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Lifetime cannabis exposure and small airway function in a population-based cohort study

Hua Shin Tan, Helena M. McAnally, Jack Dummer, Robert J. Hancox
ERJ Open Research 2022 8: 00688-2021; DOI: 10.1183/23120541.00688-2021
Hua Shin Tan
1Dept of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Helena M. McAnally
1Dept of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Jack Dummer
2Dept of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Robert J. Hancox
1Dept of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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  • TABLE 1

    Descriptive values

    Whole sampleWomenMen
    Cannabis use (joint-years)0.08 (0–28)0.03 (0–26.45)0.17 (0–28)
    Cannabis use (non-tobacco users only)0.01 (0–28)0 (0–19.32)0.03 (0–28)
    Cannabis use (tobacco and cannabis users only)0.62 (0.003–27.97)0.23 (0.003–26.45)2.12 (0.003–27.97)
    Tobacco use (pack-years)0.11 (0–51.03)0.25 (0–41.41)0 (0–51.03)
    BMI (kg·m−2)27.6 (16.2–62.2)27.1 (16.2–62.2)27.8 (19.0–47.5)
    Childhood SES3.3 (1–6)3.3 (1–6)3.3 (1–6)
    Adult SES4 (1–6)4 (1–6)4 (1–6)

    Data are presented as median (range). Socioeconomic status (SES) is on a 1–6 scale with 1 representing the highest SES. Childhood SES is based on parental occupations between birth and age 15 years. Adult SES is based on occupation at age 45 years.

    • TABLE 2

      Pre-bronchodilator impulse oscillometry (IOS) values at age 45 years

      WomenMen
      Participants (n)Mean (95% CI)Participants (n)Mean (95% CI)
      R5 (cmH2O·L·s−1)4415.17 (5.00–5.35)4544.49 (4.34–4.64)
      R20 (cmH2O·L·s−1)4414.15 (4.01–4.28)4543.65 (3.54–3.77)
      R5–R20 (cmH2O·L·s−1)4411.03 (0.94–1.13)4540.84 (0.76–0.84)
      X5 (cmH2O·L·s−1)440−1.60 (−1.69– −1.50)454−1.19 (−1.26– −1.12)
      AX (cmH2O·L·s−1)4376.99 (6.32–7.67)4494.86 (4.35–5.37)
      fres (Hz)44014.29 (13.81–14.77)45213.06 (12.61–13.51)

      Means are geometric means of raw IOS values. The n values differ slightly because of missing data. R5: resistance at 5 Hz; R20: resistance at 20 Hz; R5−R20: difference between R5 and R20; X5: reactance at 5 Hz; AX: area under the reactance curve between 5 Hz and resonant frequency (fres).

      • TABLE 3

        Adjusted associations of cannabis and tobacco with pre-bronchodilator impulse oscillometry (IOS) measures for the whole sample

        R5R20R5−R20X5AXfres
        Participants (n)877877877876868870
        Joint-years
         β (95% CI)0.104 (0.033–0.175)0.073 (−0.001–0.148)0.086 (0.013–0.158)0.110 (0.039–0.174)0.130 (0.060–0.200)0.133 (0.062–0.204)
         p-value0.0040.0540.0200.002<0.001<0.001
        Pack-years
         β (95% CI)0.042 (−0.029–0.113)0.003 (−0.072–0.077)0.076 (0.004–0.149)0.041 (−0.027–0.108)0.052 (−0.018–0.123)0.047 (−0.025–0.119)
         p-value0.2480.9460.0390.2370.1470.197
        Interaction term# (p-value)0.0310.1310.0340.0620.0340.054

        All IOS measures are log-transformed and analyses are adjusted for use of both substances and also adjusted for sex, body mass index and height. Bolded values are statistically significant. β-values are standardised regression coefficients, which represent the standard deviation difference in IOS measure associated with each standard deviation change in joint- or pack-years. R5: resistance at 5 Hz; R20: resistance at 20 Hz; R5−R20: difference between R5 and R20; X5: reactance at 5 Hz; AX: area under the reactance curve between 5 Hz and resonant frequency (fres). #: interaction term p-values are for joint-years by sex in the adjusted model for each IOS measure tested for after the adjusted model was run.

        • TABLE 4

          Adjusted associations of cannabis and tobacco with pre-bronchodilator impulse oscillometry (IOS) measures stratified by sex

          R5R20R5−R20X5AXfres
          Women
           Participants (n)434434434433430432
           Joint-years
            β (95% CI)0.187 (0.058–0.315)0.150 (0.014–0.286)0.137 (−0.007–0.281)0.234 (0.109–0.358)0.240 (0.116–0.364)0.222 (0.095–0.350)
            p-value0.0040.0300.061<0.001<0.0010.001
           Pack-years
            β (95% CI)0.058 (−0.058–0.175)−0.005 (−0.128–0.119)0.139 (0.009–0.270)−0.038 (−0.151–0.075)0.015 (−0.098–0.128)0.030 (−0.086–0.146)
            p-value0.3270.9400.0370.5100.7960.612
          Men
           Participants (n)443443443443438438
           Joint-years
            β (95% CI)0.070 (−0.015–0.156)0.042 (−0.047–0.132)0.066 (−0.011–0.143)0.053 (−0.026–0.113)0.083 (−0.003–0.168)0.094 (0.009–0.179)
            p-value0.1070.3510.0950.1860.0580.030
           Pack-years
            β (95% CI)0.024 (−0.066–0.114)<0.001 (−0.095–0.094)0.032 (−0.049–0114)0.079 (−0.005–0.163)0.067 (−0.024–0.158)0.051 (−0.040–0.142)
            p-value0.5990.9960.4370.0640.1500.272

