Jha Prabhat, Jacob Binu, Gajalakshmi Vendhan, Gupta Prakash C, Dhingra Neeraj, Kumar Rajesh, Sinha Dhirendra N, Dikshit Rajesh P, Parida Dillip K, Kamadod Rajeev, Boreham Jillian, Peto Richard
Centre for Global Health Research, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
N Engl J Med. 2008 Mar 13;358(11):1137-47. doi: 10.1056/NEJMsa0707719. Epub 2008 Feb 13.
The nationwide effects of smoking on mortality in India have not been assessed reliably.
In a nationally representative sample of 1.1 million homes, we compared the prevalence of smoking among 33,000 deceased women and 41,000 deceased men (case subjects) with the prevalence of smoking among 35,000 living women and 43,000 living men (unmatched control subjects). Mortality risk ratios comparing smokers with nonsmokers were adjusted for age, educational level, and use of alcohol.
About 5% of female control subjects and 37% of male control subjects between the ages of 30 and 69 years were smokers. In this age group, smoking was associated with an increased risk of death from any medical cause among both women (risk ratio, 2.0; 99% confidence interval [CI], 1.8 to 2.3) and men (risk ratio, 1.7; 99% CI, 1.6 to 1.8). Daily smoking of even a small amount of tobacco was associated with increased mortality. Excess deaths among smokers, as compared with nonsmokers, were chiefly from tuberculosis among both women (risk ratio, 3.0; 99% CI, 2.4 to 3.9) and men (risk ratio, 2.3; 99% CI, 2.1 to 2.6) and from respiratory, vascular, or neoplastic disease. Smoking was associated with a reduction in median survival of 8 years for women (99% CI, 5 to 11) and 6 years for men (99% CI, 5 to 7). If these associations are mainly causal, smoking in persons between the ages of 30 and 69 years is responsible for about 1 in 20 deaths of women and 1 in 5 deaths of men. In 2010, smoking will cause about 930,000 adult deaths in India; of the dead, about 70% (90,000 women and 580,000 men) will be between the ages of 30 and 69 years. Because of population growth, the absolute number of deaths in this age group is rising by about 3% per year.
Smoking causes a large and growing number of premature deaths in India.
吸烟对印度全国死亡率的影响尚未得到可靠评估。
在一个具有全国代表性的110万户家庭样本中，我们比较了33000名已故女性和41000名已故男性（病例对象）中的吸烟率与35000名在世女性和43000名在世男性（非匹配对照对象）中的吸烟率。比较吸烟者与非吸烟者的死亡风险比根据年龄、教育水平和饮酒情况进行了调整。
年龄在30至69岁之间的女性对照对象中约5%为吸烟者，男性对照对象中37%为吸烟者。在这个年龄组中，吸烟与女性（风险比为2.0；99%置信区间[CI]为1.8至2.3）和男性（风险比为1.7；99%CI为1.6至1.8）因任何医疗原因导致的死亡风险增加有关。即使每天少量吸烟也与死亡率增加有关。与非吸烟者相比，吸烟者的额外死亡主要来自女性（风险比为3.0；99%CI为2.4至3.9）和男性（风险比为2.3；99%CI为2.1至2.6）的结核病以及呼吸、血管或肿瘤疾病。吸烟与女性中位生存期缩短8年（99%CI为5至11年）和男性中位生存期缩短6年（99%CI为5至7年）有关。如果这些关联主要是因果关系，那么30至69岁人群中的吸烟导致约二十分之一的女性死亡和约五分之一的男性死亡。2010年，吸烟将在印度导致约93万成年人死亡；其中约70%（9万女性和58万男性）年龄在30至69岁之间。由于人口增长，这个年龄组的绝对死亡人数每年约增加3%。
吸烟在印度导致大量且不断增加的过早死亡。
