Smoking and Mortality - Beyond Established Causes
Smoking and Mortality - Beyond Established Causes
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DOI：
10.1056/nejmsa1407211
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发表时间：
2015-02-12
影响因子：
158.5
通讯作者：
Jacobs, Eric J.
中科院分区：
文献类型：
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作者：
Carter, Brian D.;Abnet, Christian C.;Jacobs, Eric J.
目前吸烟者的死亡率是从不吸烟者的2至3倍。据信，这一超额死亡率的大部分是由21种常见疾病造成的，这些疾病已被正式确定为吸烟引起的，并被纳入美国吸烟所致死亡率的官方估计数。然而，如果吸烟会导致其他疾病，这些官方估计可能会大大低估了吸烟导致的死亡人数。METHODSWe汇集了5个当代美国队列研究的数据，包括421，378名男性和532，651名女性55岁或以上。从2000年到2011年，对参与者进行了随访，并使用考克斯比例风险模型估计了相对风险和95%置信区间，该模型对年龄，种族，教育水平，每日饮酒量和队列进行了调整。总体而言，目前吸烟者中约17%的超额死亡率是由于与目前尚未确定的吸烟原因有关。这些研究包括目前吸烟与肾衰竭死亡之间的关系（相对风险，2.0; 95%置信区间[CI]，1.7 - 2.3），肠缺血（相对危险度，6.0; 95% CI，4.5 - 8.1），高血压性心脏病（相对风险，2.4; 95% CI，1.9 - 3.0），感染（相对风险，2.3; 95% CI，2.0 - 2.7），各种呼吸系统疾病（相对风险，2.0; 95%CI，1.6至2.4），乳腺癌（相对风险，1.3; 95%CI，1.2至1.5）和前列腺癌（相对风险，1.4; 95%CI，1.2至1.7）。在前吸烟者中，这些结果的相对风险随着戒烟年限的增加而下降。CONCLUSIONSA 2000年至2011年期间，当前吸烟者的超额死亡率中有很大一部分是由于与尚未正式确定为吸烟引起的疾病相关。应进一步调查这些关联，并在适当时，在调查吸烟的死亡负担时考虑到这些关联。（由美国癌症协会资助。
BACKGROUNDMortality among current smokers is 2 to 3 times as high as that among persons who never smoked. Most of this excess mortality is believed to be explained by 21 common diseases that have been formally established as caused by cigarette smoking and are included in official estimates of smoking-attributable mortality in the United States. However, if smoking causes additional diseases, these official estimates may significantly underestimate the number of deaths attributable to smoking.METHODSWe pooled data from five contemporary U.S. cohort studies including 421,378 men and 532,651 women 55 years of age or older. Participants were followed from 2000 through 2011, and relative risks and 95% confidence intervals were estimated with the use of Cox proportional-hazards models adjusted for age, race, educational level, daily alcohol consumption, and cohort.RESULTSDuring the follow-up period, there were 181,377 deaths, including 16,475 among current smokers. Overall, approximately 17% of the excess mortality among current smokers was due to associations with causes that are not currently established as attributable to smoking. These included associations between current smoking and deaths from renal failure (relative risk, 2.0; 95% confidence interval [CI], 1.7 to 2.3), intestinal ischemia (relative risk, 6.0; 95% CI, 4.5 to 8.1), hypertensive heart disease (relative risk, 2.4; 95% CI, 1.9 to 3.0), infections (relative risk, 2.3; 95% CI, 2.0 to 2.7), various respiratory diseases (relative risk, 2.0; 95% CI, 1.6 to 2.4), breast cancer (relative risk, 1.3; 95% CI, 1.2 to 1.5), and prostate cancer (relative risk, 1.4; 95% CI, 1.2 to 1.7). Among former smokers, the relative risk for each of these outcomes declined as the number of years since quitting increased.CONCLUSIONSA substantial portion of the excess mortality among current smokers between 2000 and 2011 was due to associations with diseases that have not been formally established as caused by smoking. These associations should be investigated further and, when appropriate, taken into account when the mortality burden of smoking is investigated. (Funded by the American Cancer Society.)