Department of Epidemiology, American Cancer Society, Atlanta, GA 30303-1002, USA.
N Engl J Med. 2013 Jan 24;368(4):351-64. doi: 10.1056/NEJMsa1211127.
The disease risks from cigarette smoking increased in the United States over most of the 20th century, first among male smokers and later among female smokers. Whether these risks have continued to increase during the past 20 years is unclear.
We measured temporal trends in mortality across three time periods (1959-1965, 1982-1988, and 2000-2010), comparing absolute and relative risks according to sex and self-reported smoking status in two historical cohort studies and in five pooled contemporary cohort studies, among participants who became 55 years of age or older during follow-up.
For women who were current smokers, as compared with women who had never smoked, the relative risks of death from lung cancer were 2.73, 12.65, and 25.66 in the 1960s, 1980s, and contemporary cohorts, respectively; corresponding relative risks for male current smokers, as compared with men who had never smoked, were 12.22, 23.81, and 24.97. In the contemporary cohorts, male and female current smokers also had similar relative risks for death from chronic obstructive pulmonary disease (COPD) (25.61 for men and 22.35 for women), ischemic heart disease (2.50 for men and 2.86 for women), any type of stroke (1.92 for men and 2.10 for women), and all causes combined (2.80 for men and 2.76 for women). Mortality from COPD among male smokers continued to increase in the contemporary cohorts in nearly all the age groups represented in the study and within each stratum of duration and intensity of smoking. Among men 55 to 74 years of age and women 60 to 74 years of age, all-cause mortality was at least three times as high among current smokers as among those who had never smoked. Smoking cessation at any age dramatically reduced death rates.
The risk of death from cigarette smoking continues to increase among women and the increased risks are now nearly identical for men and women, as compared with persons who have never smoked. Among men, the risks associated with smoking have plateaued at the high levels seen in the 1980s, except for a continuing, unexplained increase in mortality from COPD.
在美国，20 世纪大部分时间里，香烟导致的疾病风险都在增加，首先是男性吸烟者，后来是女性吸烟者。在过去的 20 年里，这些风险是否继续增加尚不清楚。
我们通过两项历史队列研究和五项当代队列研究，在随访期间达到 55 岁或以上的参与者中，根据性别和自我报告的吸烟状况，比较了三个时期（1959-1965 年、1982-1988 年和 2000-2010 年）的死亡率趋势，测量了绝对风险和相对风险。
与从不吸烟者相比，在 20 世纪 60 年代、80 年代和当代队列中，当前吸烟的女性患肺癌的相对风险分别为 2.73、12.65 和 25.66；相应的男性当前吸烟者与从不吸烟者相比，其风险分别为 12.22、23.81 和 24.97。在当代队列中，男性和女性当前吸烟者患慢性阻塞性肺疾病（COPD）的相对风险也相似（男性为 25.61，女性为 22.35）、缺血性心脏病（男性为 2.50，女性为 2.86）、任何类型的中风（男性为 1.92，女性为 2.10）和所有原因的总和（男性为 2.80，女性为 2.76）。在当代队列中，在研究中代表的几乎所有年龄组和每个吸烟持续时间和强度的分层中，男性吸烟者的 COPD 死亡率仍在继续上升。在 55 至 74 岁的男性和 60 至 74 岁的女性中，当前吸烟者的全因死亡率至少是从不吸烟者的三倍。任何年龄戒烟都能显著降低死亡率。
女性因吸烟而死亡的风险继续增加，与从不吸烟者相比，女性的风险增加现在几乎与男性相同。在男性中，除 COPD 死亡率持续增加外，吸烟相关风险在 20 世纪 80 年代的高水平上趋于平稳。
