Meta-Analysis
Copyright ©The Author(s) 2023.
World J Meta-Anal. Sep 18, 2023; 11(6): 290-312
Published online Sep 18, 2023. doi: 10.13105/wjma.v11.i6.290
Table 1 Details of the 10 studies of acute myocardial infarction
Study IDa
Ref.
Country
Design
Study population
Start year
Yr followed
Age
Sexb
Cases
Adjustc
Excld
Latencye
Endpoint
NRRf
BIOBANK[37]United KingdomCohortNational20061240-69M, F5081200Diagnosed2
CaCHS[38]CanadaCohortRegional20011320+M, F11331500Diagnosed2
CALIBER[39]United KingdomCohortGP records19971330+F5628100Diagnosed1
EPIC-GERM[40]GermanyCohortRegional19941435-65C5070, 900Diagnosed2
ESTONGENOME[41]EstoniaCohortNational20021318+M, F1180, 100Died4g
KIHD[42]FinlandCohortRegional19841842-60M205000Diagnosed1
TROMSO[43]NorwayCohortRegional19793320-94F8540, 400Diagnosed2
VASTERBOTTEN[44]SwedenCohortRegional19901930-60C20622, 900Diagnosed2
WHILA[45]SwedenCohortRegional19952050-59F2051, 700Diagnosed2
WHS[46]United StatesCohortNational19922645+F6290, 1400Diagnosed2
Table 2 Details of the 23 studies of ischaemic heart disease
Study IDa
Ref.
Country
Design
Study population
Start year
Yr followed
Ageb
Sexc
Casesd
Adjuste
Exclf
Latencyg
Endpoint
NRRh
7CNTRY-ITALY[47]ItalyCohortRegional19605040-59M319300Died1
ARIC[48]United StatesCohortNational19873045-64C17980, 1500Diagnosed2
BIOBANK[49]United KingdomCohortNational20061240-69C547000Diagnosed1
CALIBER[39]United KingdomCohortGP records19971330+F16800100Diagnosed1
CPS-II[50]United StatesCohortNational19822230+C134780, 2300Died2
CoCHS[51]DenmarkCohortRegional19912220-93F900100Diagnosed1
ELSA[52]United KingdomCohortNational20041352+C3520, 700Diagnosed2
EPIC-10[53]MultiCohortInternational19911935-70M, F7198000Diagnosed2
[54]MultiNested CCInternational19911935-70C7198000Diagnosed1
EPIC-UK[55]United KingdomCohortRegional19931445-79C23320, 2, 600Diagnosed3
ESTON-GENOME[41]EstoniaCohortNational20021318+M, F6960, 100Died4i
FINRISK[56]FinlandCohortNational19822525-74FNR3, 800Died2
HAPIEE[57]MultiCohortInternational20029NARC225000Died1
HSE-SHS[58]United KingdomCohortNational199417NARC14120, 700Died2
JACC[59]JapanCohortRegional19882140-79M, F15540, 7, 9x0Died4
MALMO[60]SwedenCohortRegional19912246-67M, F32170, 600Diagnosed4
MESA[61]United StatesCohortRegional20001145-84C4491, 1400Diagnosed3
[62]United StatesCohortRegional20001145-84C449000Diagnosed1
NAS[63]United StatesCohortRegional199120NARF137000Diagnosed1
NHS[64]United StatesCohortMedical workers19891743-68F3874000Diagnosed1
NHS-II[65]United StatesCohortMedical workers19912025-42F4561, 1500Diagnosed2
PREVEND[66]NetherlandsCohortRegional2001932-80C2120, 2, 1000Diagnosed3
USA5[67]United StatesCohortRegional20001155+M, F299310, 500Died4
WHI[68]United StatesCohortNational19932050-79F29751100Died1
WHITEHALL[69]United KingdomCohortCivil servants19674340-69M3250100Died1
Table 3 Details of the 31 studies of stroke
Study IDa
Ref.
