Mortality in relation to smoking: 50 years' observations on male British doctors
Mortality in relation to smoking: 50 years' observations on male British doctors
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DOI：
10.1136/bmj.38142.554479.ae
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发表时间：
2004-06-26
影响因子：
105.7
通讯作者：
Sutherland, I
中科院分区：
文献类型：
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作者：
Doll, R;Peto, R;Sutherland, I
目的比较在不同时期形成吸烟习惯的男性吸烟的危害，以及在不同年龄段停止吸烟时风险降低的程度。设计前瞻性研究，从1951年持续到2001年。有关他们的吸烟习惯的信息是在1951年获得的，并定期此后，原因特异性死亡率进行了监测，为50 years.Main outcome measures吸烟习惯的总体死亡率，分别考虑出生在不同时期的男性。出生于1900-1930年的男性，如果只吸烟，并且继续吸烟，平均比终身不吸烟的人年轻10岁。在60岁、50岁、40岁或30岁时戒烟，预期寿命分别增加约3年、6年、9年或10年。与吸烟相关的超额死亡率在19世纪出生的男性中较低，在20世纪20年代出生的男性中最高。在1900-1909年出生的人中，吸烟者与不吸烟者在中年（35-69岁）死亡的概率分别为42%和24%（死亡率比为两倍），但在20世纪20年代出生的人中，这一比例为43%和15%（死亡率比为三倍）。在年龄较大的地区，吸烟者与不吸烟者从70岁到90岁的存活率在20世纪50年代的死亡率中分别为10%和12（也就是说，在19世纪70年代左右出生的男性中），（死亡率比率也是三倍）（即，结论在过去的半个世纪里，非吸烟者的死亡率有了明显的下降，在吸烟者中，由于早期和更密集地使用香烟，吸烟者与非吸烟者死亡率比率的逐步增加完全超过了（由于预防和改善疾病治疗）。在1920年左右出生的男性中，从成年早期开始的长期吸烟使特定年龄的死亡率增加了两倍，但在50岁时停止吸烟使危险减少了一半，30岁时停止吸烟几乎避免了所有危险。
Objective To compare the hazards of cigarette smoking in men who formed their habits at different periods, and the extent of the reduction in risk when cigarette smoking is stopped at different ages.Design Prospective study that has continued from 1951 to 2001.Setting United Kingdom.Participants 34 439 male British doctors. Information about their smoking habits was obtained in 1951, and periodically thereafter; cause specific mortality was monitored for 50 years.Main outcome measures Overall mortality by smoking habit, considering separately men born in different periods.Results The excess mortality associated with smoking chiefly involved vascular, neoplastic, and respiratory diseases that can be caused by smoking. Men born in 1900-1930 who smoked only cigarettes mid continued smoking died on average about 10 years younger than lifelong non-smokers. Cessation at age 60, 50, 40, or 30 years gained respectively, about 3, 6, 9, or 10 years of life expectancy. The excess mortality associated with cigarette smoking was less for men born in the 19th century and was greatest for men born in the 1920s. The cigarette smoker versus non-smoker probabilities of dying in middle age (35-69) were 42% v 24% (a twofold death rate ratio) for those born in 1900-1909, but were 43% v 15% (a threefold death rate ratio) for those born in the 1920s. At older acres, the cigarette smoker versus non-smoker probabilities Of surviving from age 70 to 90 were 10% v 12% at the death rates of the 1950s (that is, among men born around the 1870s) but were 7% v 33% (again a threefold death rate ratio) at the death rates of the 1990s (that is, among men born around the 1910s).Conclusion A substantial progressive decrease in the mortality rates among non-smokers over the past half century (due to prevention and improved treatment of disease) has been wholly outweighed, among cigarette smokers, by a progressive increase in the smoker v non-smoker death rate ratio due to earlier and more intensive use of cigarettes. Among the men born around 1920, prolonged cigarette smoking from early adult life tripled age specific mortality rates, but cessation at age 50 halved the hazard, and cessation at age 30 avoided almost all of it.