Lifetime Smoking History and Cause-Specific Mortality in a Cohort Study with 43 Years of Follow-Up.
Lifetime Smoking History and Cause-Specific Mortality in a Cohort Study with 43 Years of Follow-Up.
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在一项43年随访的队列研究中，终生吸烟史和特定原因死亡率。
DOI：
10.1371/journal.pone.0153310
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Boezen HM
中科院分区：
文献类型：
--
作者：
Taghizadeh N;Vonk JM;Boezen HM
一般来说，吸烟会增加死亡的风险。然而，相对危险度如何因死亡原因而异尚不清楚。一生中吸烟习惯的改变对不同死亡风险的确切影响研究较少。在一项队列研究（Vlagtwedde-Vlaardingen 1965-1990，随访至2009年，n = 8,645）中，研究了基线和终生吸烟习惯以及吸烟持续时间对全因死亡率、心血管疾病（CVD）、慢性阻塞性肺疾病（COPD）、任何癌症和四种最常见癌症（肺癌、结直肠癌、前列腺癌和乳腺癌）死亡率的影响。我们使用Cox回归模型校正了年龄、BMI、性别和居住地。由于先前的研究表明性别的潜在影响改变，我们进一步按性别分层并测试相互作用。此外，为了确定哪种死亡原因风险最高，我们对心血管疾病、癌症、慢性阻塞性肺病和其他原因导致的死亡率进行了竞争风险分析。当前吸烟（轻度、中度和重度吸烟）和终生持续吸烟与全因、心血管疾病、慢性阻塞性肺病、任何癌症和肺癌死亡率的风险增加有关。较高的基线包龄与全因、心血管疾病、慢性阻塞性肺病、任何癌症、肺癌、结直肠癌和前列腺癌死亡率增加有关。终生持续吸烟斗/雪茄的男性患肺癌的风险更高[HR (95% CI) = 7.72(1.72-34.75)]，全因死亡率和任何癌症死亡率也更高。吸烟时间越长，患慢性阻塞性肺病、肺癌和肺癌的风险越高[相对危险度（95% CI）分别为1.06（1.00-1.12）、1.03（1.00-1.06）和1.10(1.03 - 1.17)]，但与其他死亡原因无关。相互竞争的风险分析表明，与所有其他死亡原因相比，曾经和现在的吸烟者患癌症、心血管疾病和慢性阻塞性肺病的风险更高。此外，与癌症和心血管疾病死亡率相比，重度吸烟者患慢性阻塞性肺病的风险更高。我们的研究表明，一生中吸烟的数量和吸烟的持续时间对不同的死亡原因有不同的影响。此外，我们的研究结果强调了在研究普通人群中与吸烟相关的癌症死亡率时，吸烟相关的竞争风险的重要性，并且戒烟立即有效地降低了全因和任何癌症死亡率的风险。
In general, smoking increases the risk of mortality. However, it is less clear how the relative risk varies by cause of death. The exact impact of changes in smoking habits throughout life on different mortality risks is less studied. We studied the impact of baseline and lifetime smoking habits, and duration of smoking on the risk of all-cause mortality, mortality of cardiovascular diseases (CVD), chronic obstructive pulmonary disease (COPD), any cancer and of the four most common types of cancer (lung, colorectal, prostate, and breast cancer) in a cohort study (Vlagtwedde-Vlaardingen 1965–1990, with a follow-up on mortality status until 2009, n = 8,645). We used Cox regression models adjusted for age, BMI, sex, and place of residence. Since previous studies suggested a potential effect modification of sex, we additionally stratified by sex and tested for interactions. In addition, to determine which cause of death carried the highest risk we performed competing-risk analyses on mortality due to CVD, cancer, COPD and other causes. Current smoking (light, moderate, and heavy cigarette smoking) and lifetime persistent smoking were associated with an increased risk of all-cause, CVD, COPD, any cancer, and lung cancer mortality. Higher numbers of pack years at baseline were associated with an increased risk of all-cause, CVD, COPD, any cancer, lung, colorectal, and prostate cancer mortality. Males who were lifetime persistent pipe/cigar smokers had a higher risk of lung cancer [HR (95% CI) = 7.72 (1.72–34.75)] as well as all-cause and any cancer mortality. A longer duration of smoking was associated with a higher risk of COPD, any and lung cancer [HR (95% CI) = 1.06 (1.00–1.12), 1.03 (1.00–1.06) and 1.10 (1.03–1.17) respectively], but not with other mortality causes. The competing risk analyses showed that ex- and current smokers had a higher risk of cancer, CVD, and COPD mortality compared to all other mortality causes. In addition, heavy smokers had a higher risk for COPD mortality compared to cancer, and CVD mortality. Our study indicates that lifetime numbers of cigarettes smoked and the duration of smoking have different impacts for different causes of mortality. Moreover, our findings emphasize the importance of smoking-related competing risks when studying the smoking-related cancer mortality in a general population and that smoking cessation immediately effectively reduces the risk of all-cause and any cancer mortality.