Country
Design
Study population
Start year
Yr followed
Ageb
Sexc
Cases
Adjustd
Excle
Latencyf
Endpoint
NRRg
7CNTRY-ITALY[47]ItalyCohortRegional19605040-59M225300Died1
ARIC[48]USACohortNational19873045-64C11060, 1400Diagnosed2
BIOBANK[70]UKCohortNational20061240-69M, F4662200Diagnosed2
CALIBER[39]UKCohortGP records19971330+F11842100Diagnosed1
CPS-II[50]USACohortNational19822230+C55820, 2300Died2
CaCHS[38]CanadaCohortRegional20011320+M, F16361500Diagnosed2
[71]CanadaCohortRegional20011120+M, F1636000Diagnosed2
ELSA[52]UKCohortNational20041352+C3260, 700Diagnosed2
EPIC-10[54]MultiNested CCInternational19911935-70C2187000Diagnosed1
EPIC-ITALY[72]ItalyCohortRegional19931535-74M, F3860, 2, 1000Diagnosed6
EPIC-SPAIN[73]SpainCohortRegional19921629-69F301000Diagnosed1
EPIC-UK[55]UKCohortRegional19931445-79C3850, 2, 600Diagnosed3
ESTON-GENOME[41]EstoniaCohortNational20021318+M, F1560, 100Died4h
HAPIEE[57]MultiCohortInternational20029NARC109000Died1
HSE-SHS[58]UKCohortNational199417NARC6900, 700Died2
JACC[59]JapanCohortRegional19882140-79M, F31630, 7, 9x0Died4
JHS[74]USACohortRegional20001521-84C1830, 1100Diagnosed2
JP8[75]JapanCohortNational19833040+M3487000Died1
MALMO[76]SwedenCohortRegional19912246-67C305000Diagnosed1
MESA[62]United StatesCohortRegional20001145-84C180000Diagnosed1
MILLION[28]United KingdomCohortNational19961946-66F8103800Diagnosed1
NFBC[77]FinlandCohortRegional19664914-46C3520, 1000Diagnosed2
NHIS[78]United StatesCohortNational19872418-95C20460, 5x0Died2
[79]United StatesCohortNational19871418-95C20460, 8, 90xDied3
[80]United StatesCohortNational19872840-79M20460, 1, 90xDied3
NHS[64]United StatesCohortMedical workers19891743-68F3288000Diagnosed1
NIH-AARP[81]United StatesCohortRegional2004770+C13690, 400Died2
NLMS[82]United StatesCohortNational19852635-80C30830, 1, 5x0Died3
OHASAMA[83]JapanCohortRegional19981260+C2932x0Diagnosed1
PREVEND[66]NetherlandsCohortRegional2001932-80C830, 2, 1000Diagnosed3
SCCS[84]United StatesCohortRegional20021140-79C389700Died1
USA5[67]United StatesCohortRegional20001155+M, F98210, 500Died4
WHITEHALL[69]United KingdomCohortCivil servants19674340-69M1061100Diagnosed1
WHS[46]United StatesCohortNational19922645+F8870, 1400Diagnosed2
Table 4 Acute myocardial infarction and current vs never cigarette smoking – results from random effects meta-analyses
Full output table
Factor
Level
No. of RRs
No. of studies
RR (95%CI)
Test of heterogeneity by level (NS = P ≥ 0.1) and trend if relevant, P value
All13102.72 (2.40-3.08)< 0.001
5SexCombined222.98 (2.20-4.04)
Males442.30 (1.57-3.37)
Females772.83 (2.40-3.34)NS
6RegionN. America323.42 (2.93-3.99)
Europe1082.54 (2.22-2.90)< 0.01
7Study populationNational532.85 (2.16-3.77)
Regional762.69 (2.18-3.33)
Other112.51 (2.33-2.71)NS
8Year of start of baseline< 1988221.81 (1.28-2.56)
1988+1182.93 (2.58-3.32)< 0.05
9Number of cases< 1000762.52 (1.96-3.25)
1000+642.87 (2.46-3.35)NS
10Lowest age considered< 30533.02 (2.09-4.35)
30-44652.58 (2.20-3.04)
45+222.88 (2.40-3.46)NS trend NS
11Yr of follow-up10-< 201072.78 (2.40-3.23)
20-< 30222.88 (2.40-3.46)
