{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T02:17:26Z","timestamp":1773713846135,"version":"3.50.1"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,8,30]],"date-time":"2023-08-30T00:00:00Z","timestamp":1693353600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,8,30]],"date-time":"2023-08-30T00:00:00Z","timestamp":1693353600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Smoking patients with diabetes mellitus (DM) are at greater risk of developing pneumonia. How smoking behavior changes affect the risk of pneumonia hospitalization, however, remains unclear. Therefore, we investigated the association between smoking behavior change and the risk of pneumonia hospitalization in patients with DM. From January 1, 2009 and December 31, 2018, we investigated the association between smoking behavior change and the risk of pneumonia hospitalization in patients with DM. A total of 332,798 adult patients with DM from the Korean National Health Insurance System database who underwent health screening examination between 2009 and 2012, and were smokers at the first health examination were included. During a mean follow-up of 4.89\u00a0years, 14,598 (4.39%) incident pneumonia hospitalization cases were identified. Reducers had a slightly increased risk of pneumonia hospitalization (aHR 1.06, 95% CI 1.01\u20131.10) compared to sustainers. Quitters did not have a significant association with incidence of pneumonia hospitalization. However, increasers had 13% higher risk of pneumonia hospitalization (aHR 1.13, 95% CI 1.07\u20131.18), regardless of whether initial smoking was light, moderate, or heavy. Our study showed that an increase in smoking intensity was associated with an increased risk of pneumonia hospitalization in people with DM. However, a protective effect of smoking reduction or cessation on pneumonia risk was not demonstrated.<\/jats:p>","DOI":"10.1038\/s41598-023-40658-9","type":"journal-article","created":{"date-parts":[[2023,8,30]],"date-time":"2023-08-30T10:02:50Z","timestamp":1693389770000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Smoking behavior change and the risk of pneumonia hospitalization among smokers with diabetes mellitus"],"prefix":"10.1038","volume":"13","author":[{"given":"Dong-Woo","family":"Han","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wonyoung","family":"Jung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyu Na","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyungdo","family":"Han","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sei Won","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dong Wook","family":"Shin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,8,30]]},"reference":[{"key":"40658_CR1","doi-asserted-by":"publisher","first-page":"108086","DOI":"10.1016\/j.diabres.2020.108086","volume":"162","author":"P Saeedi","year":"2020","unstructured":"Saeedi, P. et al. Mortality attributable to diabetes in 20\u201379 years old adults, 2019 estimates: Results from the International Diabetes Federation Diabetes Atlas, 9(th) edition. Diabetes Res. Clin. Pract. 162, 108086 (2020).","journal-title":"Diabetes Res. Clin. Pract."},{"issue":"1","key":"40658_CR2","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1186\/s12933-020-01159-5","volume":"19","author":"W Ling","year":"2020","unstructured":"Ling, W. et al. Global trend of diabetes mortality attributed to vascular complications, 2000\u20132016. Cardiovasc. Diabetol. 19(1), 182 (2020).","journal-title":"Cardiovasc. Diabetol."},{"issue":"2","key":"40658_CR3","doi-asserted-by":"publisher","first-page":"142","DOI":"10.3803\/EnM.2015.30.2.142","volume":"30","author":"KH Ha","year":"2015","unstructured":"Ha, K. H. & Kim, D. J. Trends in the Diabetes Epidemic in Korea. Endocrinol Metab (Seoul). 30(2), 142\u2013146 (2015).","journal-title":"Endocrinol Metab (Seoul)."},{"issue":"5","key":"40658_CR4","first-page":"442","volume":"16","author":"A Berbudi","year":"2020","unstructured":"Berbudi, A., Rahmadika, N., Tjahjadi, A. I. & Ruslami, R. Type 2 Diabetes and its Impact on the Immune System. Curr. Diabetes Rev. 16(5), 442\u2013449 (2020).","journal-title":"Curr. Diabetes Rev."},{"issue":"2","key":"40658_CR5","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1016\/S2213-8587(15)00379-4","volume":"4","author":"J Pearson-Stuttard","year":"2016","unstructured":"Pearson-Stuttard, J., Blundell, S., Harris, T., Cook, D. G. & Critchley, J. Diabetes and infection: assessing the association with glycaemic control in population-based studies. Lancet Diabetes Endocrinol. 4(2), 148\u2013158 (2016).","journal-title":"Lancet Diabetes Endocrinol."