How smoking affects the proportion of deaths attributable to obesity: assessing the role of relative risks and weight distributions.
How smoking affects the proportion of deaths attributable to obesity: assessing the role of relative risks and weight distributions.
复制标题
吸烟如何影响肥胖导致的死亡比例：评估相对风险和体重分布的作用。
DOI：
10.1136/bmjopen-2015-009232
复制
发表时间：
2016
期刊：
影响因子：
2.9
通讯作者：
Preston,SamuelH
中科院分区：
文献类型：
--
作者：
Stokes,Andrew;Preston,SamuelH
虽然在美国，老烟民占老年人口的大多数，但他们经常被排除在肥胖对死亡率影响的研究之外。了解吸烟和肥胖如何相互作用对于评估肥胖导致的死亡比例至关重要。美国非收容人口的全国代表性样本。基线数据来自1988-1994年和1999-2004年的全国健康和营养检查调查。参与者为50-74岁的成年人（n=9835）。主要结局指标：我们使用Cox模型来估计吸烟状况导致肥胖的死亡风险。前瞻性评估了截至2006年12月31日的全因死亡率（n=1243例死亡）。最大身体质量指数（BMI）被指定为关键暴露变量。我们还通过吸烟状况计算了人口归因分数（paf），并在分解分析中调查了paf的差异。结果不吸烟者BMI超过25.0 kg/m2每增加一个单位的HR分别为1.057 （95% CI 1.033 ~ 1.082, p<0.001）、1.036 （95% CI 1.015 ~ 1.059, p<0.01）和1.024 （95% CI 0.997 ~ 1.052）。我们估计19.8%的死亡可归因于超重。不吸烟者、曾经吸烟者和现在吸烟者的paf分别为31.9、20.4和11.3。从不吸烟者和现在吸烟者之间paf的差异几乎完全可以用hr的差异来解释。结论不吸烟者因肥胖死亡的比例是目前吸烟者的近3倍。这一发现与吸烟者面临重大竞争风险的事实是一致的。排除吸烟者的分析很可能大大高估了美国因肥胖而死亡的比例。
ObjectiveAlthough ever-smokers make up the majority of the older adult population in the USA, they are often excluded from studies examining the impact of obesity on mortality. Understanding how smoking and obesity interact is critical to assessing the proportion of deaths attributable to obesity.SettingNationally representative sample of the non-institutionalised population of the USA. Baseline data were drawn from the National Health and Nutrition Examination Survey, 1988–1994 and 1999–2004.ParticipantsUS adults aged 50–74 (n=9835).Primary outcome measureWe used Cox models to estimate the mortality risks of obesity by smoking status. All-cause mortality was assessed prospectively through 31 December 2006 (n=1243 deaths). Maximum body mass index (BMI) was specified as the key exposure variable. We also calculated population attributable fractions (PAFs) by smoking status and investigated differences in PAFs in a decomposition analysis.ResultsThe HR associated with a one-unit increment in BMI beyond 25.0 kg/m2was 1.057 for never-smokers (95% CI 1.033 to 1.082; p<0.001), 1.036 for former smokers (95% CI 1.015 to 1.059; p<0.01) and 1.024 for current smokers (95% CI 0.997 to 1.052).We estimated that 19.8% of deaths were attributable to excess weight. The PAFs were 31.9, 20.4 and 11.3 for never-smokers, former and current smokers, respectively. The difference in PAFs between never-smokers and current smokers was almost entirely explained by the difference in HRs.ConclusionsThe proportion of deaths attributable to obesity is nearly 3 times as high among never-smokers compared with current smokers. This finding is consistent with the fact that smokers are subject to significant competing risks. Analyses that exclude smokers are likely to substantially overestimate the proportion of deaths attributable to obesity in the USA.