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Meta-Analysis
.2019 Jan 1;22(1):19-27.
doi: 10.1093/ijnp/pyy061.

Smoking Rates and Number of Cigarettes Smoked per Day in Schizophrenia: A Large Cohort Meta-Analysis in a Japanese Population

Affiliations
Meta-Analysis

Smoking Rates and Number of Cigarettes Smoked per Day in Schizophrenia: A Large Cohort Meta-Analysis in a Japanese Population

Kazutaka Ohi et al. Int J Neuropsychopharmacol..

Abstract

Background: Cigarette smoking is consistently more common among schizophrenia patients than the general population worldwide; however, the findings of studies in Japan are inconsistent. Recently, the smoking rate has gradually decreased among the general population.

Methods: We performed a meta-analysis of smoking status in a large Japanese cohort of (1) 1845 schizophrenia patients and 196845 general population and (2) 842 schizophrenia patients and 766 psychiatrically healthy controls from 12 studies over a 25-year period, including 301 patients and 131 controls from our study.

Results: In our case-control sample, schizophrenia patients had a significantly higher smoking rate than healthy controls (P=.031). The proportion of heavy smokers (P=.027) and the number of cigarettes smoked per day (P=8.20×10-3) were significantly higher among schizophrenia patients than healthy controls. For the smokers in the schizophrenia group, atypical antipsychotics dosage was positively correlated with cigarettes per day (P=1.00×10-3). A meta-analysis found that schizophrenia patients had a higher smoking rate than the general population for both men (OR=1.53, P=.035; schizophrenia patients, 52.9%; general population, 40.1%) and women (OR=2.40, P=1.08×10-5; schizophrenia patients, 24.4%; general population, 11.8%). In addition, male schizophrenia patients had a higher smoking rate than male healthy controls (OR=2.84, P=9.48×10-3; schizophrenia patients, 53.6%; healthy controls, 32.9%), but the difference was not significant for women (OR=1.36, P=.53; schizophrenia patients, 17.0%; healthy controls,14.1%). Among both males and females, schizophrenia patients had a higher smoking rate than both the general population (OR=1.88, P=2.60×10-5) and healthy controls (OR=2.05, P=.018). These rates were not affected by the patients' recruitment year (P>.05). The cigarettes per day values of schizophrenia patients and the general population were 22.0 and 18.8, respectively.

Conclusions: Schizophrenia patients are approximately 2 times more likely to smoke than the general population and healthy controls based on data collected over a decade in Japan.

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Figures

Figure 1.
Figure 1.
Correlation between the number of cigarettes smoked per day (CPD) and the chlorpromazine equivalents (CPZ-eq.) of atypical antipsychotics (mg/d) in patients with schizophrenia (SZ).
Figure 2.
Figure 2.
Forest plots demonstrating the ORs of the differences in current smoking rate between patients with schizophrenia (SZ) and the general population (GP). The results are presented using ORs with 95% CIs in the forest plots for each study. The diamond (blue: male, red: female, black: combined) in the bottom portion represents the pooled OR with a 95% CI. A positive OR indicates that SZ patients have a higher prevalence of current smoking than the GP, while a negative OR indicates that SZ patients have a lower prevalence than the GP.
Figure 3.
Figure 3.
Forest plots demonstrating the ORs of the differences in the current smoking rate between schizophrenia (SZ) patients and healthy controls (HCs). The results are presented using ORs with 95% CIs in the forest plots for each study. The diamond (blue: male, red: female, black: combined) in the bottom portion represents the pooled OR with a 95% CI. A positive OR indicates that SZ patients have a higher prevalence of current smoking than HCs, while a negative OR indicates that SZ patients have a lower prevalence than HCs.
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