A case control study to determine the association between Perthes’ disease and the recalled use of tobacco during pregnancy, and biological markers of current tobacco smoke exposure

<h4>Introduction</h4> <p>It is well established that there is a strong association between Perthes’ disease and worsening socioeconomic deprivation. It has been suggested that the primary determinant driving this association is exposure to tobacco smoke. This study aimed to examin...

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Bibliographic Details
Main Authors: Perry, D, Thomson, C, Pope, D, Bruce, C, Platt, M
Format: Journal article
Published: British Editorial Society of Bone and Joint Surgery 2017
Description
Summary:<h4>Introduction</h4> <p>It is well established that there is a strong association between Perthes’ disease and worsening socioeconomic deprivation. It has been suggested that the primary determinant driving this association is exposure to tobacco smoke. This study aimed to examine this hypothesis.</p> <h4>Method</h4> <p>A hospital case-control study (n=149/146) examined the association between tobacco smoke and Perthes’ disease, adjusting for area-level socioeconomic deprivation. Tobacco smoke exposure was assessed by parental questionnaire of smoking habits during pregnancy, and by quantitative assay of current exposure; urinary cotinine-creatinine ratio – a widely used and validated measure of tobacco smoke exposure.</p> <h4>Results</h4> <p>The odds of Perthes’ disease significantly increased with reported in-utero exposure after adjustment for socioeconomic deprivation (maternal smoking odds ratio (OR) 2.06 (95% CI 1.17 – 3.63), paternal smoking - OR 2.09 (95% CI 1.26 – 3.46). The cotinine-creatinine ratio was significantly greater in cases (OR 1.63 (1.09 – 2.43)), suggesting a greater ‘dose’ of current tobacco exposure.</p> <h4>Conclusion</h4> <p>An association exists between tobacco smoke exposure and Perthes’ disease, however we remain unable to disentangle the association with socioeconomic deprivation.</p> <h4>Take Home Message</h4> <p>Perthes’ Disease is associated with tobacco smoke exposure, but we are unable to determine if this is causal; it may be the result of residual confounding.</p>