Association of Smoking and Obesity on the Risk of Developing Primary Sjögren Syndrome: A Population-based Cohort Study

From the Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, and Division of Pulmonary and Critical Care Medicine, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel, Montevideo, Uruguay; Department of Rheumatology, Hospital of Prato, Prato, Italy; Rheumatology Department, Brest Teaching Hospital, Brest, France; Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, Milan, Italy; Rheumatology Department, Santa Chiara Hospital, Trento, Italy. Dr. Cornec received fellowship grants from the French Society of Rheumatology and from Brest University Hospital, France. This work used the resources of the Rochester Epidemiology Project, which is supported by the US National Institute on Aging of the National Institutes of Health (NIH) under Award Number R01AG034676, and Clinical and Translational Science Awards Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences, a component of the NIH. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. L. Servioli, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Autoimmune diseases Department, Medical Clinic 1, Hospital Maciel; G. Maciel, MD, Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel; C. Nannini, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Department of Rheumatology, Hospital of Prato; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; D. Cornec, MD, PhD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and Rheumatology Department, Brest Teaching Hospital; A. Berti, MD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and the Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, and the Rheumatology Department, Santa Chiara Hospital. Address correspondence to Dr. E.L. Matteson, Divisions of Rheumatology and Epidemiology, Mayo Clinic College of Medicine, 200 1st St. SW, Rochester, Minnesota 55905, USA. E-mail: Matteson.eric@mayo.edu. Accepted for publication October 9, 2018.

From the Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, and Division of Pulmonary and Critical Care Medicine, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel, Montevideo, Uruguay; Department of Rheumatology, Hospital of Prato, Prato, Italy; Rheumatology Department, Brest Teaching Hospital, Brest, France; Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, Milan, Italy; Rheumatology Department, Santa Chiara Hospital, Trento, Italy. Dr. Cornec received fellowship grants from the French Society of Rheumatology and from Brest University Hospital, France. This work used the resources of the Rochester Epidemiology Project, which is supported by the US National Institute on Aging of the National Institutes of Health (NIH) under Award Number R01AG034676, and Clinical and Translational Science Awards Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences, a component of the NIH. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. L. Servioli, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Autoimmune diseases Department, Medical Clinic 1, Hospital Maciel; G. Maciel, MD, Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel; C. Nannini, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Department of Rheumatology, Hospital of Prato; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; D. Cornec, MD, PhD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and Rheumatology Department, Brest Teaching Hospital; A. Berti, MD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and the Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, and the Rheumatology Department, Santa Chiara Hospital. Address correspondence to Dr. E.L. Matteson, Divisions of Rheumatology and Epidemiology, Mayo Clinic College of Medicine, 200 1st St. SW, Rochester, Minnesota 55905, USA. E-mail: Matteson.eric@mayo.edu. Accepted for publication October 9, 2018.

From the Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, and Division of Pulmonary and Critical Care Medicine, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel, Montevideo, Uruguay; Department of Rheumatology, Hospital of Prato, Prato, Italy; Rheumatology Department, Brest Teaching Hospital, Brest, France; Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, Milan, Italy; Rheumatology Department, Santa Chiara Hospital, Trento, Italy. Dr. Cornec received fellowship grants from the French Society of Rheumatology and from Brest University Hospital, France. This work used the resources of the Rochester Epidemiology Project, which is supported by the US National Institute on Aging of the National Institutes of Health (NIH) under Award Number R01AG034676, and Clinical and Translational Science Awards Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences, a component of the NIH. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. L. Servioli, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Autoimmune diseases Department, Medical Clinic 1, Hospital Maciel; G. Maciel, MD, Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel; C. Nannini, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Department of Rheumatology, Hospital of Prato; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; D. Cornec, MD, PhD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and Rheumatology Department, Brest Teaching Hospital; A. Berti, MD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and the Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, and the Rheumatology Department, Santa Chiara Hospital. Address correspondence to Dr. E.L. Matteson, Divisions of Rheumatology and Epidemiology, Mayo Clinic College of Medicine, 200 1st St. SW, Rochester, Minnesota 55905, USA. E-mail: Matteson.eric@mayo.edu. Accepted for publication October 9, 2018.

From the Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, and Division of Pulmonary and Critical Care Medicine, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel, Montevideo, Uruguay; Department of Rheumatology, Hospital of Prato, Prato, Italy; Rheumatology Department, Brest Teaching Hospital, Brest, France; Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, Milan, Italy; Rheumatology Department, Santa Chiara Hospital, Trento, Italy. Dr. Cornec received fellowship grants from the French Society of Rheumatology and from Brest University Hospital, France. This work used the resources of the Rochester Epidemiology Project, which is supported by the US National Institute on Aging of the National Institutes of Health (NIH) under Award Number R01AG034676, and Clinical and Translational Science Awards Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences, a component of the NIH. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. L. Servioli, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Autoimmune diseases Department, Medical Clinic 1, Hospital Maciel; G. Maciel, MD, Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel; C. Nannini, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Department of Rheumatology, Hospital of Prato; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; D. Cornec, MD, PhD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and Rheumatology Department, Brest Teaching Hospital; A. Berti, MD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and the Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, and the Rheumatology Department, Santa Chiara Hospital. Address correspondence to Dr. E.L. Matteson, Divisions of Rheumatology and Epidemiology, Mayo Clinic College of Medicine, 200 1st St. SW, Rochester, Minnesota 55905, USA. E-mail: Matteson.eric@mayo.edu. Accepted for publication October 9, 2018.

