Tobacco smoking and risks of more than 470 diseases in China: a prospective cohort study.
Tobacco smoking and risks of more than 470 diseases in China: a prospective cohort study.
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DOI：
10.1016/s2468-2667(22)00227-4
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发表时间：
2022-12
期刊：
影响因子：
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通讯作者：
China Kadoorie Biobank collaborative group
中科院分区：
文献类型：
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作者：
Chan KH;Wright N;Xiao D;Guo Y;Chen Y;Du H;Yang L;Millwood IY;Pei P;Wang J;Turnbull I;Gilbert S;Avery D;Kartsonaki C;Yu C;Chen J;Lv J;Clarke R;Collins R;Peto R;Li L;Wang C;Chen Z;China Kadoorie Biobank collaborative group
据估计，中国每年因吸烟而死亡的人数超过100万，男性吸烟人数继续增加。与不同健康记录相关的大型全国性前瞻性研究可以帮助定期评估归因于吸烟的疾病负担。我们研究了吸烟与中国广泛疾病发病率和死亡率的关系。2004-2008年，中国嘉道理生物样本库从10个不同地区招募了超过512，000名年龄在30-79岁的成年人，并记录了详细的吸烟信息。在12年的随访期间，记录了1，137，603例ICD-10编码的住院事件和48，760例死亡，涉及476和85种不同的疾病，每种疾病分别有≥100例事件病例和死亡。考克斯回归得出了调整后的风险比（HR），吸烟与疾病结局相关，调整了多重检验。在基线时，67.7%的男性和3.2%的女性（总体为29.4%）经常吸烟。与从不吸烟者相比，在35-84岁的年龄段，曾经吸烟者在18个ICD-10疾病章节中有9个章节的风险显著更高。就个人情况而言，吸烟者患56种疾病（男性50种;女性24种）和22种死亡原因（男性17种;女性9种）的风险明显较高。在男性中，曾吸烟者的任何疾病发病率的HR为1.09（95% CI 1.08 - 1.11），并且发作次数和住院时间也显著增加，特别是癌症和呼吸系统疾病。对于总体死亡率，城市男性的HR高于农村男性（1·50 [1·43-1·58] vs. 1·25 [1·20-1·30]）。在18岁以下开始吸烟的城市男性中，总死亡率的HR为2.06（1.89 - 2.24），任何疾病发病率的HR为1.32（1.27 - 1.37）。在这一人群中，20%的男性（城市24%;农村16%）和3%的女性死亡归因于经常吸烟。在中国成年人中，吸烟与多种疾病的发病率和死亡率风险较高相关。在男性中，未来吸烟引起的疾病负担将进一步增加，突出表明迫切需要通过广泛戒烟和预防摄入来减少消费。
Tobacco smoking is estimated to account for >1 million annual deaths in China, and the epidemic continues to increase in men. Large nationwide prospective studies linked to different health records can help assess periodically disease burden attributed to smoking. We examined associations of smoking with an extensive range of disease incidence and mortality in China. The prospective China Kadoorie Biobank recruited >512,000 adults aged 30-79 years from 10 diverse areas during 2004-2008, and recorded detailed smoking information. During 12-year follow-up, 1,137,603 ICD-10 coded hospitalisation events and 48,760 deaths were recorded, involving 476 and 85 distinct conditions, each with ≥100 incident cases and deaths, respectively. Cox regression yielded adjusted hazard ratios (HRs) associating smoking with disease outcomes, adjusting for multiple-testing. At baseline 67·7% of men and 3·2% of women (overall 29·4%) ever smoked regularly. Compared with never-smokers, ever-smokers had significantly higher risks for 9 of 18 ICD-10 disease chapters examined at ages 35-84 years. For individual conditions, smokers had significantly higher risks of 56 diseases (men 50; women 24) and 22 causes of death (men 17; women 9). Among men, ever-smokers had HR of 1·09 (95% CI 1·08-1·11) for any disease incidence, and also significantly more episodes and longer duration of hospitalisation, particularly those due to cancer and respiratory diseases. For overall mortality, the HRs were greater in urban than in rural men (1·50 [1·43-1·58] vs. 1·25 [1·20-1·30]). Among urban men who began smoking at age <18 years, the HRs were 2·06 (1·89-2·24) for overall mortality and 1·32 (1·27-1·37) for any disease incidence. In this population, 20% of male (urban 24%; rural 16%) and 3% of female deaths were attributed to ever-regular smoking. Among Chinese adults, smoking was associated with higher risks of morbidity and mortality from a wide range of diseases. Among men, the future smoking-attributed disease burden will increase further, highlighting a pressing need for reducing consumption, through widespread cessation and uptake prevention.