},{"issue":"3","key":"40658_CR6","first-page":"267","volume":"10","author":"J Liu","year":"2013","unstructured":"Liu, J. Impact of diabetes mellitus on pneumonia mortality in a senior population: Results from the NHANES III follow-up study. J. Geriatr. Cardiol. 10(3), 267\u2013271 (2013).","journal-title":"J. Geriatr. Cardiol."},{"issue":"7","key":"40658_CR7","doi-asserted-by":"publisher","first-page":"e0220204","DOI":"10.1371\/journal.pone.0220204","volume":"14","author":"V Baskaran","year":"2019","unstructured":"Baskaran, V., Murray, R. L., Hunter, A., Lim, W. S. & McKeever, T. M. Effect of tobacco smoking on the risk of developing community acquired pneumonia: A systematic review and meta-analysis. PLoS ONE 14(7), e0220204 (2019).","journal-title":"PLoS ONE"},{"issue":"6","key":"40658_CR8","doi-asserted-by":"publisher","first-page":"1274","DOI":"10.1183\/09031936.00095807","volume":"31","author":"J Almirall","year":"2008","unstructured":"Almirall, J. et al. New evidence of risk factors for community-acquired pneumonia: a population-based study. Eur. Respir. J. 31(6), 1274\u20131284 (2008).","journal-title":"Eur. Respir. J."},{"issue":"45","key":"40658_CR9","doi-asserted-by":"publisher","first-page":"1013","DOI":"10.15585\/mmwr.mm6845a2","volume":"68","author":"MR Creamer","year":"2019","unstructured":"Creamer, M. R. et al. Tobacco product use and cessation indicators among adults\u2014United States, 2018. Morb. Mortal. Weekly Rep. 68(45), 1013 (2019).","journal-title":"Morb. Mortal. Weekly Rep."},{"issue":"40","key":"40658_CR10","doi-asserted-by":"publisher","first-page":"4141","DOI":"10.1093\/eurheartj\/ehab578","volume":"42","author":"SM Jeong","year":"2021","unstructured":"Jeong, S. M. et al. Smoking cessation, but not reduction, reduces cardiovascular disease incidence. Eur. Heart J. 42(40), 4141\u20134153 (2021).","journal-title":"Eur. Heart J."},{"issue":"11","key":"40658_CR11","doi-asserted-by":"publisher","first-page":"2126","DOI":"10.1002\/cncr.34172","volume":"128","author":"JE Yoo","year":"2022","unstructured":"Yoo, J. E. et al. Effect of smoking reduction, cessation, and resumption on cancer risk: A nationwide cohort study. Cancer 128(11), 2126\u20132137 (2022).","journal-title":"Cancer"},{"issue":"6","key":"40658_CR12","doi-asserted-by":"publisher","first-page":"399","DOI":"10.4093\/dmj.2012.36.6.399","volume":"36","author":"SA Chang","year":"2012","unstructured":"Chang, S. A. Smoking and type 2 diabetes mellitus. Diabetes Metab. J. 36(6), 399\u2013403 (2012).","journal-title":"Diabetes Metab. J."},{"issue":"7","key":"40658_CR13","doi-asserted-by":"publisher","first-page":"1055","DOI":"10.1016\/j.rmed.2012.03.018","volume":"106","author":"LM Cecere","year":"2012","unstructured":"Cecere, L. M. et al. Smoking cessation and the risk of hospitalization for pneumonia. Respir. Med. 106(7), 1055\u20131062 (2012).","journal-title":"Respir. Med."},{"issue":"1","key":"40658_CR14","doi-asserted-by":"publisher","first-page":"9","DOI":"10.23838\/pfm.2021.00135","volume":"6","author":"DW Shin","year":"2022","unstructured":"Shin, D. W., Cho, J., Park, J. H. & Cho, B. National general health screening program in Korea: History, current status, and future direction. Precis. Future Med. 6(1), 9\u201331 (2022).","journal-title":"Precis. Future Med."},{"issue":"9","key":"40658_CR15","doi-asserted-by":"publisher","first-page":"2169","DOI":"10.2337\/dc19-0760","volume":"43","author":"SY Rhee","year":"2020","unstructured":"Rhee, S. Y. et al. Association between glycemic status and the risk of parkinson disease: A nationwide population-based study. Diabetes Care 43(9), 2169\u20132175 (2020).","journal-title":"Diabetes Care"},{"issue":"2","key":"40658_CR16","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1002\/mds.27922","volume":"35","author":"SM Jeong","year":"2020","unstructured":"Jeong, S. M. et al. Body mass index, diabetes, and the risk of Parkinson\u2019s disease. Mov Disord. 35(2), 236\u2013244 (2020).","journal-title":"Mov Disord."},{"issue":"19","key":"40658_CR17","doi-asserted-by":"publisher","first-page":"1765","DOI":"10.1056\/NEJMp1409841","volume":"371","author":"HS Ahn","year":"2014","unstructured":"Ahn, H. S., Kim, H. J. & Welch, H. G. Korea\u2019s thyroid-cancer \u201cepidemic\u201d\u2013screening and overdiagnosis. N. Engl. J. Med. 371(19), 1765\u20131767 (2014).","journal-title":"N. Engl. J. Med."},{"issue":"40","key":"40658_CR18","doi-asserted-by":"publisher","first-page":"4141","DOI":"10.1093\/eurheartj\/ehab578","volume":"42","author":"S-M Jeong","year":"2021","unstructured":"Jeong, S.-M. et al. Smoking cessation, but not reduction, reduces cardiovascular disease incidence. Eur. Heart J. 42(40), 4141\u20134153 (2021).","journal-title":"Eur. Heart J."