Lifestyle factors associated with incidence of rheumatoid arthritis in US adults: analysis of National Health and Nutrition Examination Survey database and meta-analysis
Open Access
- 26 January 2021
- Vol. 11 (1), e038137
- https://doi.org/10.1136/bmjopen-2020-038137
Abstract
Objective To quantify rheumatoid arthritis (RA) cases attributable to selected non-genetic risk factors. Design National Health and Nutrition Examination Survey (NHANES) and meta-analysis. Participants US adults. Data sources The prevalence of exposure was obtained from NHANES. Weighted analysis was performed to account for the complex sampling design in NHANES. PubMed and Web of Science up to 31 March 2019 were searched to identify epidemiological studies reported the association between non-genetic risk factors and RA in US adults. Relative risk (RR) value and the corresponding CI were pooled by meta-analysis to evaluate the associations between modifiable risk factors and RA. Population attributable fraction (PAF) was calculated based on the prevalence and RR data. Results The weighted percentages of former smokers, current smokers and overweight or obese people were 24.84%, 23.93% and 63.97%, and the average alcohol consumption was 51.34 g/week. In the meta-analysis, we found that former smokers (RR 1.22, 95% CI 1.10 to 1.36) and current smokers (RR 1.47, 95% CI 1.29 to 1.68) had higher risks of RA. Overweight and obese individuals had 1.27-fold (95% CI 1.09 to 1.48) increased risk of RA. Each per 50 g/week increment of alcohol consumption was associated with 8% (95% CI 0% to 16%) reduction in the risk of RA. Therefore, PAF value of smoking was 14.00% (95% CI 8.13% to 23.33%). Excess body mass index (BMI) was found to account for 14.73% (95% CI 5.45% to 23.50%) of RA incidence. The fraction of RA risk attributed by low alcohol intake was 8.21% (95% CI 0.31% to 16.39%). Collectively, we found that 32.69% (95% CI 13.41% to 50.96%) of RA cases were attributable to smoking, overweight or obesity and low alcohol drinking. Conclusion Nearly 33% of RA incidence was attributed to smoking, excess BMI and low alcohol drinking in USA. Our findings could provide a basis for developing guidelines of RA prevention and control in USA.Funding Information
- National Key R&D Program of China (2018YFC1705500)
- National Natural Science Foundation of China (81973663)
This publication has 47 references indexed in Scilit:
- Genetics and epigenetics of rheumatoid arthritisNature Reviews Rheumatology, 2013
- Past and current alcohol consumption patterns and elevations in serum hepatic enzymes among US adultsAddictive Behaviors, 2012
- Meta-Analysis for Linear and Nonlinear Dose-Response Relations: Examples, an Evaluation of Approximations, and SoftwareAmerican Journal of Epidemiology, 2011
- Smoking is a major preventable risk factor for rheumatoid arthritis: estimations of risks after various exposures to cigarette smokeAnnals Of The Rheumatic Diseases, 2010
- Associations of cigarette smoking with rheumatoid arthritis in African AmericansArthritis & Rheumatism, 2010
- Facilitating meta‐analyses by deriving relative effect and precision estimates for alternative comparisons from a set of estimates presented by exposure level or disease categoryStatistics in Medicine, 2007
- The Effects of Changes in Smoking Prevalence on Obesity Prevalence in the United StatesAmerican Journal of Public Health, 2007
- Measuring inconsistency in meta-analysesBMJ, 2003
- Quantifying heterogeneity in a meta-analysisStatistics in Medicine, 2002
- Meta-analysis in clinical trialsControlled Clinical Trials, 1986