger cases but not in the older cases. This finding may explain the conflicting results from previous studies.

*Collaborators for the EUROPARKINSON Study Group are listed in theAppendix on page 1271.

Supported by the European Community Concerted Action "Incidence and Risk Factors for Parkinson's Disease: a European Collaborative Study" (Contract BMH1 CT92 1101). Dr. Rocca was supported in part by the National Institutes of Health, grant NS 33978.

Presented in part at the 47th annual meeting of the American Academy of Neurology, Seattle, WA, May 1995.

Received March 4, 1997. Accepted in final form June 3, 1997.

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