30+112.11 (1.81-2.46)< 0.05 trend < 0.01
12EndpointDied212.99 (1.34-6.67)
Diagnosed1192.71 (2.38-3.08)NS
13Number of adjustment factorsNone111.47 (1.08-2.01)
Age only322.52 (2.34-2.71)
More972.89 (2.48-3.37)< 0.001
14Disease definition standardNo672.43 (2.06-2.87)
Yes75 3.14 (2.63-3.74)< 0.05
Table 5 Ischaemic heart disease and current vs never cigarette smoking – results from random effects meta-analyses
Full output table
Factor
Level
No. of RRs
No. of studies
RR (95%CI)
Test of heterogeneity by level (NS = P ≥ 0.1) and trend if relevant, P value
All28232.01 (1.84-2.21)< 0.001
19SexCombined10101.94 (1.71-2.21)
Males771.86 (1.53-2.26)
Females11112.23 (1.86-2.69)NS
20RegionN. America982.23 (1.92-2.58)
Europe17141.90 (1.67-2.15)
Japan212.15 (1.73-2.69)NS
21Study populationNational982.10 (1.92-2.30)
Regional1291.85 (1.56-2.19)
Other762.18 (1.77-2.69)NS
22Year of start of baseline< 1988551.89 (1.56-2.27)
1988+23182.04 (1.83-2.28)NS
23Number of cases< 100012111.97 (1.58-2.45)
1000+16122.04 (1.83-2.27)NS
24Exclusive cigarettesNo26222.00 (1.82-2.21)
Yes212.15 (1.73-2.69)NS
25, 26Lowest age considered< 30542.45 (1.77-3.39)
30-441191.81 (1.61-2.05)
45+972.06 (1.76-2.42)NS trend without missing NS
Missing332.09 (1.16-3.78)
27Yr of follow-up< 10222.52 (1.07-5.90)
10-< 2013102.04 (1.77-2.35)
20-< 301081.99 (1.78-2.23)
30+331.68 (1.23-2.29)NS trend NS
28EndpointDied13102.23 (1.94-2.57)
Diagnosed15131.83 (1.62-2.05)< 0.05
29Number of adjustment factorsNone652.11 (1.78-2.50)
Age only541.64 (1.39-1.93)
More17142.10 (1.88-2.35)< 0.05
30Disease definition standardNo13121.83 (1.59-2.10)
Yes15112.17 (1.93-2.45)< 0.1
Table 6 Stroke and current vs never cigarette smoking – results from random effects meta-analyses
Full output table
Factor
Level
No. of RRs
No. of Studies
RR (95%CI)
Test of heterogeneity by level (NS = P ≥ 0.1) and trend if relevant, P value
All37311.62 (1.48-1.77)< 0.001
35SexCombined17171.65 (1.52-1.50)
Males991.48 (1.21-1.80)
Females11111.66 (1.39-1.99)NS
36RegionN. America14121.64 (1.48-1.83)
Europe19161.71 (1.51-1.94)
Japan431.18 (1.04-1.34)< 0.001
37Study populationNational13111.76 (1.47-2.11)
Regional19151.55 (1.36-1.78)
Other551.51 (1.39-1.65)N.S.
38Yr of start of baseline< 1988881.43 (1.23-1.67)
1988+29231.68 (1.52-1.85)< 0.1
39Number of cases< 100018161.66 (1.44-1.91)
1000+19151.59 (1.41-1.78)NS
40Exclusive cigarettesNo32271.67 (1.52-1.84)
Yes541.31 (1.19-1.45)< 0.001
41, 42Lowest age considered< 36861.59 (1.19-2.14)
30-4416131.48 (1.35-1.62)
45+11101.89 (1.68-2.12)< 0.01 trend without missing < 0.01
Missing221.87 (1.54-2.28)
43Yr of follow-up< 10332.13 (1.80-2.53)
10-< 2022171.69 (1.52-1.89)
20-< 30761.43 (1.29-1.60)
30+551.44 (1.10-1.89)< 0.001 trend < 0.001
44EndpointDied16131.60 (1.41-1.81)
Diagnosed21181.63 (1.46-1.83)NS
45Number of adjustment factorsNone771.32 (1.08-1.62)
Age only431.70 (1.31-2.20)
More26211.69 (1.53-1.88)< 0.1
46Disease definition standardNo20181.68 (1.51-1.88)
Yes17131.55 (1.36-1.77)NS
Table 7 Comparison of meta-analysis relative risks for ischaemic heart disease in this study and in other publications
Ref.
