Gellert Carolin, Schöttker Ben, Brenner Hermann
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
Arch Intern Med. 2012 Jun 11;172(11):837-44. doi: 10.1001/archinternmed.2012.1397.
BACKGROUND Smoking is an established risk factor of premature death. However, most pertinent studies primarily relied on middle-aged adults. We performed a systematic review and meta-analysis of the empirical evidence on the association of smoking with all-cause mortality in people 60 years and older. METHODS A systematic literature search was conducted in multiple databases including MEDLINE, EMBASE, and ISI Web of Knowledge and complemented by cross-referencing to identify cohort studies published before July 2011. Core items of identified studies were independently extracted by 2 reviewers, and results were summarized by standard methods of meta-analysis. RESULTS We identified 17 studies from 7 countries. Current smoking was associated with increased all-cause mortality in all studies. Relative mortality (RM) compared with never smokers ranged from 1.2 to 3.4 across studies and was 1.83 (95% CI, 1.65-2.03) in the meta-analysis. A decrease of RM of current smokers with increasing age was observed, but mortality remained increased up to the highest ages. Furthermore, a dose-response relationship of the amount of smoked cigarettes and premature death was observed. Former smokers likewise had an increased mortality (meta-analysis: RM, 1.34; 95% CI, 1.28-1.40), but excess mortality compared with never smokers clearly decreased with duration of cessation. Benefits of smoking cessation were evident in all age groups, including subjects 80 years and older. CONCLUSIONS Smoking remains a strong risk factor for premature mortality also at older age. Smoking cessation is beneficial at any age.
背景 吸烟是早死的一个既定风险因素。然而，大多数相关研究主要依赖中年成年人。我们对60岁及以上人群中吸烟与全因死亡率之间关联的实证证据进行了系统评价和荟萃分析。方法 在包括MEDLINE、EMBASE和ISI Web of Knowledge在内的多个数据库中进行系统文献检索，并通过交叉引用进行补充，以识别2011年7月之前发表的队列研究。由2名评审员独立提取已识别研究的核心项目，并采用荟萃分析的标准方法汇总结果。结果 我们从7个国家识别出17项研究。在所有研究中，当前吸烟与全因死亡率增加相关。各研究中，与从不吸烟者相比的相对死亡率（RM）范围为1.2至3.4，荟萃分析中为1.83（95%CI，1.65 - 2.03）。观察到当前吸烟者的RM随着年龄增长而降低，但直至最高年龄死亡率仍保持增加。此外，观察到吸烟量与过早死亡之间存在剂量反应关系。既往吸烟者同样死亡率增加（荟萃分析：RM，1.34；95%CI，1.28 - 1.40），但与从不吸烟者相比的超额死亡率随着戒烟时间明显降低。戒烟的益处在所有年龄组中都很明显，包括80岁及以上的人群。结论 在老年阶段，吸烟仍然是过早死亡的一个强大风险因素。任何年龄戒烟都是有益的。
