Smoking trajectories and risk of stroke until age of 50 years - The Northern Finland Birth Cohort 1966

PLoS One. 2019 Dec 17;14(12):e0225909. doi: 10.1371/journal.pone.0225909. eCollection 2019.


Background: Smoking is a well-known risk factor for stroke. However, the relationship between smoking trajectories during the life course and stroke is not known.

Aims: We aimed to study the association of smoking trajectories and smoked pack-years with risk of ischemic and haemorrhagic strokes in a population-based birth cohort followed up to 50 years of age.

Methods: Within the Northern Finland Birth Cohort 1966, 11,999 persons were followed from antenatal period to age 50 years. The smoking behaviour was assessed with postal questionnaires at ages 14, 31 and 46 years. Stroke diagnoses were collected from nationwide registers using unique study number linkage. The associations between smoking behaviour and stroke risk were estimated using Cox regression models.

Results: Six different patterns in smoking habits throughout the life course were found in trajectory modelling. During 542,140 person-years of follow-up, 352 (2.9%) persons had a stroke. Continuous smoking during the life course was associated with increased stroke risk (HR = 1.69; 95% CI 1.10-2.60) after adjusting for sex, educational level, family history of strokes, leisure-time physical activity, body mass index, alcohol consumption, hypertension, hypercholesterolemia, and diabetes. Per every smoked pack-year the stroke risk increased 1.04-fold (95% CI 1.03-1.06). Other smoking trajectories were not significantly associated with stroke risk, nor were starting or ending age of smoking.

Conclusion: Accumulation of smoking history is associated with increased risk of stroke until age of 50 years. The increased stroke risk does not depend on the age at which smoking started. Given that the majority starts smoking at young age, primary prevention of strokes should focus on adolescent smoking.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Finland / epidemiology
  • Humans
  • Incidence
  • Middle Aged
  • Proportional Hazards Models
  • Risk Assessment
  • Risk Factors
  • Smoking / adverse effects*
  • Stroke / epidemiology*
  • Stroke / etiology*
  • Surveys and Questionnaires
  • Young Adult

Grants and funding

NFBC1966 received financial support from University of Oulu [grant no. 65354, 24000692]; Oulu University Hospital [grant no. 2/97, 8/97, 24301140]; Ministry of Health and Social Affairs [grant no. 23/251/97, 160/97, 190/97]; National Institute for Health and Welfare, Helsinki [grant no. 54121]; Regional Institute of Occupational Health, Oulu, Finland [grant no. 50621, 54231]; and ERDF European Regional Development Fund [grant no. 539/2010 A31592]. This work was supported by The Research Foundation of the Pulmonary Diseases (Hengityssairauksien tutkimussäätiö), Finland, The Maire Taponen Foundation (Maire Taposen säätiö), Finland, and The Jalmari and Rauha Ahokas Foundation (Jalmari ja Rauha Ahokkaan säätiö), Finland. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.