Association of cigarette smoking from adolescence to middle-age with later total and cardiovascular disease mortality: theHarvard Alumni Health Study.
Association of cigarette smoking from adolescence to middle-age with later total and cardiovascular disease mortality: theHarvard Alumni Health Study.
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DOI：
10.1016/j.jacc.2012.06.047
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发表时间：
2012-10-30
影响因子：
24
通讯作者：
Batty, G. David
中科院分区：
文献类型：
--
作者：
Whitley, Elise;Lee, I-Min;Sesso, Howard D.;Batty, G. David
致编辑：关于年轻人吸烟对未来健康影响的证据通常是基于对这种健康行为的回顾性报告，这与同期报告只有中等程度的一致性（1）。在青少年或成年早期前瞻性测量吸烟的后续死亡风险的研究很少，往往集中在总死亡率（2，3）。只有一项研究（4）考虑了原因特异性死亡率，特别是心血管疾病（CVD）。此外，这些研究中使用的青少年吸烟的单一基线测量不太可能完全捕获终身风险。例如，有证据表明，终身吸烟者与终身不吸烟者的死亡风险远远高于目前吸烟者与不吸烟者在任何单个时间点的估计死亡风险（2）。青少年吸烟很常见，而且还在继续增加。决策者需要对风险疾病负担进行可靠的估计。因此，我们在一个大的美国男性大学生队列中探索了成年早期到老年吸烟与全因、心血管疾病和癌症死亡率的关系。据我们所知，这种对吸烟的寿命进行前瞻性测量的方法在文献中是无与伦比的。哈佛校友健康研究是一项正在进行的队列研究，对象是1916年至1950年进入大学的哈佛大学男性校友。在体检期间获得基线吸烟状况，在1962/1966、1977和1988年的随访调查中也报告了可比的吸烟数据。我们采用考克斯比例风险回归分析，探讨了基线吸烟与1998年底死亡率的关系：1）所有原因，2）心血管疾病，3）与吸烟相关的癌症，4）与吸烟无关的癌症。我们还根据基线和1962/1966年、1977年和1988年收集的吸烟状况，研究了全因死亡率与持续吸烟状况的关系。男性定义为持续不吸烟者（所有4个时间点均不吸烟）、持续吸烟者（所有4个时间点均为当前吸烟者）或戒烟者（基线时为当前吸烟者，1988年为非吸烟者，仅1次状态变化）。这些分析中忽略了改变吸烟状态超过一次或在随访期间吸烟的男性。在原始队列的33，415名男性中，28，236人（84.5%）在基线时（平均年龄18岁）有吸烟数据。纳入和排除分析的男性的基线特征相似。总体而言，10，253名男性（36.3%）在基线时吸烟，尽管吸烟者的比例因访谈的十年而异：20世纪10年代约有四分之一的受访男性吸烟。
To the Editor: Evidence regarding the future health impact of smoking at younger ages is usually based on retrospective reporting of this health behavior, which demonstrates only moderate agreement with contemporaneous reporting (1). Studies of subsequent mortality risk with prospectively measured smoking in adolescence or early adulthood are rare and tend to focus on total mortality (2, 3). Only one study (4) has considered cause-specific mortality, in particular cardiovascular disease (CVD). In addition, the single baseline measure of smoking in adolescence used in these studies is unlikely to completely capture lifetime risk For example, there is evidence that mortality risk in lifelong smokers versus lifelong nonsmokers is far greater than that estimated for current smokers versus nonsmokers at any individual time point (2). Cigarette smoking in adolescence is common and continues to increase. Policy makers require reliable estimates of risk disease burden. Accordingly, we have explored all-cause, CVD, and cancer mortality associations with cigarette smoking in early adulthood to older age in a large cohort of male US college students. To our knowledge, this duration of lifetime prospective measurement of cigarette smoking is unrivaled in the literature. The Harvard Alumni Health Study is an ongoing cohort study of male alumni from Harvard University who entered college between 1916 and 1950. Cigarette smoking status was obtained at baseline during a medical examination, and comparable smoking data were also reported in follow-up surveys in 1962/1966, 1977, and 1988. We explored baseline smoking associations with mortality to the end of 1998 from: 1) all causes, 2) CVD, 3) cancers related to smoking, and 4) cancers not related to smoking, using Cox proportional hazards regression. We also examined the associations of all-cause mortality with continuing smoking status based on smoking status collected at baseline and in 1962/1966, 1977, and 1988. Men were defined as continuing nonsmokers (nonsmoker at all 4 time points), continuing smokers (current smokers at all 4 time points), or quitters (current smoker at baseline and nonsmoker by 1988 with only 1 change in status). Men who changed their smoking status more than once or took up smoking during follow-up were omitted from these analyses. There were too few deaths to explore cause-specific mortality in this context.Of 33,415 men in the original cohort, 28,236 (84.5%) had data on cigarette smoking at baseline (mean age 18 years). Baseline characteristics of men included and excluded from analyses were similar. Overall, 10,253 men (36.3%) smoked at baseline, although the proportion of smokers varied according to the decade of interview: Approximately one-quarter of men interviewed in the 1910s were
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影响因子：
6
作者：
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DOI：
10.1136/bmj.b496
发表时间：
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期刊：
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