From the Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, and Division of Pulmonary and Critical Care Medicine, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel, Montevideo, Uruguay; Department of Rheumatology, Hospital of Prato, Prato, Italy; Rheumatology Department, Brest Teaching Hospital, Brest, France; Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, Milan, Italy; Rheumatology Department, Santa Chiara Hospital, Trento, Italy. Dr. Cornec received fellowship grants from the French Society of Rheumatology and from Brest University Hospital, France. This work used the resources of the Rochester Epidemiology Project, which is supported by the US National Institute on Aging of the National Institutes of Health (NIH) under Award Number R01AG034676, and Clinical and Translational Science Awards Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences, a component of the NIH. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. L. Servioli, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Autoimmune diseases Department, Medical Clinic 1, Hospital Maciel; G. Maciel, MD, Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel; C. Nannini, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Department of Rheumatology, Hospital of Prato; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; D. Cornec, MD, PhD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and Rheumatology Department, Brest Teaching Hospital; A. Berti, MD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and the Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, and the Rheumatology Department, Santa Chiara Hospital. Address correspondence to Dr. E.L. Matteson, Divisions of Rheumatology and Epidemiology, Mayo Clinic College of Medicine, 200 1st St. SW, Rochester, Minnesota 55905, USA. E-mail: Matteson.eric@mayo.edu. Accepted for publication October 9, 2018.

From the Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, and Division of Pulmonary and Critical Care Medicine, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel, Montevideo, Uruguay; Department of Rheumatology, Hospital of Prato, Prato, Italy; Rheumatology Department, Brest Teaching Hospital, Brest, France; Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, Milan, Italy; Rheumatology Department, Santa Chiara Hospital, Trento, Italy. Dr. Cornec received fellowship grants from the French Society of Rheumatology and from Brest University Hospital, France. This work used the resources of the Rochester Epidemiology Project, which is supported by the US National Institute on Aging of the National Institutes of Health (NIH) under Award Number R01AG034676, and Clinical and Translational Science Awards Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences, a component of the NIH. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. L. Servioli, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Autoimmune diseases Department, Medical Clinic 1, Hospital Maciel; G. Maciel, MD, Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel; C. Nannini, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Department of Rheumatology, Hospital of Prato; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; D. Cornec, MD, PhD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and Rheumatology Department, Brest Teaching Hospital; A. Berti, MD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and the Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, and the Rheumatology Department, Santa Chiara Hospital. Address correspondence to Dr. E.L. Matteson, Divisions of Rheumatology and Epidemiology, Mayo Clinic College of Medicine, 200 1st St. SW, Rochester, Minnesota 55905, USA. E-mail: Matteson.eric@mayo.edu. Accepted for publication October 9, 2018.

From the Division of Rheumatology, and Division of Biomedical Statistics and Informatics, and Division of Epidemiology, and Division of Pulmonary and Critical Care Medicine, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel, Montevideo, Uruguay; Department of Rheumatology, Hospital of Prato, Prato, Italy; Rheumatology Department, Brest Teaching Hospital, Brest, France; Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, Milan, Italy; Rheumatology Department, Santa Chiara Hospital, Trento, Italy. Dr. Cornec received fellowship grants from the French Society of Rheumatology and from Brest University Hospital, France. This work used the resources of the Rochester Epidemiology Project, which is supported by the US National Institute on Aging of the National Institutes of Health (NIH) under Award Number R01AG034676, and Clinical and Translational Science Awards Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences, a component of the NIH. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. L. Servioli, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Autoimmune diseases Department, Medical Clinic 1, Hospital Maciel; G. Maciel, MD, Autoimmune Diseases Department, Medical Clinic 1, Hospital Maciel; C. Nannini, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science, and Department of Rheumatology, Hospital of Prato; C.S. Crowson, PhD, Division of Rheumatology, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; D. Cornec, MD, PhD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and Rheumatology Department, Brest Teaching Hospital; A. Berti, MD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, and the Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, and the Rheumatology Department, Santa Chiara Hospital. Address correspondence to Dr. E.L. Matteson, Divisions of Rheumatology and Epidemiology, Mayo Clinic College of Medicine, 200 1st St. SW, Rochester, Minnesota 55905, USA. E-mail: Matteson.eric@mayo.edu. Accepted for publication October 9, 2018.