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ASSOCIATION BETWEEN POPULATION PREVALENCE OF SMOKING AND INCIDENCE OF MENINGOCOCCAL DISEASE

Monday, 10th of February 2014

ASSOCIATION BETWEEN POPULATION PREVALENCE OF SMOKING AND INCIDENCE OF MENINGOCOCCAL DISEASE

BMJ Open 2014;4:e003312 doi:10.1136/bmjopen-2013-003312

• Public health

Association between population prevalence of smoking and incidence of meningococcal disease in Norway, Sweden, Denmark and the Netherlands between 1975 and 2009: a population-based time series analysis

Abstract below; full text is at http://bmjopen.bmj.com/content/4/2/e003312.full http://bmjopen.bmj.com/content/4/2/e003312.full

1. Gunnstein Norheim1,2,
2. Manish Sadarangani1,
3. Omar Omar3,
4. Ly-Mee Yu3,
5. Kåre Mølbak4,
6. Michael Howitz4,
7. Per Olcén5,
8. Margaretha Haglund6,
9. Arie van der Ende7,
10. Andrew J Pollard1

+ Author Affiliations

1. ¹Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, UK
2. ²Norwegian Institute of Public Health, Oslo, Norway
3. ³Centre for Statistics in Medicine, University of Oxford, Oxford, UK
4. ⁴Department of Infectious Disease Epidemiology, Statens Serum Institut, Copenhagen S, Denmark
5. ⁵University of Örebro, Örebro, Sweden
6. ⁶ThinkTank Tobaksfakta, Stockholm, Sweden
7. ⁷Department of Medical Microbiology, The Netherlands Reference Laboratory for Bacterial Meningitis, Academic Center, Amsterdam, The Netherlands

1. Correspondence to Dr Gunnstein Norheim; gunnstein.norheim@fhi.no

• Received 29 May 2013
• Revised 21 December 2013
• Accepted 10 January 2014
• Published 10 February 2014

Abstract

Objective To investigate the relationship between the prevalence of smoking in the population and incidence of invasive meningococcal disease (IMD) among children under 5 years of age.

Design Retrospective, longitudinal, observational study. Poisson regression controlled for confounding factors.

Setting Norway, Sweden, Denmark and the Netherlands between 1975 and 2009.

Population Total population of approximately 35 million people in these four countries.

Data sources Data were collected from the Ministries of Health, National Statistics Bureaus and other relevant national institutes.

Results In Norway, there was a significant positive relationship between the annual prevalence of daily smokers among individuals aged 25–49 years and the incidence of IMD in children under 5 years of age, unadjusted (RR=1.04–1.06, 95% CI 1.02 to 1.07, p<0.001) and after adjustment for time of year (quarter), incidence of influenza-like illness and household crowding (RR=1.05–1.07, 95% CI 1.03 to 1.09, p<0.001). Depending on age group, the risk of IMD increased by 5.2–6.9% per 1% increase in smoking prevalence among individuals aged 25–49 years in adjusted analyses. Using limited datasets from the three other countries, unadjusted analysis showed positive associations between IMD in children related to older smokers in Sweden and the Netherlands and negative associations related to younger smokers in Sweden. However, there were no demonstrable associations between incidence of IMD and prevalence of smoking, after adjustment for the same confounding variables.

Conclusions The reduced incidence of IMD in Norway between 1975 and 2009 may partly be explained by the reduced prevalence of smoking during this period. High-quality surveillance data are required to confirm this in other countries. Strong efforts to reduce smoking in the whole population including targeted campaigns to reduce smoking among adults may have a role to play in the prevention of IMD in children.

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