A prospective study of cigarette smoking and age-related macular degeneration in women.
A prospective study of cigarette smoking and age-related macular degeneration in women.
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DOI：
10.1001/jama.1996.03540140029022
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发表时间：
1996-10
期刊：
影响因子：
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通讯作者：
J. Seddon;W. Willett;F. Speizer;S. Hankinson
中科院分区：
文献类型：
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作者：
J. Seddon;W. Willett;F. Speizer;S. Hankinson
目的探讨吸烟与女性年龄相关性黄斑变性（AMD）发病的关系。设计：前瞻性队列研究，随访12年（1980 ~ 1992），吸烟习惯信息每2年更新一次。设置在美国的11个州。参与者：共有31843名注册护士参加了护士健康研究，他们在1980年年龄在50到59岁之间，在研究开始时没有报告癌症或AMD的诊断。其他妇女在达到50岁时进入分析队列。主要观察指标AMD合并视力下降的发生率。结果：在556338人年的随访中，215名女性被新诊断为AMD。在调整了AMD的其他危险因素后，目前每天吸烟25支或更多的女性与从不吸烟的女性相比，AMD的相对危险度（RR）为2.4（95%置信区间[CI]，1.4-4.0）。与从不吸烟者相比，这一数量的既往吸烟者的风险也增加了2倍（RR=2.0; 95% CI，1.2-3.4）。与目前的吸烟者相比，即使戒烟15年或更长时间，风险也几乎没有降低。AMD的风险也随着吸烟包年数的增加而增加（趋势P <.001）;在吸烟65包年或以上的女性中，风险是从不吸烟者的2.4倍（95%CI，1.5-3.8）。对干性和渗出型AMD以及其他AMD定义的分析显示了相似的结果。结论：吸烟是女性AMD的一个独立的和可避免的危险因素。由于AMD是老年人严重视力障碍的最常见原因，并且对大多数患者来说治疗不可用或无效，因此降低这种疾病的风险是避免吸烟的另一个重要原因。
OBJECTIVE To evaluate the relationship between cigarette smoking and incidence of age-related macular degeneration (AMD) among women. DESIGN Prospective cohort study with 12 years of follow-up (1980 to 1992), in which information on smoking habits was updated every 2 years. SETTING Eleven states throughout the United States. PARTICIPANTS A total of 31 843 registered nurses enrolled in the Nurses' Health Study who were aged 50 to 59 years in 1980 and did not report a diagnosis of cancer or AMD at the beginning of the study. Additional women entered the analytic cohort as they reached 50 years of age. MAIN OUTCOME MEASURE Incidence of AMD with visual loss. RESULTS During 556 338 person-years of follow-up, 215 women were newly diagnosed as having AMD. After adjusting for other risk factors for AMD, women who currently smoked 25 or more cigarettes per day had a relative risk (RR) of AMD of 2.4 (95% confidence interval [CI], 1.4-4.0) compared with women who never smoked. Past smokers of this amount also had a 2-fold increased risk (RR=2.0; 95% CI, 1.2-3.4) relative to never smokers. Compared with current smokers, little reduction in risk was suggested even after quitting smoking for 15 or more years. Risk of AMD also increased with an increasing number of pack-years smoked (P for trend <.001); among women who smoked for 65 or more pack-years, the risk was 2.4 times the risk of never smokers (95% CI, 1.5-3.8). Analyses of dry and exudative types of AMD and other alternative definitions of AMD revealed similar results. CONCLUSIONS Cigarette smoking is an independent and avoidable risk factor for AMD among women. Because AMD is the most common cause of severe visual impairment among the elderly and treatment is not available or is ineffective for most patients, reducing the risk of this disease is another important reason to avoid smoking.