Causes of and Clinical Features Associated with Death in Tobacco Cigarette Users by Lung Function Impairment.
Causes of and Clinical Features Associated with Death in Tobacco Cigarette Users by Lung Function Impairment.
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吸烟者因肺功能损伤死亡的原因和相关临床特征。
DOI：
10.1164/rccm.202210-1887oc
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发表时间：
2023
影响因子：
24.7
通讯作者：
Kazerooni
中科院分区：
文献类型：
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作者：
Labaki,WassimW;Gu,Tian;Murray,Susan;Curtis,JeffreyL;Wells,JMichael;Bhatt,SuryaP;Bon,Jessica;Diaz,AlejandroA;Hersh,CraigP;Wan,EmilyS;Kim,Victor;Beaty,TerriH;Hokanson,JohnE;Bowler,RussellP;Arenberg,DouglasA;Kazerooni
基本原理：吸烟通过不同的机制增加死亡风险。目的：通过肺功能损害，确定烟草吸烟者死亡的原因和与死亡相关的临床特征如何变化。方法：我们将参加慢性阻塞性肺疾病遗传流行病学（COPDGene）的当前和以前的烟草吸烟者分层为正常肺功能测定、PRISm（保留比率肺功能测定）、慢性阻塞性肺疾病全球倡议（GOLD）1-2 COPD和GOLD 3-4 COPD。通过纵向随访和社会保障死亡指数搜索确定死亡。在审查死亡证明、医疗记录和近亲面谈后裁定死亡原因。我们使用多变量考克斯比例风险模型检验了基线临床变量和全因死亡率之间的相关性。测量和主要结果：在10.1年的中位随访中，10,132名参与者中发生了2,200例死亡（年龄59.5 ± 9.0岁; 46.6%为女性）。心血管疾病死亡在PRISm中最常见（占死亡的31%）。肺癌死亡在GOLD 1-2组中最常见（死亡率为18%，其他组为9-11%）。在GOLD 3-4中，呼吸道死亡超过了竞争性死亡原因，特别是当BODE指数为1.07时。所有组中，圣乔治呼吸问卷评分> 25与较高的死亡率相关：风险比（HR），1.48（1.20-1.84）肺功能正常; HR，1.40（1.05-1.87）PRISm; HR，1.80（1.49-2.17）GOLD 1-2; HR，1.65（1.26-2.17）GOLD 3-4。GOLD 1-2和GOLD 3-4组中，呼吸恶化史与较高的死亡率相关，GOLD 1-2组中，定量肺气肿与较高的死亡率相关，PRISm和GOLD 3- 4组中，呼吸道壁厚度与较高的死亡率相关。无论肺功能如何，手术相关的生活质量越差，全因死亡率越高。
Rationale:Cigarette smoking contributes to the risk of death through different mechanisms.Objectives:To determine how causes of and clinical features associated with death vary in tobacco cigarette users by lung function impairment.Methods:We stratified current and former tobacco cigarette users enrolled in Genetic Epidemiology of Chronic Obstructive Pulmonary Disease (COPDGene) into normal spirometry, PRISm (Preserved Ratio Impaired Spirometry), Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1–2 COPD, and GOLD 3–4 COPD. Deaths were identified via longitudinal follow-up and Social Security Death Index search. Causes of death were adjudicated after a review of death certificates, medical records, and next-of-kin interviews. We tested associations between baseline clinical variables and all-cause mortality using multivariable Cox proportional hazards models.Measurements and Main Results:Over a 10.1-year median follow-up, 2,200 deaths occurred among 10,132 participants (age 59.5 ± 9.0 yr; 46.6% women). Death from cardiovascular disease was most frequent in PRISm (31% of deaths). Lung cancer deaths were most frequent in GOLD 1–2 (18% of deaths vs. 9–11% in other groups). Respiratory deaths outpaced competing causes of death in GOLD 3–4, particularly when BODE index ⩾7. St. George’s Respiratory Questionnaire score ⩾25 was associated with higher mortality in all groups: Hazard ratio (HR), 1.48 (1.20–1.84) normal spirometry; HR, 1.40 (1.05–1.87) PRISm; HR, 1.80 (1.49–2.17) GOLD 1–2; HR, 1.65 (1.26–2.17) GOLD 3–4. History of respiratory exacerbations was associated with higher mortality in GOLD 1–2 and GOLD 3–4, quantitative emphysema in GOLD 1–2, and airway wall thickness in PRISm and GOLD 3–4.Conclusions:Leading causes of death vary by lung function impairment in tobacco cigarette users. Worse respiratory-related quality of life is associated with all-cause mortality regardless of lung function.