Accortt Neil A, Waterbor John W, Beall Colleen, Howard George
Department of Epidemiology and International Health, School of Public Health, University of Alabama at Birmingham, 35294, USA.
Am J Epidemiol. 2002 Oct 15;156(8):730-7. doi: 10.1093/aje/kwf106.
The purpose of this study was to characterize the relation between smokeless tobacco use and the risk of all-cause and disease-specific mortality. Using data from the First National Health and Nutrition Examination Survey Epidemiologic Followup Study, the authors assessed the 20-year mortality experience of smokeless tobacco users. Subjects aged 45 years or more at baseline (1971-1975) were categorized as either smokeless tobacco users (n = 1,068) or non-smokeless tobacco users (n = 5,737). Subjects were further stratified by smoking status and gender. Proportional hazard ratios were used to assess associations. After adjustment for confounders, no association between smokeless tobacco use and all-cause (hazard ratio = 1.1, 95% confidence interval (CI): 0.9, 1.3), all cancer (hazard ratio = 1.1, 95% CI: 0.6, 1.9), or all cardiovascular (hazard ratio = 1.1, 95% CI: 0.8, 1.5) mortality was found. There was an increase in all cancer mortality of borderline significance among female smokeless tobacco users (hazard ratio = 1.7, 95% CI: 1.0, 2.8). The lung cancer mortality rate among combined users (smokeless tobacco and cigarettes), based on the rates for exclusive smokeless tobacco users and exclusive smokers, was higher than expected, possibly because of heavier smoking among these subjects. The mortality experience of smokeless tobacco users was not significantly greater than that of non-tobacco users and was appreciably less than that of cigarette smokers. Furthermore, combined use of smokeless tobacco and cigarettes did not increase overall mortality beyond that expected from use of the individual products.
本研究的目的是描述无烟烟草使用与全因死亡率及特定疾病死亡率之间的关系。作者利用第一次全国健康与营养检查调查流行病学随访研究的数据，评估了无烟烟草使用者20年的死亡经历。基线时（1971 - 1975年）年龄在45岁及以上的受试者被分为无烟烟草使用者（n = 1068）或非无烟烟草使用者（n = 5737）。受试者进一步按吸烟状况和性别分层。采用比例风险比来评估关联性。在对混杂因素进行调整后，未发现无烟烟草使用与全因死亡率（风险比 = 1.1，95%置信区间（CI）：0.9，1.3）、所有癌症死亡率（风险比 = 1.1，95% CI：0.6，1.9）或所有心血管疾病死亡率（风险比 = 1.1，95% CI：0.8，1.5）之间存在关联。在女性无烟烟草使用者中，所有癌症死亡率有边缘性显著增加（风险比 = 1.7，95% CI：1.0，2.8）。基于单纯无烟烟草使用者和单纯吸烟者的死亡率，无烟烟草与香烟联合使用者的肺癌死亡率高于预期，可能是因为这些受试者吸烟量更大。无烟烟草使用者的死亡经历并不显著高于非烟草使用者，且明显低于吸烟者。此外，无烟烟草与香烟联合使用并未使总体死亡率高于单独使用每种产品所预期的死亡率。
