Leistikow B N, Shipley M J
Department of Epidemiology and Preventive Medicine, University of California, Davis, California, 95616-8638, USA.
Prev Med. 1999 Mar;28(3):255-9. doi: 10.1006/pmed.1998.0412.
Smokers have excesses of injuries. Randomized, controlled trials (RCT) could assess whether cigarette smoking (smoking) causes (and smoking cessation (cessation) prevents) those injuries. We analyzed injury, accident, suicide, and homicide deaths as secondary endpoints in RCT that induced cessation.
RCT were sought via MEDLINE, bibliographies, the CDC Smoking and Health database, and the GLOBALink Tobacco listserver. RCT were included if (1) net (intervention minus control) cessation totaled over 10% of all intervention smokers and (2) injury data were available. Relative risks (RR) were summarized by fixed effects modeling.
Three trials were located (the Lung Health Study, MRFIT, and Whitehall RCT). In-trial annual point prevalence cessation averaged 41, 46, and 59% in the intervention group smokers versus 17, 22, and 28% in the respective controls. Intervention (cessation) was associated with pooled injury RR of 0.65 within the trials (95% confidence interval (CI) 0.36-1.19) and 0.68 (95% CI 0.43-1.09) with additional follow-up in the Lung Health and MRFIT populations.
The smoking/injury death association is of borderline statistical significance in currently available RCT data. It modestly supports the significant forensic, cohort, case-control, cross-sectional, challenge-rechallenge, in vitro, and animal data suggesting that smoking may cause injury. Direct tests of the hypothesis could strengthen this inference.
吸烟者受伤情况更为常见。随机对照试验（RCT）可以评估吸烟是否会导致这些伤害（以及戒烟是否能预防这些伤害）。我们将伤害、事故、自杀和他杀死亡作为诱导戒烟的随机对照试验的次要终点进行了分析。
通过医学文献数据库（MEDLINE）、参考文献、美国疾病控制与预防中心（CDC）吸烟与健康数据库以及全球烟草信息网络（GLOBALink）烟草邮件列表服务器查找随机对照试验。如果符合以下条件则纳入随机对照试验：（1）干预组（干预减去对照）的净戒烟率总计超过所有干预组吸烟者的10%，且（2）有伤害数据。通过固定效应模型汇总相对风险（RR）。
找到了三项试验（肺部健康研究、多重危险因素干预试验（MRFIT）和白厅随机对照试验）。在试验中，干预组吸烟者的年度点患病率戒烟率平均分别为41%、46%和59%，而相应对照组分别为17%、22%和28%。在试验中，干预（戒烟）与合并的伤害相对风险为0.65相关（95%置信区间（CI）0.36 - 1.19），在肺部健康研究和多重危险因素干预试验人群中进行额外随访后，该相对风险为0.68（95%CI 0.43 - 1.09）。
在目前可用的随机对照试验数据中，吸烟与伤害死亡之间的关联具有临界统计学意义。它适度支持了大量法医学、队列研究、病例对照研究、横断面研究、激发 - 再激发研究、体外研究和动物研究数据，这些数据表明吸烟可能导致伤害。对该假设的直接检验可以加强这一推断。
