Department of Population Sciences, Beckman Research Institute, City of Hope, 1500 East Duarte Road, Duarte, CA 91010, USA.
Am J Epidemiol. 2011 Sep 1;174(5):563-73. doi: 10.1093/aje/kwr127. Epub 2011 Jul 18.
Epidemiologic studies conducted to date have shown evidence of a causal relation between smoking and non-Hodgkin lymphoma (NHL) risk. However, previous studies did not account for passive smoking exposure in the never-smoking reference group. The California Teachers Study collected information about lifetime smoking and household passive smoking exposure in 1995 and about lifetime exposure to passive smoking in 3 settings (household, workplace, and social settings) in 1997-1998. Multivariable-adjusted relative risks and 95% confidence intervals were estimated by fitting Cox proportional hazards models with follow-up through 2007. Compared with never smokers, ever smokers had a 1.11-fold (95% confidence interval (CI): 0.94, 1.30) higher NHL risk that increased to a 1.22-fold (95% CI: 0.95, 1.57) higher risk when women with household passive smoking were excluded from the reference category. Statistically significant dose responses were observed for lifetime cumulative smoking exposure (intensity and pack-years; both P 's for trend = 0.02) when women with household passive smoking were excluded from the reference category. Among never smokers, NHL risk increased with increasing lifetime exposure to passive smoking (relative risk = 1.51 (95% CI: 1.03, 2.22) for >40 years vs. ≤5 years of passive smoking; P for trend = 0.03), particularly for follicular lymphoma (relative risk = 2.89 (95% CI: 1.23, 6.80); P for trend = 0.01). The present study provides evidence that smoking and passive smoking may influence NHL etiology, particularly for follicular lymphoma.
迄今进行的流行病学研究表明，吸烟与非霍奇金淋巴瘤（NHL）风险之间存在因果关系。然而，以前的研究并未考虑从不吸烟的参考组中被动吸烟的暴露情况。加利福尼亚教师研究于 1995 年收集了关于终生吸烟和家庭被动吸烟暴露的信息，并于 1997-1998 年收集了关于三种环境（家庭、工作场所和社交环境）中终生被动吸烟暴露的信息。通过拟合 Cox 比例风险模型进行多变量调整的相对风险和 95%置信区间，随访至 2007 年。与从不吸烟者相比，曾经吸烟者 NHL 风险增加 1.11 倍（95%置信区间（CI）：0.94，1.30），当排除家庭被动吸烟的女性作为参考类别时，风险增加至 1.22 倍（95% CI：0.95，1.57）。当排除家庭被动吸烟的女性作为参考类别时，观察到终生累积吸烟暴露（强度和包年数；两者 P 趋势值均为 0.02）与 NHL 风险呈显著剂量反应关系。在从不吸烟者中，随着终生暴露于被动吸烟的增加，NHL 风险也随之增加（相对风险=1.51（95% CI：1.03，2.22）与≤5 年 vs. >40 年的被动吸烟；趋势 P 值=0.03），尤其是滤泡性淋巴瘤（相对风险=2.89（95% CI：1.23，6.80）；趋势 P 值=0.01）。本研究提供了证据表明，吸烟和被动吸烟可能影响 NHL 的病因学，特别是滤泡性淋巴瘤。
