归因于被动吸烟的冠心病：冠心病政策模型。
Coronary heart disease attributable to passive smoking: CHD Policy Model.
作者信息
Lightwood James M, Coxson Pamela G, Bibbins-Domingo Kirsten, Williams Lawrence W, Goldman Lee
机构信息
Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA.
出版信息
Am J Prev Med. 2009 Jan;36(1):13-20. doi: 10.1016/j.amepre.2008.09.030.
BACKGROUND
Passive smoking is a major risk factor for coronary heart disease (CHD), and existing estimates are out of date due to recent and substantial changes in the level of exposure.
OBJECTIVE
To estimate the annual clinical burden and cost of CHD treatment attributable to passive smoking.
OUTCOME MEASURES
Annual attributable CHD deaths, myocardial infarctions (MI), total CHD events, and the direct cost of CHD treatment.
METHODS
A Monte Carlo simulation estimated the CHD events and costs as a function of the prevalence of CHD risk factors, including passive-smoking prevalence and a low (1.26) and high (1.65) relative risk of CHD due to passive smoking. Estimates were calculated using the CHD Policy Model, calibrated to reproduce key CHD outcomes in the baseline Year 2000 in the U.S.
RESULTS
At 1999-2004 levels, passive smoking caused 21,800 (SE=2400) to 75,100 (SE=8000) CHD deaths and 38,100 (SE=4300) to 128,900 (SE=14,000) MIs annually, with a yearly CHD treatment cost of $1.8 (SE=$0.2) to $6.0 (SE=$0.7) billion. If recent trends in the reduction in the prevalence of passive smoking continue from 2000 to 2008, the burden would be reduced by approximately 25%-30%.
CONCLUSIONS
Passive smoking remains a substantial clinical and economic burden in the U.S.
背景
被动吸烟是冠心病（CHD）的主要危险因素，由于近期暴露水平发生了重大变化，现有的估计已过时。
目的
估计被动吸烟所致冠心病治疗的年度临床负担和成本。
观察指标
年度归因冠心病死亡、心肌梗死（MI）、冠心病总事件以及冠心病治疗的直接成本。
方法
采用蒙特卡罗模拟法，根据冠心病危险因素的患病率，包括被动吸烟患病率以及被动吸烟导致冠心病的低（1.26）、高（1.65）相对风险，估计冠心病事件和成本。使用冠心病政策模型进行估计，并进行校准以再现2000年美国基线时的关键冠心病结局。
结果
按照1999 - 2004年的水平，被动吸烟每年导致21,800（标准误 = 2400）至75,100（标准误 = 8000）例冠心病死亡以及38,100（标准误 = 4300）至128,900（标准误 = 14,000）例心肌梗死，每年冠心病治疗成本为18亿美元（标准误 = 0.2亿美元）至60亿美元（标准误 = 0.7亿美元）。如果从2000年到2008年被动吸烟患病率下降的近期趋势持续下去，负担将减少约25% - 30%。
结论
在美国，被动吸烟仍然是一项巨大的临床和经济负担。
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