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Article |

Smoking and the Risk of Gallstones

Albert B. Lowenfels, MD
Arch Intern Med. 1991;151(2):398. doi:10.1001/archinte.1991.00400020134029.
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To the Editor.—  In their case-control study of risk factors for gallstones, Pastides and coworkers1 found smoking to be protective. It seems that this might well be a spurious association since three previous epidemiologic studies2-4 of gallstones have reported exactly the opposite finding-smoking appears to increase the risk of gall-stones.In any case-control study, the choice of a suitable control group is critical. The control group selected for this study consisted of patients admitted to a large trauma center; many of the patients had sustained motor vehicle injuries. Smoking is a known risk factor for various types of injury and has been found to increase the risk of motor vehicle accidents and traffic violations by about 50%, even after adjustment for alcohol consumption.5 Thus, it appears likely that the apparent protective effect of smoking on gallstones noted by Pastides and coworkers may be largely attributable to excess


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