Fichtenberg C M, Glantz S A
Cardiovascular Research Institute, Department of Medicine, University of California, San Francisco 94143-0130, USA.
N Engl J Med. 2000 Dec 14;343(24):1772-7. doi: 10.1056/NEJM200012143432406.
The California Tobacco Control Program, a large, aggressive antitobacco program implemented in 1989 and funded by a voter-enacted cigarette surtax, accelerated the decline in cigarette consumption and in the prevalence of smoking in California. Since the excess risk of heart disease falls rapidly after the cessation of smoking, we tested the hypothesis that this program was associated with lower rates of death from heart disease.
Data on per capita cigarette consumption and age-adjusted rates of death from heart disease in California and the United States from 1980 to 1997 were fitted in multiple regression analyses. The regression analyses included the rates in the rest of the United States and variables that allowed for changes in the rates after 1988, when the tobacco-control program was approved, and after 1992, when the program was cut back.
Between 1989 and 1992, the rates of decline in per capita cigarette consumption and mortality from heart disease in California, relative to the rest of the United States, were significantly greater than the pre-1989 rates, by 2.72 packs per year per year (P = 0.001) and by 2.93 deaths per year per 100,000 population per year (P<0.001). These rates of decline were reduced (by 2.05 packs per year per year, [P=0.04], and by 1.71 deaths per year per 100,000 population per year, [P=0.031) when the program was cut back, beginning in 1992. Despite these problems, the program was associated with 33,300 fewer deaths from heart disease between 1989 and 1997 than the number that would have been expected if the earlier trend in mortality from heart disease in California relative to the rest of the United States had continued. The diminished effectiveness of the program after 1992 was associated with 8300 more deaths than would have been expected had its initial effectiveness been maintained.
A large and aggressive tobacco-control program is associated with a reduction in deaths from heart disease in the short run.
加利福尼亚州烟草控制项目是一项规模庞大且积极的反烟草项目，于1989年实施，资金来源于选民通过的香烟消费税，该项目加速了加利福尼亚州香烟消费量的下降以及吸烟率的降低。由于戒烟后心脏病的额外风险会迅速下降，我们检验了这一假设，即该项目与较低的心脏病死亡率相关。
对1980年至1997年加利福尼亚州和美国的人均香烟消费量以及年龄调整后的心脏病死亡率数据进行多元回归分析。回归分析纳入了美国其他地区的死亡率以及一些变量，这些变量考虑了1988年（烟草控制项目获批）和1992年（项目缩减）之后死亡率的变化。
1989年至1992年期间，相对于美国其他地区，加利福尼亚州人均香烟消费量和心脏病死亡率的下降幅度显著大于1989年之前的水平，分别为每年2.72包（P = 0.001）和每10万人口每年2.93例死亡（P<0.001）。从1992年开始项目缩减后，这些下降幅度有所减小（分别为每年2.05包，[P = 0.04]，以及每10万人口每年1.71例死亡，[P = 0.031]）。尽管存在这些问题，但与1989年至1997年期间如果加利福尼亚州相对于美国其他地区心脏病死亡率的早期趋势持续下去所预期的死亡人数相比，该项目使心脏病死亡人数减少了33300例。1992年之后该项目效果的减弱导致比维持其初始效果时预期的死亡人数多8300例。
一项大规模且积极的烟草控制项目在短期内与心脏病死亡人数的减少相关。
