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Biomarker assessment of tobacco smoking exposure and risk of dementia death: pooling of individual participant data from 14 cohort studies
  1. G David Batty1,
  2. Martin J Shipley1,
  3. Elisabeth Kvaavik2,
  4. Tom Russ3,
  5. Mark Hamer4,
  6. Emmanouil Stamatakis5,
  7. Mika Kivimaki1
  1. 1 Department of Epidemiology and Public Health, University College London, London, UK
  2. 2 Department of Drug Policy, Norwegian Institute of Public Health, Oslo, Norway
  3. 3 Department of Psychology, Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
  4. 4 School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
  5. 5 Charles Perkins Centre, Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, Australia
  1. Correspondence to Dr G David Batty, Department of Epidemiology and Public Health, University College of London, London WC1E6BT, UK; david.batty{at}


Background While there is a suggestion that self-reported tobacco smoking may be a risk factor for dementia, to date, it has not been possible to explore the thresholds at which this exposure elevates risk. Accordingly, our aim was to relate cotinine, a biomarker of tobacco smoking, to risk of dementia death.

Methods We pooled 14 prospective cohort studies that held data on cotinine (plasma or saliva), covariates and death records.

Results In the 33 032 study members (17 107 women) with salivary cotinine data, a mean duration of 8.3 years of follow-up gave rise to 135 deaths ascribed to dementia; while in 15 130 study members (7995 women) with plasma cotinine data, there were 119 dementia deaths during 14.3 years of mortality surveillance. After multiple adjustment, both plasma cotinine (per 1 SD higher cotinine; 95% CI 1.29; (1.05 to 1.59)) and salivary cotinine (1.10 (0.89 to 1.36)) were positively related to dementia risk, with stronger effects apparent for plasma.

Conclusion Our finding that plasma cotinine was related to an elevated risk of dementia death warrants testing in studies with measures of disease onset as opposed to just mortality.

  • smoking
  • dementia
  • cohort studies

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  • Contributors GDB generated the idea for the study, developed the analytical plan and wrote the manuscript. MJS and MK developed the analytical plan. MJS analysed the data. ES built the data set. All authors commented on the first draft of the manuscript and saw and agreed on the final manuscript as well as the decision to submit for publication. All authors equally contributed to the critical revision of the manuscript for important intellectual content.

  • Competing interests None declared.

  • Ethics approval Local Research Ethics Committees.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement For access to the data, contact the corresponding author.