Woloshin Steven, Schwartz Lisa M, Welch H Gilbert
The Veterans Affairs Outcomes Group (111B), Department of Veterans Affairs Medical Center, White River Junction, VT 05009, USA.
J Natl Cancer Inst. 2008 Jun 18;100(12):845-53. doi: 10.1093/jnci/djn124. Epub 2008 Jun 10.
To make sense of the disease risks they face, people need basic facts about the magnitude of a particular risk and how one risk compares with other risks. Unfortunately, this fundamental information is not readily available to patients or physicians. We created simple one-page charts that present the 10-year chance of dying from various causes according to age, sex, and smoking status.
We used the National Center for Health Statistics Multiple Cause of Death Public Use File for 2004 and data from the 2004 US Census to calculate age- and sex-specific death rates for various causes of death. We then combined data on smoking prevalence (from the National Health Interview Survey) and the relative risks of death from various causes for smokers vs never smokers (from the American Cancer Society's Cancer Prevention Study-II) to determine age-, sex-, and smoking-specific death rates. Finally, we accumulated these risks for various starting ages in a series of 10-year life tables. The charts present the 10-year risks of dying from heart disease; stroke; lung, colon, breast, cervical, ovarian, and prostate cancer; pneumonia; influenza; AIDS; chronic obstructive pulmonary disease; accidents; and all causes.
At all ages, the 10-year risk of death from all causes combined is higher for men than women. The effect of smoking on the chance of dying is similar to the effect of adding 5 to 10 years of age: for example, a 55-year-old man who smokes has about the same 10-year risk of death from all causes as a 65-year-old man who never smoked (ie, 178 vs 176 of 1000 men, respectively). For men who never smoked, heart disease death represents the single largest cause of death from age 50 on and the chance of dying from heart disease exceeds the chances of dying from lung, colon, and prostate cancers combined at every age. For men who currently smoke, the chance of dying from lung cancer is of the same order of magnitude as the chance dying from heart disease and after age 50 it is about 10 times greater than the chance of dying from prostate or colon cancer. For women who have never smoked, the magnitudes of the 10-year risks of death from breast cancer and heart disease are similar until age 60; from this age on, heart disease represents the single largest cause of death. For women who currently smoke, the chance of dying from heart disease or lung cancer exceeds the chance of dying from breast cancer from age 40 on (and does so by at least a factor of 5 after age 55).
The availability of simple charts with consistent data presentations of important causes of death may facilitate discussion about disease risk between physicians and their patients and help highlight the dangers of smoking.
为了了解自身面临的疾病风险，人们需要掌握特定风险程度的基本事实，以及一种风险与其他风险相比较的情况。遗憾的是，患者和医生都无法轻易获取这些基本信息。我们制作了简单的单页图表，根据年龄、性别和吸烟状况展示因各种原因导致的10年死亡几率。
我们使用了美国国家卫生统计中心2004年的多死因公共使用文件以及2004年美国人口普查数据，来计算各种死因的特定年龄和性别的死亡率。然后，我们将吸烟流行率数据（来自国家健康访谈调查）以及吸烟者与从不吸烟者因各种原因导致的相对死亡风险数据（来自美国癌症协会的癌症预防研究-II）相结合，以确定特定年龄、性别和吸烟状况的死亡率。最后，我们在一系列10年生命表中累计了不同起始年龄的这些风险。这些图表展示了因心脏病、中风、肺癌、结肠癌、乳腺癌、宫颈癌、卵巢癌、前列腺癌、肺炎、流感、艾滋病、慢性阻塞性肺疾病、事故以及所有原因导致的10年死亡风险。
在所有年龄段，男性因所有原因导致的10年综合死亡风险均高于女性。吸烟对死亡几率的影响类似于年龄增加5至10岁的影响：例如，一名55岁的吸烟男性因所有原因导致的10年死亡风险与一名65岁的从不吸烟男性大致相同（即每1000名男性中分别为178人和176人）。对于从不吸烟的男性，从50岁起心脏病死亡是单一最大死因，且在每个年龄段因心脏病死亡的几率超过因肺癌、结肠癌和前列腺癌死亡几率的总和。对于目前吸烟的男性，因肺癌死亡的几率与因心脏病死亡的几率处于同一数量级，50岁以后因肺癌死亡的几率约为因前列腺癌或结肠癌死亡几率的10倍。对于从不吸烟的女性，60岁之前乳腺癌和心脏病的10年死亡风险程度相似；从这个年龄起，心脏病成为单一最大死因。对于目前吸烟的女性，从40岁起因心脏病或肺癌死亡的几率超过因乳腺癌死亡的几率（55岁以后至少高出5倍）。
提供包含重要死因一致数据呈现的简单图表，可能有助于医生与患者之间关于疾病风险的讨论，并有助于突出吸烟的危害。