},{"key":"40658_CR19","unstructured":"Prevention KCfDC. Korea national health and nutrition examination survey. (2021)."},{"key":"40658_CR20","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1164\/ajrccm\/151.3_Pt_1.630","volume":"151","author":"F Verra","year":"1995","unstructured":"Verra, F. et al. Ciliary abnormalities in bronchial epithelium of smokers, ex-smokers, and nonsmokers. Am. J. Respir. Crit. Care Med. 151, 630\u2013634 (1995).","journal-title":"Am. J. Respir. Crit. Care Med."},{"issue":"1","key":"40658_CR21","doi-asserted-by":"publisher","first-page":"268","DOI":"10.18632\/oncotarget.13613","volume":"8","author":"F Qiu","year":"2017","unstructured":"Qiu, F. et al. Impacts of cigarette smoking on immune responsiveness: Up and down or upside down?. Oncotarget 8(1), 268\u2013284 (2017).","journal-title":"Oncotarget"},{"issue":"1","key":"40658_CR22","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1186\/s12967-019-1971-7","volume":"17","author":"C Huang","year":"2019","unstructured":"Huang, C. & Shi, G. Smoking and microbiome in oral, airway, gut and some systemic diseases. J. Transl. Med. 17(1), 225 (2019).","journal-title":"J. Transl. Med."},{"issue":"1","key":"40658_CR23","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1186\/1465-9921-8-85","volume":"8","author":"TS Lapperre","year":"2007","unstructured":"Lapperre, T. S. et al. Smoking cessation and bronchial epithelial remodelling in COPD: A cross-sectional study. Respir. Res. 8(1), 85 (2007).","journal-title":"Respir. Res."},{"issue":"5","key":"40658_CR24","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1183\/09031936.05.00108904","volume":"26","author":"BWM Willemse","year":"2005","unstructured":"Willemse, B. W. M. et al. Effect of 1-year smoking cessation on airway inflammation in COPD and asymptomatic smokers. Eur. Respir. J. 26(5), 835 (2005).","journal-title":"Eur. Respir. J."},{"key":"40658_CR25","doi-asserted-by":"publisher","first-page":"95","DOI":"10.2147\/JAA.S200492","volume":"12","author":"SI Pelton","year":"2019","unstructured":"Pelton, S. I., Shea, K. M., Bornheimer, R., Sato, R. & Weycker, D. Pneumonia in young adults with asthma: Impact on subsequent asthma exacerbations. J. Asthma. Allergy. 12, 95\u201399 (2019).","journal-title":"J. Asthma. Allergy."},{"issue":"3","key":"40658_CR26","doi-asserted-by":"publisher","first-page":"187","DOI":"10.4046\/trd.2018.0030","volume":"81","author":"MI Restrepo","year":"2018","unstructured":"Restrepo, M. I., Sibila, O. & Anzueto, A. Pneumonia in patients with chronic obstructive pulmonary disease. Tuberc. Respir. Dis. (Seoul). 81(3), 187\u2013197 (2018).","journal-title":"Tuberc. Respir. Dis. (Seoul)."},{"issue":"6","key":"40658_CR27","doi-asserted-by":"publisher","first-page":"e0156677","DOI":"10.1371\/journal.pone.0156677","volume":"11","author":"KJ Bai","year":"2016","unstructured":"Bai, K. J., Lee, J. J., Chien, S. T., Suk, C. W. & Chiang, C. Y. The influence of smoking on pulmonary tuberculosis in diabetic and non-diabetic patients. PLoS ONE 11(6), e0156677 (2016).","journal-title":"PLoS ONE"},{"issue":"7","key":"40658_CR28","doi-asserted-by":"publisher","first-page":"1086","DOI":"10.2105\/AJPH.84.7.1086","volume":"84","author":"DL Patrick","year":"1994","unstructured":"Patrick, D. L. et al. The validity of self-reported smoking: A review and meta-analysis. Am. J. Public Health. 84(7), 1086\u20131093 (1994).","journal-title":"Am. J. Public Health."},{"issue":"20","key":"40658_CR29","doi-asserted-by":"publisher","first-page":"2206","DOI":"10.1001\/archinte.164.20.2206","volume":"164","author":"L Arcavi","year":"2004","unstructured":"Arcavi, L. & Benowitz, N. L. Cigarette smoking and infection. Arch. Intern. Med. 164(20), 2206\u20132216 (2004).","journal-title":"Arch. Intern. Med."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-023-40658-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-023-40658-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-023-40658-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,18]],"date-time":"2023-11-18T22:05:29Z","timestamp":1700345129000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-023-40658-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,30]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["40658"],"URL":"https:\/\/doi.org\/10.1038\/s41598-023-40658-9","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,30]]},"assertion":[{"value":"22 April 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 August 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 August 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"14189"}}