Smoking and Mortality in Stroke Survivors: Can We Eliminate the Paradox?
Smoking and Mortality in Stroke Survivors: Can We Eliminate the Paradox?
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DOI：
10.1016/j.jstrokecerebrovasdis.2013.10.026
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发表时间：
2014-07-01
影响因子：
2.5
通讯作者：
Mulhorn, Kristine A.
中科院分区：
文献类型：
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作者：
Levine, Deborah A.;Walter, James M.;Mulhorn, Kristine A.
背景：许多研究表明，吸烟不会增加中风幸存者的死亡率。指数事件偏差，一种样本选择偏差，可能解释了这一矛盾的发现。因此，我们比较了卒中幸存者中吸烟状况导致的全因、心血管疾病（CVD）和癌症死亡率，采用了考虑指数事件偏倚的方法。方法：在5797名45岁或以上的中风幸存者中，他们参加了1997-2004年的全国健康访谈调查，这是一项与全国死亡指数相关的美国社区成年人的年度人口调查，我们使用Cox比例回归和倾向评分分析来估计吸烟状况的全因、心血管疾病和癌症死亡率，以考虑人口统计学、社会经济和临床因素。平均随访时间为4.5年。结果：从1997年到2004年，18.7%的中风幸存者吸烟。在这个中风幸存者队列中有1988人死亡，其中50%死于心血管疾病，15%死于癌症。在控制了人口统计学、社会经济和临床因素后，与从不吸烟者相比，当前吸烟者的全因死亡率（危险比[HR]， 1.36； 95%置信区间[CI]， 1.14-1.63）和癌症死亡率（危险比，3.83;95% CI, 2.48-5.91）的风险增加。在控制了年龄和性别因素后，当前吸烟者心血管疾病死亡风险增加（HR, 1.29; 95% CI, 1.01-1.64），但在控制了社会经济和临床因素后，这种风险不存在（HR, 1.15; 95% CI, 0.88 -1.50）。结论：吸烟的中风幸存者的全因死亡率增加，这主要是因为癌症死亡率。社会经济和临床因素解释了中风幸存者与吸烟相关的心血管疾病死亡率较高的风险。
Background: Many studies have suggested that smoking does not increase mortality in stroke survivors. Index event bias, a sample selection bias, potentially explains this paradoxical finding. Therefore, we compared all-cause, cardiovascular disease (CVD), and cancer mortality by cigarette smoking status among stroke survivors using methods to account for index event bias. Methods: Among 5797 stroke survivors of 45 years or older who responded to the National Health Interview Survey years 1997-2004, an annual, population-based survey of community-dwelling US adults, linked to the National Death Index, we estimated all-cause, CVD, and cancer mortality by smoking status using Cox proportional regression and propensity score analysis to account for demographic, socioeconomic, and clinical factors. Mean follow-up was 4.5 years. Results: From 1997 to 2004, 18.7% of stroke survivors smoked. There were 1988 deaths in this stroke survivor cohort, with 50% of deaths because of CVD and 15% because of cancer. Current smokers had an increased risk of all-cause mortality (hazard ratio [HR], 1.36; 95% confidence interval [CI], 1.14-1.63) and cancer mortality (HR, 3.83; 95% CI, 2.48-5.91) compared with never smokers, after controlling for demographic, socioeconomic, and clinical factors. Current smokers had an increased risk of CVD mortality controlling for age and sex (HR, 1.29; 95% CI, 1.01-1.64), but this risk did not persist after controlling for socioeconomic and clinical factors (HR, 1.15; 95% CI, .88-1.50). Conclusions: Stroke survivors who smoke have an increased risk of all-cause mortality, which is largely because of cancer mortality. Socioeconomic and clinical factors explain stroke survivors' higher risk of CVD mortality associated with smoking.