Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
Tob Control. 2013 Jul;22(4):227-30. doi: 10.1136/tobaccocontrol-2012-050572. Epub 2012 Sep 22.
Standard epidemiological measures of the risk of premature death from smoking might be unsuitable for risk communication in actual counselling situations. The rate advancement period (RAP) is an epidemiologic metric that could be useful for conveying information on the benefits of quitting. More effective risk communication could motivate older smokers to make an attempt at quitting. We provide empirical evidence on the impact of smoking, and the benefits of quitting on all-cause mortality and RAPs for people aged 60 years and older in a large cohort of older adults.
Smoking information was obtained from 6545 participants aged 60-74 years of ESTHER, a population-based German cohort. Cox proportional hazards regression was applied to estimate associations of smoking status, amount of smoking and time since smoking cessation with all-cause mortality. Premature mortality was quantified by RAPs.
Current smokers had a 2.5-fold increased risk for all-cause mortality (adjusted HR: 2.53, 95% CI 2.10 to 3.03) and an RAP of 10.7 years when compared with never smokers. Strong dose-response relationships were seen with both current and life-time amount of smoking. Compared with current smokers, significant mortality reductions by 30%, 39% and 59%, and rate advancement reductions of 4.0, 5.6 and 10.0 years within <10 years, 10-19 years and ≥20 years after cessation were found for former smokers, respectively.
Smoking remains a strong risk factor for premature mortality, and smoking cessation remains highly beneficial also at older ages.
衡量因吸烟导致过早死亡风险的标准流行病学指标可能并不适合实际咨询情境下的风险沟通。率进展期（RAP）是一种流行病学指标，可用于传达关于戒烟益处的信息。更有效的风险沟通可以激励老年吸烟者尝试戒烟。我们提供了关于吸烟的影响以及戒烟对全因死亡率和 RAP 的实证证据，研究对象为年龄在 60 岁及以上的大型老年人群队列。
ESTHER 是一项基于人群的德国队列研究，共纳入了 6545 名年龄在 60-74 岁的参与者，我们从该研究中获取了参与者的吸烟信息。我们应用 Cox 比例风险回归来估计吸烟状态、吸烟量和戒烟时间与全因死亡率之间的关联。通过 RAP 来量化过早死亡。
与从不吸烟者相比，当前吸烟者的全因死亡率风险增加了 2.5 倍（调整后的 HR：2.53，95%CI 2.10 至 3.03），RAP 为 10.7 年。当前和终生吸烟量均与强烈的剂量反应关系相关。与当前吸烟者相比，戒烟后 10 年内、10-19 年内和≥20 年内，分别有 30%、39%和 59%的死亡率显著降低，以及 4.0、5.6 和 10.0 年的 RAP 减少。
吸烟仍然是过早死亡的一个强危险因素，即使在老年时戒烟仍然具有高度益处。
