Gender-specific effects of smoking and alcohol consumption on cardiometabolic diseases and multimorbidity: A cross-sectional study

Gender-specific variations in hormonal profiles, adipose tissue distribution, and metabolic pathways may differentially modulate the health impacts of smoking and alcohol use. Current population-based studies on the impact of smoking and alcohol consumption on cardiometabolic diseases (CMD) and multimorbidity (CMM) often lack gender-stratified analyses, thereby limiting the evidence base for gender-tailored preventive strategies. This population-based cross-sectional study used data from the 2020 China Health and Retirement Longitudinal Study (CHARLS), and a total of 11447 participants were included in the analysis. Multinomial logistic regression was conducted to assess behavioral risk factors, with interaction terms evaluating effect modification by gender. The prevalence was 16.67% for CMD and 5.66% for CMM. Participants who smoked were more likely to report CMM than those who did not smoke (OR=2.70, p<0.05). Smoking was significantly associated with the prevalence of CMD in females (AOR=1.34, p<0.05), but not in males (p=0.556). Moreover, female smokers were more likely to report CMM compared to male smokers (AORfemales=3.53, AORmales=2.02, p<0.05). No significant associations were found between alcohol consumption and the prevalence of CMD or CMM, nor were any gender-specific differences observed. Smoking may have a potential gender-specific effect on the risk of CMD and CMM, with female smokers exhibiting a higher prevalence of CMM than males. This highlights the need to integrate gender considerations into chronic disease prevention frameworks.