Association of Long-term, Low-Intensity Smoking With All-Cause and Cause-Specific Mortality in the National Institutes of Health-AARP Diet and Health Study.
Association of Long-term, Low-Intensity Smoking With All-Cause and Cause-Specific Mortality in the National Institutes of Health-AARP Diet and Health Study.
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DOI：
10.1001/jamainternmed.2016.7511
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发表时间：
2017-01-01
影响因子：
39
通讯作者：
Freedman ND
中科院分区：
文献类型：
--
作者：
Inoue-Choi M;Liao LM;Reyes-Guzman C;Hartge P;Caporaso N;Freedman ND
越来越多的美国吸烟者现在每天吸烟少于10支（CPD），这一比例在未来可能会上升。在一生中只吸少量CPD对健康的影响不如吸烟量大的影响那么令人了解，尽管许多吸烟者认为他们的水平是适度的。评估与从不吸烟相比，长期吸烟少于1或1至10 CPD（低强度）与全因和病因特异性死亡率的相关性。美国国立卫生研究院-美国退休人员协会（以前称为美国退休人员协会）饮食和健康研究中的290 215名成年人的前瞻性队列研究，他们在2004-2005日历年（基线）年龄为59至82岁。通过评估终生吸烟史的问卷收集数据。确定了截至2011年底的全因死亡率和特定原因死亡率的风险比（HR）和95% CI。使用考克斯比例风险回归模型估计风险比和95% CI，使用年龄作为基础时间指标，并根据性别、人种/种族、教育水平、体力活动和酒精摄入量进行校正。数据分析于2015年12月15日至2016年9月30日进行。在2004-2005年调查问卷中评估的9个既往年龄段（<15岁至≥70岁）的当前和历史吸烟强度。当前吸烟者、既往吸烟者和从不吸烟者的全因和特定原因死亡率在完成2004-2005年调查问卷的290215名队列参与者中，168140名为男性（57.9%）;平均（SD）年龄为71（5.3）岁（范围：59-82岁）。大多数在基线时吸烟少于1或1至10个CPD的人在他们生命的早期报告吸烟的CPD数量大大增加。然而，这些人中分别有159人（9.1%）和1493人（22.5%）报告在每个吸烟年龄段持续吸烟少于1或1至10 CPD。相对于从不吸烟者，持续吸烟少于1个CPD（HR，1.64; 95% CI，1.07-2.51）和1至10个CPD（HR，1.87; 95% CI，1.64-2.13）的吸烟者具有更高的全因死亡风险。女性和男性的全因死亡率的相关性相似，并且在一系列与吸烟相关的死亡原因中观察到，与肺癌的相关性特别强（<1和1-10 CPD的HR，9.12; 95%CI，2.92-28.47和HR，11.61; 95%CI，8.25-16.35）。持续吸烟少于1或1至10 CPD的前吸烟者随着戒烟年龄的减小，风险逐渐降低。例如，50岁或50岁以上戒烟的CPD少于1和1至10的持续吸烟者的HR分别为1.44（95% CI，1.12-1.85）和1.42（95% CI，1.27-1.59）。这项研究提供的证据表明，在一生中吸烟少于1或1至10 CPD的人比从不吸烟的人有更高的死亡风险，并将从戒烟中受益。这些结果提供了进一步的证据，表明没有无风险的烟草烟雾暴露水平。
A growing proportion of US smokers now smoke fewer than 10 cigarettes per day (CPD), and that proportion will likely rise in the future. The health effects of smoking only a few CPD over one’s lifetime are less understood than are the effects of heavier smoking, although many smokers believe that their level is modest. To evaluate the associations of long-term smoking of fewer than 1 or 1 to 10 CPD (low intensity) with all-cause and cause-specific mortality compared with never smoking cigarettes. Prospective cohort study of 290 215 adults in the National Institutes of Health–AARP (formerly known as the American Association of Retired Persons) Diet and Health Study who were aged 59 to 82 years in calendar years 2004–2005 (baseline). Data were gathered with a questionnaire assessing lifetime cigarette smoking history. Hazard ratios (HRs) and 95% CIs were determined for all-cause mortality and cause-specific mortality through the end of 2011. Hazard ratios and 95% CIs were estimated using Cox proportional hazards regression models using age as the underlying time metric and adjusted for sex, race/ethnicity, educational level, physical activity, and alcohol intake. Data analysis was conducted from December 15, 2015, to September 30, 2016. Current and historical smoking intensity during 9 previous age periods (from <15 years to ≥70 years) over the lifetime assessed on the 2004–2005 questionnaire. All-cause and cause-specific mortality among current, former, and never smokers. Of the 290 215 cohort participants who completed the 2004–2005 questionnaire, 168 140 were men (57.9%); the mean (SD) age was 71 (5.3) years (range, 59–82 years). Most people who smoked fewer than 1 or 1 to 10 CPD at baseline reported smoking substantially higher numbers of CPD earlier in their lives. Nevertheless, 159 (9.1%) and 1493 (22.5%) of these individuals reported consistently smoking fewer than 1 or 1 to 10 CPD in each age period that they smoked, respectively. Relative to never smokers, consistent smokers of fewer than 1 CPD (HR, 1.64; 95% CI, 1.07–2.51) and 1 to 10 CPD (HR, 1.87; 95% CI, 1.64–2.13) had a higher all-cause mortality risk. Associations were similar in women and men for all-cause mortality and were observed across a range of smoking-related causes of death, with an especially strong association with lung cancer (HR, 9.12; 95% CI, 2.92–28.47, and HR, 11.61; 95% CI, 8.25–16.35 for <1 and 1–10 CPD, respectively). Former smokers who had consistently smoked fewer than 1 or 1 to 10 CPD had progressively lower risks with younger age at cessation. For example, the HRs for consistent smokers of fewer than 1 and 1 to 10 CPD who quit at 50 years or older were 1.44 (95% CI, 1.12–1.85) and 1.42 (95% CI, 1.27–1.59), respectively. This study provides evidence that individuals who smoke fewer than 1 or 1 to 10 CPD over their lifetime have higher mortality risks than never smokers and would benefit from cessation. These results provide further evidence that there is no risk-free level of exposure to tobacco smoke.
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DOI：
10.1158/1055-9965.epi-13-1014
发表时间：
2014-07
期刊：
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
影响因子：
--
作者：
Shiffman S;Dunbar MS;Benowitz NL
通讯作者：
Benowitz NL
影响因子：
5.5
作者：
Holford, Theodore R.;Levy, David T.;Mckay, Lisa A.;Clarke, Lauren;Racine, Ben;Meza, Rafael;Land, Stephanie;Jeon, Jihyoun;Feuer, Eric J.
通讯作者：
Feuer, Eric J.
影响因子：
11.1
作者：
ROSENGREN, A;WILHELMSEN, L;WEDEL, H
通讯作者：
WEDEL, H
影响因子：
12.7
作者：
Hassmiller, KM;Warner, KE;Romano, E
通讯作者：
Romano, E
影响因子：
5
作者：
Caraballo, RS;Giovino, GA;Mowery, PD
通讯作者：
Mowery, PD