The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK
The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK
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DOI：
10.1016/s0140-6736(12)61720-6
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发表时间：
2013-01-12
期刊：
影响因子：
168.9
通讯作者：
Beral, Valerie
中科院分区：
文献类型：
--
作者：
Pirie, Kirstin;Peto, Richard;Beral, Valerie
背景1940年左右出生于英国和美国等国家的女性是第一代在整个成年生活中大量吸烟的人。因此，只有在21世纪世纪，我们可以直接观察到长期吸烟的全面影响，并长期戒烟，对死亡率的妇女在UK.Methods为这项前瞻性研究，130万英国妇女在1996-2001年招募和resurveyed postally约3年和8年后。所有患者均随访至2011年1月1日，通过国家死亡率记录（平均12女性年，SD 2）。参与者在进入时被问及他们是当前吸烟者还是前吸烟者，以及他们目前吸烟的数量。那些在入组和3年再调查时都是戒烟者并且在55岁之前戒烟的人根据他们戒烟的年龄进行分类。我们使用考克斯回归模型，以获得调整后的相对风险，比较类别的吸烟者或前吸烟者与其他类似never-smokers.Findings排除0.1万妇女与以前的疾病后，120万妇女仍然存在，中位出生年份1943年（IQR 1938-46）和年龄55岁（IQR 52-60）。总体而言，6%（66 489/1 180 652）死亡，平均年龄65岁（SD 6）。基线时，20%（232 461）为当前吸烟者，28%（328 417）为既往吸烟者，52%（619 774）为从不吸烟者。对于12年死亡率，基线时吸烟者与从不吸烟者相比的死亡率比为2.76（95%CI 2.71-2.81），尽管44%（37 240/85 256）的基线吸烟者在8年重新调查时已经戒烟。在3年的再调查中，仍吸烟者的死亡率增加了两倍，主要与年龄无关（率比2.97，2.88-3.07）。即使对于基线时每天吸烟少于10支的女性，12年死亡率也增加了一倍（率比1.98，1.91-2.04）。在30种最常见的死亡原因中，吸烟者有23种明显增加，肺癌的率比为21.4（19.7-23.2）。吸烟者（与从不吸烟者相比）的死亡率过高主要是因为吸烟可能导致的疾病，如肺癌。在25-34岁或35-44岁永久戒烟的戒烟者中，全因死亡的相对风险分别为1.05（95%CI 1.00-1.11）和1.20（1.14-1.26），肺癌死亡的相对风险分别为1.84（1.45-2.34）和3.34（2.76-4.03）。因此，尽管在这些长期戒烟者中仍存在一些额外的死亡率，但仅为继续吸烟者中额外死亡率的3%和10%。如果与2010年英国全国死亡率相结合，吸烟者死亡率增加两倍，表明53%的吸烟者和22%的不吸烟者在80岁之前死亡，以及11年的寿命差异。解释在英国妇女中，三分之二的吸烟者在50多岁，60多岁和70多岁的死亡是由吸烟引起的;吸烟者至少损失10年的寿命。虽然吸烟到40岁然后停止吸烟的危害很大，但继续吸烟的危害要大十倍。在40岁之前戒烟（最好是在40岁之前戒烟）可以避免超过90%的由继续吸烟引起的死亡率;在30岁之前戒烟可以避免超过97%的死亡率。
Background Women born around 1940 in countries such as the UK and USA were the first generation in which many smoked substantial numbers of cigarettes throughout adult life. Hence, only in the 21st century can we observe directly the full effects of prolonged smoking, and of prolonged cessation, on mortality among women in the UK.Methods For this prospective study, 1.3 million UK women were recruited in 1996-2001 and resurveyed postally about 3 and 8 years later. All were followed to Jan 1, 2011, through national mortality records (mean 12 woman-years, SD 2). Participants were asked at entry whether they were current or ex-smokers, and how many cigarettes they currently smoked. Those who were ex-smokers at both entry and the 3-year resurvey and had stopped before the age of 55 years were categorised by the age they had stopped smoking. We used Cox regression models to obtain adjusted relative risks that compared categories of smokers or ex-smokers with otherwise similar never-smokers.Findings After excluding 0.1 million women with previous disease, 1.2 million women remained, with median birth year 1943 (IQR 1938-46) and age 55 years (IQR 52-60). Overall, 6% (66 489/1 180 652) died, at mean age 65 years (SD 6). At baseline, 20% (232 461) were current smokers, 28% (328 417) were ex-smokers, and 52% (619 774) were never-smokers. For 12-year mortality, those smoking at baseline had a mortality rate ratio of 2.76 (95% CI 2.71-2.81) compared with never-smokers, even though 44% (37 240/85 256) of the baseline smokers who responded to the 8-year resurvey had by then stopped smoking. Mortality was tripled, largely irrespective of age, in those still smoking at the 3-year resurvey (rate ratio 2.97, 2.88-3.07). Even for women smoking fewer than ten cigarettes per day at baseline, 12-year mortality was doubled (rate ratio 1.98, 1.91-2.04). Of the 30 most common causes of death, 23 were increased signifi cantly in smokers; for lung cancer, the rate ratio was 21.4 (19.7-23.2). The excess mortality among smokers (in comparison with neversmokers) was mainly from diseases that, like lung cancer, can be caused by smoking. Among ex-smokers who had stopped permanently at ages 25-34 years or at ages 35-44 years, the respective relative risks were 1.05 (95% CI 1.00-1.11) and 1.20 (1.14-1.26) for all-cause mortality and 1.84 (1.45-2.34) and 3.34 (2.76-4.03) for lung cancer mortality. Thus, although some excess mortality remains among these long-term ex-smokers, it is only 3% and 10% of the excess mortality among continuing smokers. If combined with 2010 UK national death rates, tripled mortality rates among smokers indicate 53% of smokers and 22% of never-smokers dying before age 80 years, and an 11-year lifespan difference.Interpretation Among UK women, two-thirds of all deaths of smokers in their 50s, 60s, and 70s are caused by smoking; smokers lose at least 10 years of lifespan. Although the hazards of smoking until age 40 years and then stopping are substantial, the hazards of continuing are ten times greater. Stopping before age 40 years (and preferably well before age 40 years) avoids more than 90% of the excess mortality caused by continuing smoking; stopping before age 30 years avoids more than 97% of it.