Region
What is smoked
Comparison groupa
RR (95%CI) males
RR (95%CI) females
RR (95%CI) any
Woodward et al[17], 2005Asia-PacificCigarettesNon1.56 (1.44-1.70)1.73 (1.50-2.01)1.60 (1.49-1.72)
Woodward et al[18], 2005Asia, Australia, New ZealandCigarettesNon1.86 (1.69-2.06)
Nakamura et al[16], 2009AsiaUndefinedNever1.97 (1.66-2.33)
Huxley et al[19], 2011AnyCigarettesNon1.72 (1.57-1.88)1.92 (1.66-2.23)1.79 (1.61-1.98)
Mons et al[15], 2015AnyUndefinedNever1.80 (1.51-2.15)2.26 (1.98-2.59)2.03 (1.63-2.54)b
Lee et al[5], 2017cNorth America, Europe, AsiaCigarettesdNever1.99 (1.81-2.19)2.12 (1.87-2.40)2.05 (1.90-2.21)
Colpani et al[13], 2018AnyCigaretteseNever3.12 (2.15-4.52)
Hackshaw et al[14], 2018Any20 cigarettes per dayNever2.04 (1.86-2.24)2.84 (2.21-3.64)2.34 (1.96-2.79)
Lee et al[11], 2018cJapanCigarettesdNever1.98 (1.74-2.25)2.59 (2.06-3.27)2.21 (1.96-2.50)
This meta-analysisNorth America, Europe, JapanCigarettesNever1.86 (1.53-2.26)2.23 (1.86-2.69)2.01 (1.84-2.21)
Table 8 Comparison of meta-analysis relative risks for stroke in this study and in other publications
Ref.
Region
What is smoked
Comparison groupa
RR (95%CI) males
RR (95%CI) females
RR (95%CI) any
Woodward et al[17], 2005Asia-PacificCigarettesNon1.29 (1.20-1.38)1.42 (1.26-1.62)1.32 (1.24-1.40)
Nakamura et al[16], 2009AsiaUndefinedNever1.34 (1.12-1.48)
Peters et al[22], 2013AnyCigarettesNon1.67 (1.49-1.88)1.83 (1.58-2.12)1.73 (1.58-1.89)
Chen et al[20], 2014WesternCigarettesNever2.27 (1.76-2.93)
Mons et al[15], 2015AnyUndefinedNever1.44 (1.23-1.68)1.78 (1.46-2.17)1.59 (1.29-1.95)b
Lee et al[5], 2017North America, Europe, AsiaCigarettescNever1.42 (1.29-1.56)1.54 (1.33-1.78)1.48 (1.37-1.60)
Wang et al[23], 2017ChinaUndefinedUndefined1.53 (1.06-2.20)b
Colpani et al[13], 2018AnyCigarettesdNever2.09 (1.51-2.89)
Hackshaw et al[14], 2018Any20 cigarettes per dayNever1.64 (1.48-1.82)2.16 (1.69-2.75)1.90 (1.54-2.35)
Lee et al[11], 2018JapanCigarettescNever1.32 (1.16-1.51)1.50 (1.16-1.94)1.40 (1.25-1.57)
Pan et al[21], 2019AnyCigarettescNevere1.54 (1.11-2.13)1.88 (1.45-2.44)1.92 (1.49-2.48)
This meta-analysisNorth America, Europe, JapanCigarettesNever1.48 (1.21-1.80)1.66 (1.39-1.99)1.62 (1.48-1.77)