Peer Review #2 of "The association between lifetime cigarette smoking and dysphonia in the Korean general population: findings from a national survey (v0.2)"

Abstract

This study aims to investigate the relationship between current smoking and lifetime amount smoked and the incidence of dysphonia using data from a national cross-sectional survey that represents the Korean population. Subjects were 3,600 non-institutionalised civilian adults over the age of 19 (1,501 males and 2,099 females) who completed the laryngeal examination of the 2008 Korea National Health and Nutrition Examination Survey (KNHANES). For lifetime amount smoked, subjects were classified as light smokers (≤26.7 pack years), medium smokers (26.7-40.5 pack years), heavy smokers (40.5-55.5 pack years), and very heavy smokers (55.5-156 pack years) based on pack years (packs smoked per day × years as a smoker). The odds ratio (OR) for the statistical test was presented using hierarchical logistic regression. When adjusted for covariates (age, gender, level of education, income, occupation, alcohol consumption and pain/discomfort during the last two weeks), current smokers had a 1.8 times (OR=1.77, 95% CI: 1.17-2.68) higher risk for self-reported voice problems than non-smokers. Moreover, current smokers had a 1.6 times (OR=1.56, 95% CI: 1.02-2.38) higher risk of laryngeal disorder (p<0.05). In terms of pack years, very heavy smokers were significantly more likely to have laryngeal disorder, while self-reported voice problems were significantly more likely for heavy smokers but not very heavy smokers. The results of this study imply that chronic smoking has a significant relationship with dysphonia. Longitudinal studies are required in future work to verify the causality between lifetime smoking amount and dysphonia.