MORTALITY IN RELATION TO SMOKING - 40 YEARS OBSERVATIONS ON MALE BRITISH DOCTORS
MORTALITY IN RELATION TO SMOKING - 40 YEARS OBSERVATIONS ON MALE BRITISH DOCTORS
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DOI：
10.1136/bmj.309.6959.901
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发表时间：
1994-10-08
影响因子：
--
通讯作者：
SUTHERLAND, I
中科院分区：
文献类型：
--
作者：
DOLL, R;PETO, R;SUTHERLAND, I
目的-评估长期使用烟草的危害。设计-1951年和此后不时评估的与吸烟习惯有关的死亡率的前瞻性研究，并寻找40年(至1991年)的死亡原因。一项研究的延续，这项研究是在20年后(1951-71)最后一次报道的。研究对象--34 439名英国男医生在1951年回复了一份邮寄问卷，其中10000人在前20年死亡，另有10000人在后20年死亡。结果-在研究的后半部分，与吸烟相关的超额死亡率大约是前半部分的两倍。1971-91年期间的死亡率比率(比较持续吸烟者和终身不吸烟者)在45岁时约为的三倍，在65岁至84岁时约为两倍。超额死亡率主要是由吸烟引起的疾病造成的。吸烟与口腔癌、食道癌、咽癌、喉癌、肺癌、胰腺癌和膀胱癌；慢性阻塞性肺疾病和其他呼吸系统疾病；血管疾病；消化性溃疡；以及(可能由于性格和酒精使用的混淆)肝硬化、自杀和中毒死亡呈正相关。帕金森氏病的死亡与死亡呈负相关。那些在中年前戒烟的人随后几乎避免了他们本来会遭受的所有额外风险，但即使是那些在中年停止吸烟的人随后面临的风险也比那些继续吸烟的人低得多。结论--这项研究的前20年以及当时其他研究的结果大大低估了长期吸烟的危害。现在看来，所有经常吸烟的人中，大约有一半最终会因吸烟习惯而死亡。
Objective-To assess the hazards associated with long term use of tobacco.Design-Prospective study of mortality in relation to smoking habits assessed in 1951 and again from time to time thereafter, with causes sought of deaths over 40 years (to 1991). Continuation of a study that was last reported after 20 years' follow up (1951-71).Subjects-34 439 British male doctors who replied to a postal questionnaire in 1951, of whom 10 000 had died during the first 20 years and another 10 000 have died during the second 20 years.Results-Excess mortality associated with smoking was about twice as extreme during the second half of the study as it had been during the first half. The death rate ratios during 1971-91 (comparing continuing cigarette smokers with lifelong non-smokers) were approximately threefold at ages 45-64 and twofold at ages 65-84. The excess mortality was chiefly from diseases that can be caused by smoking. Positive associations with smoking were confirmed for death from cancers of the mouth, oesophagus, pharynx, larynx, lung, pancreas, and bladder; from chronic obstructive pulmonary disease and other respiratory diseases; from vascular diseases; from peptic ulcer; and (perhaps because of confounding by personality and alcohol use) from cirrhosis, suicide, and poisoning. A negative association was confirmed with death from Parkinson's disease. Those who stopped smoking before middle age subsequently avoided almost all of the excess risk that they would otherwise have suffered, but even those who stopped smoking in middle age were subsequently at substantially less risk than those who continued to smoke.Conclusion-Results from the first 20 years of this study, and of other studies at that time, substantially underestimated the hazards of long term use of tobacco. It now seems that about half of all regular cigarette smokers will eventually be killed by their habit.