Contrasting male and female trends in tobacco-attributed mortality in China: evidence from successive nationwide prospective cohort studies.
Contrasting male and female trends in tobacco-attributed mortality in China: evidence from successive nationwide prospective cohort studies.
复制标题
DOI：
10.1016/s0140-6736(15)00340-2
复制
发表时间：
2015-10-10
期刊：
影响因子：
--
通讯作者：
China Kadoorie Biobank (CKB) collaborative group
中科院分区：
文献类型：
--
作者：
Chen Z;Peto R;Zhou M;Iona A;Smith M;Yang L;Guo Y;Chen Y;Bian Z;Lancaster G;Sherliker P;Pang S;Wang H;Su H;Wu M;Wu X;Chen J;Collins R;Li L;China Kadoorie Biobank (CKB) collaborative group
中国男性现在吸烟量超过世界的三分之一，在城市和农村的吸烟量大幅增加之后。相反，中国女性现在吸烟的人数远低于前几代人。我们评估了烟草对男性和女性死亡率的相反变化的影响。两项相隔15年的全国性前瞻性研究在1991年招募了22万名40-79岁的男性（第一项研究），在2006年招募了21万名35-74岁的男性和30万名女性（第二项研究），分别在1991-99年（1995年年中）和2006-14年（2010年年中）进行了随访。 考克斯回归分析得出了吸烟者（包括任何因疾病而戒烟的人，但不包括其他戒烟者，他们被描述为选择戒烟）与从不吸烟者的性别特异性调整死亡率比（RR）。三分之二的男性吸烟;男性吸烟率与年龄关系不大，但许多吸烟者在整个成年生活中都没有吸烟。比较1950年以前和1950年以后出生的男子，在老一代中，开始吸烟的年龄较晚，特别是在农村地区，终生只吸烟的情况比年轻一代少。比较第一项研究中的男性死亡率RR（1995年年中）与第二次研究中的比较（2010年年中），吸烟者的比例超额风险（RR-1）在这15年期间大约翻了一番（城市：RR 1.32 [95%CI 1.24 - 1.41] vs 1.65 [1.53 - 1.79];农村：RR 1.13 [1.09 - 1.17] vs 1.22 [1.16 - 1.29]），40-79岁年龄段吸烟导致的死亡比例也是如此。（城市：17%对26%;农村：9%对14%）。在第二项研究中，20岁之前开始吸烟的城市男性吸烟者，（这在城市和农村的年轻人中很常见）的死亡率是从不吸烟者的两倍（RR 1.98，1.79 - 2.19，接近西方RR），慢性阻塞性肺疾病的死亡率大幅增加（COPD RR 9·09，5·11-16·15）、肺癌（RR 3·78，2·78-5·14）和缺血性卒中或缺血性心脏病（组合RR 2·03，1·66-2·47）。选择戒烟的戒烟者（1991年只有3%的曾经吸烟者，但2006年为9%）在戒烟后10年内几乎没有吸烟归因风险。然而，在中国女性中，吸烟率代际下降了十倍。在第二项研究中，在20世纪30年代、40年代、50年代和1960年以后出生的妇女中，吸烟的比例分别为10%、5%、2%和1%（3097/30 943、3265/62 246、2339/97 344和1068/111 933）。 40-79岁所有女性死亡的吸烟者与非吸烟者的RR为1.51（1.40 - 1.63），分别占这四个连续出生队列中所有女性死亡的5%、3%、1%和<1%。2010年，吸烟导致中国约100万人（男性84万，女性13万）死亡。 在2010年期间，吸烟将导致中国所有成年男性死亡的20%。男性吸烟比例在上升，但女性吸烟比例较低且在下降。虽然成人死亡率总体在下降，但随着中国成年人口的增长和吸烟导致的男性死亡比例的增加，除非广泛戒烟，否则中国每年因烟草导致的死亡人数将从2010年的约100万人增加到2030年的200万人和2050年的300万人。Wellcome Trust，MRC，BHF，CR-UK，Kadoorie Charitable Foundation，Chinese MST and NSFC
Chinese men now smoke more than a third of the world's cigarettes, following a large increase in urban then rural usage. Conversely, Chinese women now smoke far less than in previous generations. We assess the oppositely changing effects of tobacco on male and female mortality. Two nationwide prospective studies 15 years apart recruited 220 000 men in about 1991 at ages 40–79 years (first study) and 210 000 men and 300 000 women in about 2006 at ages 35–74 years (second study), with follow-up during 1991–99 (mid-year 1995) and 2006–14 (mid-year 2010), respectively. Cox regression yielded sex-specific adjusted mortality rate ratios (RRs) comparing smokers (including any who had stopped because of illness, but not the other ex-smokers, who are described as having stopped by choice) versus never-smokers. Two-thirds of the men smoked; there was little dependence of male smoking prevalence on age, but many smokers had not smoked cigarettes throughout adult life. Comparing men born before and since 1950, in the older generation, the age at which smoking had started was later and, particularly in rural areas, lifelong exclusive cigarette use was less common than in the younger generation. Comparing male mortality RRs in the first study (mid-year 1995) versus those in the second study (mid-year 2010), the proportional excess risk among smokers (RR-1) approximately doubled over this 15-year period (urban: RR 1·32 [95% CI 1·24–1·41] vs 1·65 [1·53–1·79]; rural: RR 1·13 [1·09–1·17] vs 1·22 [1·16–1·29]), as did the smoking-attributed fraction of deaths at ages 40–79 years (urban: 17% vs 26%; rural: 9% vs 14%). In the second study, urban male smokers who had started before age 20 years (which is now typical among both urban and rural young men) had twice the never-smoker mortality rate (RR 1·98, 1·79–2·19, approaching Western RRs), with substantial excess mortality from chronic obstructive pulmonary disease (COPD RR 9·09, 5·11–16·15), lung cancer (RR 3·78, 2·78–5·14), and ischaemic stroke or ischaemic heart disease (combined RR 2·03, 1·66–2·47). Ex-smokers who had stopped by choice (only 3% of ever-smokers in 1991, but 9% in 2006) had little smoking-attributed risk more than 10 years after stopping. Among Chinese women, however, there has been a tenfold intergenerational reduction in smoking uptake rates. In the second study, among women born in the 1930s, 1940s, 1950s, and since 1960 the proportions who had smoked were, respectively, 10%, 5%, 2%, and 1% (3097/30 943, 3265/62 246, 2339/97 344, and 1068/111 933). The smoker versus non-smoker RR of 1·51 (1·40–1·63) for all female mortality at ages 40–79 years accounted for 5%, 3%, 1%, and <1%, respectively, of all the female deaths in these four successive birth cohorts. In 2010, smoking caused about 1 million (840 000 male, 130 000 female) deaths in China. Smoking will cause about 20% of all adult male deaths in China during the 2010s. The tobacco-attributed proportion is increasing in men, but low, and decreasing, in women. Although overall adult mortality rates are falling, as the adult population of China grows and the proportion of male deaths due to smoking increases, the annual number of deaths in China that are caused by tobacco will rise from about 1 million in 2010 to 2 million in 2030 and 3 million in 2050, unless there is widespread cessation. Wellcome Trust, MRC, BHF, CR-UK, Kadoorie Charitable Foundation, Chinese MoST and NSFC