Smoking and the risk of systemic lupus erythematosus: an updated systematic review and cumulative meta-analysis

Clin Rheumatol. 2015 Nov;34(11):1885-92. doi: 10.1007/s10067-015-3008-9. Epub 2015 Jul 19.


Published articles reported controversial results about the association of smoking with the risk of systemic lupus erythematosus (SLE). A meta-analysis was performed to assess the aforementioned association and arrive at a more precise estimate of effect. A comprehensive search was performed to identify case-control or cohort studies (from 1990 to 2015) of the aforementioned association. The I (2) statistic was used to examine between-study heterogeneity. Fixed or random effect model was selected based on heterogeneity test among studies. Publication bias was estimated using Egger's regression asymmetry test. A total of 12 published articles with 13 studies were finally included in our meta-analysis. Results showed that the pooled odds ratio (OR) for SLE risk was 1.56 (95% confidence interval (CI) = 1.26-1.95) among current smokers compared with nonsmokers. For ex-smokers versus nonsmokers, the pooled OR for SLE risk was 1.23 (95% CI = 0.93-1.63). Subgroup analysis by geographic location and cumulative meta-analysis were also analyzed. In conclusion, our meta-analysis suggested that smoking increased the risk of SLE. Further studies are needed to confirm this result.

Keywords: Meta-analysis; Risk; Smoking; Systemic lupus erythematosus.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Humans
  • Lupus Erythematosus, Systemic / epidemiology*
  • Odds Ratio
  • Publication Bias
  • Risk Assessment
  • Risk Factors
  • Smoking / adverse effects*