A Cohort Study of Active and Passive Smoking in Korea

尽管50年来的研究结果表明，主动吸烟和被动吸烟与癌症和其他疾病之间存在因果关系，但仍需要对吸烟的风险进行进一步的流行病学研究。一个特别的需要是在发达的西方国家以外的国家进行研究，迄今为止，大多数研究都是在这些国家进行的。世界上大多数吸烟者生活在西方国家以外，主要是在亚洲，在许多国家，那里的大多数男性都是吸烟者。背景在这些人群中，疾病发病率和生活方式危险因素的分布明显不同，特别是与先前研究的西方男性人群相比。亚洲国家的大多数妇女，主要是不吸烟者和儿童暴露在环境烟草烟雾(ETS)中。这一小额赠款申请请求提供支持，以建立一项关于通过韩国医疗保险公司(KMIC)获得医疗保险的人中主动和被动吸烟以及癌症和其他疾病风险的队列研究。KMIC为大韩民国(韩国)的公务员、教师及其家属提供保险。KMIC投保的人口总数相当可观，占1990年全国4300万居民的11%。当时，投保人包括大约120万工人和另外3.4名受抚养人。将利用KMIC的数据库开展一项队列研究。风险因素信息在两年一次的体检中收集，这是投保工人必须进行的，并由受抚养人自愿完成。在两年一次的检查中收集的数据包括吸烟和其他生活方式对疾病的风险，以及常规实验室工作的结果。结果通过医院记录系统跟踪，也通过死亡匹配来跟踪。被保险人的家庭成员可以通过记录链接使用被保险人的唯一识别号码进行识别。为了促进亚洲国家以及亚裔美国人对吸烟、癌症和其他疾病的了解，延世大学和约翰·霍普金斯大学卫生与公共卫生学院的研究人员计划合作开发，然后利用这一流行病学资源，开展一个关于韩国主动和被动吸烟风险的重大研究项目。延世大学可以接触到KMIC的队列，并且已经在几份关于癌症和心血管疾病的报告中展示了它的潜力。约翰霍普金斯大学的研究小组增加了队列研究和吸烟方面的专业知识。该应用程序请求支持建立一个全面的数据库，以支持队列研究，并对主动和被动吸烟者和癌症进行分析。在这一小额拨款申请所要求的两年支持期间，将从1992年和1993年进行的检查的关键暴露变量的医疗记录中提取数据，为预计约有160万成年人的队列提供生活方式和实验室数据。将跟踪1992-2003年的死亡率，并将确定1998-2003年的住院次数，按诊断进行编码。为了展示这项研究的潜力，将进行一项关于主动和被动吸烟与肺癌风险的调查。我们打算将数据收集到位，以维持和扩大这一群体。这一群体的庞大规模和数据联系的异常强大的可能性使KMIC群体成为一个独特的、具有成本效益的研究机会。这项队列研究将有可能产生强有力的证据，描述与之前研究的西方人群相比，具有不同背景发病率和生活方式风险因素分布的人群中吸烟的风险。

Although 50 years of research findings have causally linked active and passive smoking to cancer and other diseases, further epidemiologic research on the risks of tobacco smoking is still needed. One specific need is for studies in countries other than the developed, western countries where the majority studies have been conducted to date. Most of the world's smokers live outside of the western countries, primarily in Asia where a majority of males are smokers in many countries. Background disease rats and distributions of lifestyle risk factors are notably distinct in these populations, particularly in comparison with populations of previously studied western males. The majority of women, largely non-smokers, and children in Asian countries are exposed to environmental tobacco smoke (ETS). This small grant application requests support to establish a cohort study of active and passive smoking and risk for cancer and other diseases among persons receiving health insurance coverage through the Korean Medical Insurance Corporation (KMIC). The KMIC provides coverage to civil service workers, teachers, and their dependents in the Republic of Korea (South Korea). The total population insured by the KMIC is substantial, accounting for 11% of the country's 43 million residents in 1990. The insured then included approximately 1.2 million workers and an additional 3.4 dependents. A cohort study will be developed using the database of the KMIC. Risk factor information is collected in biennial medical examinations, which are required for the insured workers and are voluntarily completed by dependents. The data collected in the biennial examinations covering smoking and other lifestyle risk for disease and findings from routine laboratory work are also available. Outcomes are tracked through the hospital record system and also by mortality matches. Family members of the insured can be identified through record linkage using the unique identification number of the insured. In an effort to advance understanding of smoking and cancer and other diseases in Asian countries, as well as among Asian Americans, investigators at the Yonsei University and the Johns Hopkins University School of Hygiene and Public Health plan to collaborate in developing and then using this epidemiologic resource to carry out a major program of research on the risks of active and passive smoking in Korea. The Yonsei University has access to the KMIC cohort and already has shown its potential in several reports on cancer and cardiovascular disease. The Johns Hopkins group adds expertise in cohort studies and smoking. This application requests support to establish a comprehensive database in support of the cohort study and to carry out analyses on active and passive smoker and cancer. During the two years of support requested in this small grant application, data will be abstracted from medical records on key exposure variables from exams carried out in 1992 and 1993, providing lifestyle and laboratory data for cohort expected to number approximately 1.6 million adults. Mortality will be tracked from 1992-2003 and inpatient encounters, coded by diagnosis, will be identified for 1998-2003. To demonstrate the potential of the study, an investigation will be carried out on active and passive smoking and lung cancer risk. We intend to set data collection in place to maintain and extend this cohort. The large size of this cohort and the unusually strong possibility for data linkage makes the KMIC population a unique and cost effective study opportunity. This cohort study would have the potential to generate powerful evidence to describe the risk of smoking in a population with distinct background disease rates and distribution of lifestyle risk factors relative to western populations previously studied.