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The association of telomere length with substance use disorders: a systematic review and meta‐analysis of observational studies
Author(s) -
NavarroMateu Fernando,
Husky Mathilde,
CayuelaFuentes Pedro,
Álvarez FranciscoJavier,
RocaVega Agustín,
RubioAparicio María,
Chirlaque María Dolores,
Cayuela María Luisa,
Martínez Salvador,
SánchezMeca Julio
Publication year - 2021
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.15312
Subject(s) - meta analysis , funnel plot , confidence interval , forest plot , publication bias , observational study , study heterogeneity , medicine , random effects model , statistics , mathematics
Background and Aims Several recent studies have investigated the relationship between telomere length and substance use disorders with inconsistent results. We aimed to assess this association and to identify moderators of the relationship. Methods Systematic review and meta‐analysis. Selection criteria were observational studies reporting telomere length in people with a substance use disorder compared with a control group. Studies focused solely on nicotine addiction, employing other study designs, and non‐human studies were excluded. Study selection and data extraction were independently conducted by two researchers following a standardized protocol and included studies until December 2019. Standardized mean differences were used as the effect size index [ d ; 95% confidence interval (CI)] and random‐effects models were used for the meta‐analysis. Cochran's Q ‐statistic, I 2 index, visual inspection of the forest plot and a 95% prediction interval were applied to verify study heterogeneity. Subgroup analyses and meta‐regressions were conducted to explore heterogeneity. Small study effects were examined using the ‘funnel plot’, the Egger test, Duval & Tweedie's trim‐and‐fill method and the precision‐effect test–precision‐effect estimate with standard error (PET‐PEESE) method. The risk of bias and the quality of evidence were assessed. Results Ten studies (12 analysis units with 2671 cases and 4532 controls) met the selection criteria. An overall effect size of moderate magnitude was found ( d + = −0.63; 95% CI = −1.00 and −0.26; P = 0.0008). A potential small study effect was detected, as well as large heterogeneity between studies ( Q ‐statistic P < 0.001, I 2 = 97.3%). Selection of controls, reporting laboratory quality control procedures and total sample size significantly affected the effect size. The quality of the evidence was very low, based on risk of bias analysis and the grading of recommendations assessment, development and evaluation (GRADE) system. Conclusions People with substance use disorders appear to have shorter telomere length than controls; however, this finding should be interpreted with caution due to the poor quality of the evidence.