Smoking and smoking cessation in relation to mortality in women
Smoking and smoking cessation in relation to mortality in women
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DOI：
10.1001/jama.299.17.2037
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发表时间：
2008-05-07
影响因子：
120.7
通讯作者：
Colditz, Graham A.
中科院分区：
文献类型：
--
作者：
Kenfield, Stacey A.;Stampfer, Meir J.;Colditz, Graham A.
吸烟与总死亡风险和死因特异性死亡风险增加有关，但与继续吸烟相比，戒烟后死亡风险降低的比率尚不确定。没有足够或不充分的证据来推断吸烟与卵巢癌和结直肠癌之间是否存在因果关系。目的探讨吸烟和戒烟对女性总死亡率和特定原因死亡率的影响。设计、环境和参与者：对1980年至2004年护士健康研究中104519名女性参与者的前瞻性观察研究。主要结果测量总死亡率的危险比（hr），进一步分为血管和呼吸系统疾病、肺癌、其他癌症和其他原因。结果该队列共发生12483例死亡，其中从不吸烟者4485例（35.9%），当前吸烟者3602例（28.9%），既往吸烟者4396例（35.2%）。与从不吸烟者相比，目前吸烟者的总死亡率（HR, 2.81； 95%可信区间[CI]， 2.68- 2.95）和所有主要原因特异性死亡率的风险增加。根据2004年卫生局局长的报告，与吸烟有关的癌症的风险比为7.25 (95% CI, 6.43- 8.18)，其他癌症的风险比为1.58 （95% CI, 1.45- 1.73）。与从不吸烟者相比，当前吸烟者患结直肠癌的风险比为1.63 (95% CI, 1.29- 2.05)，前吸烟者的风险比为1.23 （95% CI, 1.02- 1.49）。卵巢癌未观察到明显的相关性。吸烟年龄越早，总死亡率呈显著趋势(P=。003)，呼吸系统疾病死亡率(P=。001)，以及所有与吸烟有关的癌症死亡率(P=。001)。戒烟20年后，全因死亡率的超额风险降低到从不吸烟者的水平，在不同的结果中观察到风险降低的不同时间框架。目前吸烟者中约64%的死亡和曾经吸烟者中28%的死亡可归因于吸烟。结论女性吸烟引起的血管死亡的额外风险在戒烟后和肺部疾病的20年内可迅速消除。推迟开始吸烟的年龄可以降低呼吸系统疾病、肺癌和其他与吸烟有关的癌症死亡的风险，但对其他特定原因的死亡率几乎没有影响。这些数据表明，吸烟与结直肠癌死亡率风险增加有关，但与卵巢癌死亡率无关。
Context Smoking is associated with an increased risk of total and cause- specific death, but the rate of mortality risk reduction after quitting compared with continuing to smoke is uncertain. There is inadequate or insufficient evidence to infer the presence or absence of a causal relationship between smoking and ovarian cancer and colorectal cancer.Objective To assess the relationship between cigarette smoking and smoking cessation on total and cause- specific mortality in women.Design, Setting, and Participants Prospective observational study of 104 519 female participants in the Nurses' Health Study with follow- up from 1980 to 2004.Main Outcome Measure Hazard ratios ( HRs) for total mortality, further categorized into vascular and respiratory diseases, lung cancer, other cancers, and other causes.Results A total of 12 483 deaths occurred in this cohort, 4485 ( 35.9%) among never smokers, 3602 ( 28.9%) among current smokers, and 4396 ( 35.2%) among past smokers. Compared with never smokers, current smokers had an increased risk of total mortality ( HR, 2.81; 95% confidence interval [ CI], 2.68- 2.95) and all major cause- specific mortality. The HR for cancers classified by the 2004 surgeon general's report to be smoking- related was 7.25 ( 95% CI, 6.43- 8.18) and 1.58 ( 95% CI, 1.45- 1.73) for other cancers. Compared with never smokers, the HR for colorectal cancer was 1.63 ( 95% CI, 1.29- 2.05) for current smokers and 1.23 ( 95% CI, 1.02- 1.49) for former smokers. A significant association was not observed for ovarian cancer. Significant trends were observed for earlier age at initiation of smoking for total mortality ( P=. 003), respiratory disease mortality ( P=. 001), and all smoking- related cancer mortality ( P=. 001). The excess risk for all- cause mortality decreases to the level of a never smoker 20 years after quitting, with different time frames for risk reduction observed across outcomes. Approximately 64% of deaths among current smokers and 28% of deaths among former smokers were attributable to cigarette smoking.Conclusions Most of the excess risk of vascular mortality due to smoking in women may be eliminated rapidly upon cessation and within 20 years for lung diseases. Postponing the age of smoking initiation reduces the risk of respiratory disease, lung cancer, and other smoking- related cancer deaths but has little effect on other cause-specific mortality. These data suggest that smoking is associated with an increased risk of colorectal cancer mortality but not ovarian cancer mortality.