          All IOS measures are transformed and analyses are adjusted for use of both substances and also adjusted for body mass index and height; significant associations are shown in bold. β-values are standardised regression coefficients, which represent the standard deviation difference in IOS measure associated with each standard deviation change in joint- or pack-years. R5: resistance at 5 Hz; R20: resistance at 20 Hz; R5−R20: difference between R5 and R20; X5: reactance at 5 Hz; AX: area under the reactance curve between 5 Hz and resonant frequency (fres).

          • TABLE 5

            Longitudinal analyses of cannabis and tobacco use between ages 38 and 45 years with pre-bronchodilator impulse oscillometry (IOS) measures for the whole sample

            R5R20R5−R20X5AXfres
            Participants (n)864864864862856857
            Joint-years 38–45 years
             β (95% CI)0.078 (0.023–0.132)0.060 (−0.002–0.121)0.043 (−0.014–0.100)0.059 (0.003–0.114)0.076 (0.023–0.129)0.091 (0.037–0.145)
             p-value0.0050.0560.1400.0380.0050.001
            Pack-years 38–45 years
             β (95% CI)0.017 (−0.038–0.072)−0.004 (−0.066–0.058)0.044 (−0.014–0.101)0.048 (−0.009–0.104)0.037 (−0.016–0.091)0.015 (−0.040–0.069)
             p-value0.5530.9030.1340.0990.1730.601

            All IOS measures are log-transformed. Analyses are adjusted for use of both substances and also adjusted for sex, body mass index, height and the relevant IOS measure at age 38 years (e.g. resistance at 5 Hz (R5) at 38 years is the adjustment for age 45 years R5); bolded values are statistically significant. β-values are standardised regression coefficients, which represent the standard deviation difference in IOS measure associated with each standard deviation change in joint- or pack-years. R20: resistance at 20 Hz; R5−R20: difference between R5 and R20; X5: reactance at 5 Hz; AX: area under the reactance curve between 5 Hz and resonant frequency (fres).

            • TABLE 6

              Longitudinal analyses of cannabis and tobacco use between ages 38 and 45 years with pre-bronchodilator impulse oscillometry (IOS) measures stratified by sex

              R5R20R5−R20X5AXfres
              Women
               Participants (n)426426426425422423
               Joint-years 38–45 years
                β (95% CI)0.125 (0.035–0.214)0.075 (−0.025–0.176)0.085 (−0.019–0.189)0.125 (0.035–0.218)0.140 (0.054–0.226)0.129 (0.042–0.217)
                p-value0.0060.1420.1090.0080.0010.004
               Pack-years 38–45 years
                β (95% CI)0.002 (−0.107–0.111)−0.007 (−0.129–0.115)0.077 (−0.049–0.203)−0.064 (−0.176–0.047)−0.017 (−0.121–0.087)0.013 (−0.093–0.120)
                p-value0.9720.9060.2320.2580.7490.804
              Men
               Participants (n)438438438437434434
               Joint-years 38–45 years
                β (95% CI)0.049 (−0.019–0.117)0.049 (−0.029–0.127)0.015 (−0.047–0.077)0.023 (−0.045–0.091)0.039 (−0.028–0.107)0.066 (−0.003–0.135)
                p-value0.1580.2140.6440.5100.2550.062
               Pack-years 38–45 years
                β (95% CI)0.025 (−0.038–0.088)<0.001 (−0.073–0.073)0.034 (−0.023–0.091)0.093 (0.029–0.157)0.060 (−0.003–0.122)0.017 (−0.047–0.081)
                p-value0.4320.9990.2420.0050.0630.601

              All IOS measures are log-transformed and analyses are adjusted for use of both substances and also adjusted for body mass index, height and the relevant IOS measure at age 38 years (e.g. resistance at 5 Hz (R5) at 38 years is the adjustment for age 45 years R5); statistically significant associations are bolded. β-values are standardised regression coefficients, which represent the standard deviation difference in IOS measure associated with each standard deviation change in joint- or pack-years. R20: resistance at 20 Hz; R5−R20: difference between R5 and R20; X5: reactance at 5 Hz; AX: area under the reactance curve between 5 Hz and resonant frequency (fres).

              Supplementary Materials

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                Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.

                Supplementary material 00688-2021.SUPPLEMENT

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              Lifetime cannabis exposure and small airway function in a population-based cohort study
              Hua Shin Tan, Helena M. McAnally, Jack Dummer, Robert J. Hancox
              ERJ Open Research Apr 2022, 8 (2) 00688-2021; DOI: 10.1183/23120541.00688-2021

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              Lifetime cannabis exposure and small airway function in a population-based cohort study
              Hua Shin Tan, Helena M. McAnally, Jack Dummer, Robert J. Hancox
              ERJ Open Research Apr 2022, 8 (2) 00688-2021; DOI: 10.1183/23120541.00688-2021
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