Stages of the cigarette epidemic on entering its second century
Stages of the cigarette epidemic on entering its second century
复制标题
DOI：
10.1136/tobaccocontrol-2011-050294
复制
发表时间：
2012-03-01
期刊：
影响因子：
5.2
通讯作者：
Lopez, Alan D.
中科院分区：
文献类型：
--
作者：
Thun, Michael;Peto, Richard;Lopez, Alan D.
1994年提出了一个香烟流行的四阶段模型，以说明从吸烟的广泛普及到其对死亡率的全面影响之间有很长一段时间的延迟，正如经济发达国家所经历的那样，在这些国家，吸烟在男性中根深蒂固的时间比在女性中早几十年。在目前的工作中，评估了该模型的定性预测是否与处于不同经济发展水平的国家中吸烟和因吸烟而死亡的最近趋势相符的问题，并考虑了到2025年的可能预测。方法对41个高资源和中等资源国家从1950年到可获得数据的最近年份（一般为2005-2009年）的所有死亡中烟草所占比例进行间接估计。然后，根据中年早期烟草所致死亡率的近期趋势，对中年后期烟草所致死亡率的趋势进行了预测，直至2025年。结果：在发达国家，男女吸烟率持续下降，尽管下降的速度已经放缓，而且低于模型最初版本的预测。在过去20年中，吸烟对所有死亡的比例贡献在男性中有所下降，而在女性中继续增加或保持稳定。虽然在35-69岁的所有死亡中，吸烟所占的男性比例仍然普遍高于女性，但在一些资源丰富的国家，男性和女性的比例正在趋同，并可能交叉。到2025年的预测表明，在大多数发达国家，男性和女性吸烟率以及吸烟导致的死亡率将同步下降，朝着尚未确定的下限下降。在发展中国家，该模型似乎普遍适用于男性，但无法预测女性是否或何时开始大量吸烟。修改后的标准，分别为男性和女性描述该流行病的各个阶段，将更适用于发展中国家。结论：在许多发达国家，卷烟流行的四阶段模型仍然是一种相当有用的描述。可以通过分别描述男女艾滋病流行的各个阶段来改善其与发展中国家的相关性。
Objectives A four-stage model of the cigarette epidemic was proposed in 1994 to communicate the long delay between the widespread uptake of cigarette smoking and its full effects on mortality, as had been experienced in economically developed countries where cigarette smoking became entrenched decades earlier in men than in women. In the present work, the question of whether qualitative predictions from the model have matched recent trends in smoking and deaths from smoking in countries at various levels of economic development is assessed, and possible projections to the year 2025 are considered.Methods The proportion of all deaths attributed to tobacco was estimated indirectly for 41 high-resource and medium-resource countries from 1950 to the most recent year for which data were available, generally about 2005-2009. The trends in tobacco-attributed mortality in later middle age were then projected forward to 2025, based on recent trends in tobacco-attributed mortality in early middle age.Results In developed countries the prevalence of smoking has continued to decrease in both sexes, although the rate of decrease has slowed and is less than that predicted by the original version of the model. Over the past 20 years the proportionate contribution of smoking to all deaths has decreased in men while continuing to increase or plateau among women. Although the proportion of all deaths at ages 35-69 that are attributed to smoking is still generally greater in men than in women, the male and female proportions are converging and will probably cross over in some high resource countries. Projections through to 2025 suggest that male and female smoking prevalence and smoking-attributed mortality will decrease in parallel in most developed countries towards lower limits that are not yet defined. In developing countries the model seems generally applicable to men but cannot predict whether or when women will begin smoking in large numbers. Modified criteria that describe the stages of the epidemic separately for men and women would be more generalisable to developing countries.Conclusions The four-stage model of the cigarette epidemic still provides a reasonably useful description in many developed countries. Its relevance to developing countries could be improved by describing the stages of the epidemic separately for men and women.