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More men smoked and consumed alcohol than women (P? was lower in older than in younger men (P for trend,? and women (P for trend, assessments) and 1868 women (7095 assessments). Changes in SMI by birth cohort were estimated using the general linear mixed-effect model controlled for smoking, alcohol consumption, years of education, annual income and comorbidities (hypertension, heart disease, dyslipidemia, diabetes mellitus and stroke). The main effects of time (P?=?0.03), birth cohort (P?