Association of Cigarette, Cigar, and Pipe Use With Mortality Risk in the US Population
Association of Cigarette, Cigar, and Pipe Use With Mortality Risk in the US Population
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DOI：
10.1001/jamainternmed.2017.8625
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发表时间：
2018-04-01
影响因子：
39
通讯作者：
Freedman, Neal D.
中科院分区：
文献类型：
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作者：
Christensen, Carol H.;Rostron, Brian;Freedman, Neal D.
近年来，烟草产品发生了变化。当代死亡风险估计可燃烟草制品的使用是needed.Objective调查死亡风险与当前和以前使用的雪茄，烟斗，和cigaretts.Design，设置，和参与者国家纵向死亡率研究是一个纵向的人口为基础的，全国代表性的健康调查与死亡随访，包括人口和其他信息，从当前人口调查，烟草产品使用信息来自烟草使用补充，死亡率数据来自国家死亡指数。在这项研究中，参与者在1985年开始的调查中提供了基线烟草使用信息，并对死亡率进行了跟踪，直到2011年底。该研究包括357420名参与者，他们报告只使用雪茄，烟斗或香烟或报告从未使用任何类型的烟草产品。还收集了当前每日和非每日使用的信息。根据年龄、性别、种族/民族、教育程度和调查年份调整估计值。主要结果和指标全因死亡率和死因特异性死亡率，根据死亡证明信息确定为主要死因。结果在纳入分析的357 420人中，大多数当前和以前的雪茄和烟斗吸烟者为男性（79.3%-98.0%），吸烟者按性别划分更为均匀（目前每天吸烟者中有46%为男性）。在随访期间有51150例死亡记录。目前完全吸烟者（风险比[HR]，1.98; 95% CI，1.93-2.02）和目前完全吸烟者（HR，1.20; 95% CI，1.03-1.38）的全因死亡风险高于从不吸烟者。目前吸烟者（HR，4.06; 95% CI，3.84-4.29），排除当前雪茄吸烟者（风险比，1.61; 95%置信区间，1.11-2.32），且排除当前吸烟者（HR，1.58; 95% CI，1.05-2.38）死于烟草相关癌症（包括膀胱癌、食道癌、喉癌、肺癌、口腔癌和胰腺癌）的风险升高。在目前的非日常吸烟者中，观察到与肺癌死亡的统计学显著相关性（HR，6.24; 95% CI，5.17-7.54），口腔癌（HR，4.62; 95% CI，1.84-11.58），循环系统死亡（HR，1.43; 95% CI，1.30-1.57），心血管死亡（HR，1.24; 95%CI，1.11-1.39），脑血管死亡（中风）（HR，1.39; 95% CI，1.12-1.74）和慢性阻塞性肺疾病（HR，7.66; 95%CI，6.09-9.64）以及日常吸烟者。结论和相关性这项研究提供了进一步的证据，专门使用雪茄，烟斗，和香烟都有很大的死亡风险。
IMPORTANCE Tobacco products have changed in recent years. Contemporary mortality risk estimates of combustible tobacco product use are needed.OBJECTIVE To investigate the mortality risks associated with current and former use of cigars, pipes, and cigarettes.DESIGN, SETTING, AND PARTICIPANTS The National Longitudinal Mortality Study is a longitudinal population-based, nationally representative health survey with mortality follow-up that includes demographic and other information from the Current Population Survey, tobacco product use information from the Tobacco Use Supplement, and mortality data from the National Death Index. In this study, participants provided tobacco use information at baseline in surveys starting from 1985 and were followed for mortality through the end of 2011. The study includes 357 420 participants who reported exclusively using cigar, pipes, or cigarettes or reported never using any type of tobacco product.EXPOSURES Current or former exclusive use of any cigar (little cigar, cigarillos, large cigar), traditional pipe, or cigarette and never tobacco use. Information on current daily and nondaily use was also collected. Estimates adjusted for age, sex, race/ethnicity, education, and survey year.MAIN OUTCOMES AND MEASURES All-cause and cause-specific mortality as identified as the primary cause of death from death certificate information.RESULTS Of the 357 420 persons included in the analysis, the majority of current and former cigar and pipe smokers were male (79.3%-98.0%), and smokers were more evenly divided by sex (46% of current daily smokers were male). There were 51 150 recorded deaths during follow-up. Exclusive current cigarette smokers (hazard ratio [HR], 1.98; 95% CI, 1.93-2.02) and exclusive current cigar smokers (HR, 1.20; 95% CI, 1.03-1.38) had higher all-cause mortality risks than never tobacco users. Exclusive current cigarette smokers (HR, 4.06; 95% CI, 3.84-4.29), exclusive current cigar smokers (HR, 1.61; 95% CI, 1.11-2.32), and exclusive current pipe smokers (HR, 1.58; 95% CI, 1.05-2.38) had an elevated risk of dying from a tobacco-related cancer (including bladder, esophagus, larynx, lung, oral cavity, and pancreas). Among current nondaily cigarette users, statistically significant associations were observed with deaths from lung cancer (HR, 6.24; 95% CI, 5.17-7.54), oral cancer (HR, 4.62; 95% CI, 1.84-11.58), circulatory death (HR, 1.43; 95% CI, 1.30-1.57), cardiovascular death (HR, 1.24; 95% CI, 1.11-1.39), cerebrovascular death (stroke) (HR, 1.39; 95% CI, 1.12-1.74), and chronic obstructive pulmonary disease (HR, 7.66; 95% CI, 6.09-9.64) as well as for daily smokers.CONCLUSIONS AND RELEVANCE This study provides further evidence that exclusive use of cigar, pipes, and cigarettes each confers significant mortality risks.