Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv 69978, Israel.
Am J Epidemiol. 2012 May 15;175(10):1006-12. doi: 10.1093/aje/kwr466. Epub 2012 Feb 3.
Previous studies have not shown a survival advantage for smoking reduction. The authors assessed survival and life expectancy according to changes in smoking intensity in a cohort of Israeli working men. Baseline smokers recruited in 1963 were reassessed in 1965 (n = 4,633; mean age, 51 years) and followed up prospectively for mortality through 2005. Smoking intensity at both time points was self-reported and categorized as none, 1-10, 11-20, and ≥21 cigarettes per day. Change between smoking categories was noted, and participants were classified as increased (8%), maintained (65%), reduced (17%), or quit (10%) smoking. During a median follow-up of 26 (quartiles 1-3: 16-35) years, 87% of participants died. Changes in intensity were associated with survival. In multivariable-adjusted models, the hazard ratios for mortality were 1.14 (95% confidence interval (CI): 0.99, 1.32) among increasers, 0.85 (95% CI: 0.77, 0.95) among reducers, and 0.78 (95% CI: 0.69, 0.89) among quitters, compared with maintainers. Inversely, the adjusted odds ratios of surviving to age 80 years were 0.77 (95% CI: 0.60, 0.98), 1.22 (95% CI: 1.01, 1.47), and 1.33 (95% CI: 1.07, 1.66), respectively. The survival benefit associated with smoking reduction was mostly evident among heavy smokers and for cardiovascular disease mortality. These results suggest that decreasing smoking intensity should be considered as a risk-reduction strategy for heavy smokers who cannot quit abruptly.
先前的研究并未显示出减少吸烟可带来生存优势。作者评估了以色列工作男性队列中，根据吸烟强度变化，生存率和预期寿命的变化。1963 年招募的基线吸烟者于 1965 年重新评估（n=4633；平均年龄 51 岁），并前瞻性随访至 2005 年死亡。吸烟强度在两个时间点均为自我报告，并分为无、1-10、11-20 和≥21 支/天。注意到吸烟类别之间的变化，并将参与者分为增加（8%）、维持（65%）、减少（17%）或戒烟（10%）。在中位数为 26 年（四分位间距 1-3：16-35）的随访期间，87%的参与者死亡。强度变化与生存相关。在多变量调整模型中，增量者的死亡率风险比为 1.14（95%置信区间（CI）：0.99，1.32），减量者为 0.85（95%CI：0.77，0.95），戒烟者为 0.78（95%CI：0.69，0.89），与维持者相比。相反，调整后活到 80 岁的生存几率分别为 0.77（95%CI：0.60，0.98）、1.22（95%CI：1.01，1.47）和 1.33（95%CI：1.07，1.66）。与减少吸烟相关的生存获益主要在重度吸烟者和心血管疾病死亡率中显现。这些结果表明，对于无法突然戒烟的重度吸烟者，应考虑减少吸烟强度作为降低风险的策略。
