Association Between Self-Reported Smoking Behaviour and Fuchs Endothelial Corneal Dystrophy: A Cross-Sectional...

To investigate whether smoking is associated with Fuchs endothelial corneal dystrophy (FECD).

Retrospective cross-sectional study.

Individuals with FECD in the All of Us Research Program were matched 1:10 to controls using propensity scores based on age, sex, self-reported race/ethnicity, and annual household income.

Self-reported smoking behaviour was obtained from survey data. Primary outcomes assessed cigarette-related smoking behaviour among individuals with FECD compared to matched controls, and secondary outcomes evaluated the use of other tobacco and nicotine products. Conditional logistic and fixed-effects linear regression models were applied to examine binary and continuous outcomes, respectively.

The matched cohort included 13,409 participants (1,219 FECD cases and 12,190 controls). The odds of ever smoking ≥100 cigarettes did not differ between groups (OR=0.95, 95% CI=[0.85, 1.08], p=0.4). FECD cases reported a slightly shorter total duration of smoking (MD=-2.69, 95% CI=[-4.22, -1.15], p<0.01), although mean daily cigarette consumption did not differ significantly between groups (MD=-0.20, 95% CI=[-1.67, 1.27], p=0.8). Current smoking was less frequent among FECD cases (OR=0.58, 95% CI=[0.41, 0.81], p<0.01). No significant differences were observed for lifetime or current use of electronic nicotine products (p=0.4 and p=0.1), cigars or cigarillos (p=0.2 and p=0.4), hookah (p=1.0 and p=0.9), or smokeless tobacco (p=0.1 and p=0.9).

This cross-sectional analysis of a large, nationally diverse cohort did not find evidence of an association between smoking behaviour and FECD, supporting emerging evidence that challenges the strength of this purported relationship. Nonetheless, these findings should not detract from the well-established systemic harms of smoking.