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* From the Kaiser Permanente Division of Research (Drs. Iribarren and Sidney), Oakland, CA; the Division of Epidemiology, School of Public Health (Drs. Jacobs and Gross), University of Minnesota, Minneapolis, MN; and the Department of Medicine, Division of Pulmonary and Critical Care Medicine and Cardiovascular Research Institute (Dr. Eisner), University of California, San Francisco, CA.
Correspondence to: Carlos Iribarren, MD, MPH, PhD, Kaiser Permanente Division of Research, 3505 Broadway, Oakland, CA 94611; e-mail: cgi{at}dor.kaiser.org
Study objective: To examine the association of cigarette smoking and alcohol consumption with hospital presentation of ARDS in a well-defined, multiethnic population.
Design: Retrospective cohort study.
Setting: Health maintenance organization in Northern California.
Participants: A total of 121,012 health plan subscribers (54.2% women), aged 25 to 89 years.
Outcome measure: Hospital presentation of ARDS (validated by medical chart review) from baseline in 1979 to 1985 through the end of 1993 (median, 9.9 years).
Results: There were 56
cases of ARDS (33 in men, 23 in women). The case fatality rate was 39%
in both genders. ARDS was independently related to increasing age (rate
ratio of 10 years, 1.38; 95% confidence interval [CI], 1.12 to
1.71), to current smoking of < 20 cigarettes/d (rate ratio vs never
cigarette smokers, 2.85; 95% CI, 1.23 to 6.60), and to current
cigarette smoking of 
20 cigarettes/d (rate ratio vs never smokers,
4.59; 95% CI, 2.13 to 9.88). No association was observed between
alcohol consumption and ARDS.
Conclusions: The results of this study suggest a relationship (with evidence of dose-response effect) between cigarette smoking and ARDS. Assuming a causal relationship, approximately 50% of ARDS cases were attributable to cigarette smoking.
Key Words: alcohol • ARDS • epidemiology • risk factors • smoking
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