Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 6120 Executive Blv, EPS 8015, Bethesda, MD 20892-7240, USA.
BMJ. 2012 Aug 29;345:e5414. doi: 10.1136/bmj.e5414.
To estimate the risk of lung cancer associated with the use of different types of coal for household cooking and heating.
Xuanwei County, Yunnan Province, China.
Retrospective cohort study (follow-up 1976-96) comparing mortality from lung cancer between lifelong users of "smoky coal" (bituminous) and "smokeless coal" (anthracite).
27,310 individuals using smoky coal and 9962 individuals using smokeless coal during their entire life.
Primary outcomes were absolute and relative risk of death from lung cancer among users of different types of coal. Unadjusted survival analysis was used to estimate the absolute risk of lung cancer, while Cox regression models compared mortality hazards for lung cancer between smoky and smokeless coal users.
Lung cancer mortality was substantially higher among users of smoky coal than users of smokeless coal. The absolute risks of lung cancer death before 70 years of age for men and women using smoky coal were 18% and 20%, respectively, compared with less than 0.5% among smokeless coal users of both sexes. Lung cancer alone accounted for about 40% of all deaths before age 60 among individuals using smoky coal. Compared with smokeless coal, use of smoky coal was associated with an increased risk of lung cancer death (for men, hazard ratio 36 (95% confidence interval 20 to 65); for women, 99 (37 to 266)).
In Xuanwei, the domestic use of smoky coal is associated with a substantial increase in the absolute lifetime risk of developing lung cancer and is likely to represent one of the strongest effects of environmental pollution reported for cancer risk. Use of less carcinogenic types of coal could translate to a substantial reduction of lung cancer risk.
评估使用不同类型的煤进行家庭烹饪和取暖与肺癌风险的关系。
中国云南省宣威县。
对使用“烟煤”（烟煤）和“无烟煤”（无烟煤）的人群进行终生比较肺癌死亡率的回顾性队列研究（随访 1976-96 年）。
27310 名使用烟煤和 9962 名使用无烟煤的个体。
主要结局指标为不同类型煤使用者肺癌死亡的绝对和相对风险。未调整的生存分析用于估计肺癌的绝对风险，而 Cox 回归模型比较了烟煤和无烟煤使用者肺癌死亡率的危险。
使用烟煤的人群肺癌死亡率明显高于使用无烟煤的人群。使用烟煤的男性和女性在 70 岁之前死于肺癌的绝对风险分别为 18%和 20%，而使用无烟煤的男女均低于 0.5%。肺癌单独占使用烟煤者所有 60 岁以下死亡的 40%左右。与无烟煤相比，使用烟煤与肺癌死亡风险增加相关（男性，危险比 36（95%置信区间 20 至 65）；女性，99（37 至 266））。
在宣威，家庭使用烟煤与肺癌终生风险的绝对增加密切相关，可能是报道的癌症风险环境污染最强效应之一。使用致癌性较低的煤种可大大降低肺癌风险。
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