Institut für Sozial- und Präventivmedizin der Universität Zürich, Hirschengraben 84, Zürich, Switzerland.
Nicotine Tob Res. 2013 Sep;15(9):1588-97. doi: 10.1093/ntr/ntt023. Epub 2013 Mar 14.
In Switzerland, estimations of smoking-attributable deaths were based on age- and sex-adjusted hazard ratios (HRs) from foreign cohorts, precluding consideration of country-specific properties and adjustment for confounding. In order to overcome this, we analyzed recently available individual data from Switzerland.
We included 17,861 individuals aged ≥16 years who participated between 1977-1993 in health studies and were anonymously linked with the Swiss National Cohort. Adjusted Cox regression was used to calculate mortality HRs. Smoking status at baseline was categorized into never-smokers, former smokers, and current light or heavy smokers (<20 or ≥20 cigarettes/day). As covariates, we selected education, marital status, lifestyle, alcohol consumption, and body mass index. We differentiated between cardiovascular disease (CVD), cancer, and noncancer-non-CVD deaths. Smoking-attributable deaths were estimated with a HR-based approach and with age-specific prevalence rates and mortality estimates from 2007.
Smoking men and women not only had an increased risk for all-cause (HR and 95% confidence interval vs. never-smokers: 1.71 [1.53-1.90]; 1.54 [1.36-1.75]), CVD (1.72 [1.43-2.06]; 1.50 [1.19-1.90]) and cancer (1.87 [1.56-2.25]; 1.58 [1.30-1.93]), but also for noncancer-non-CVD death (1.57 [1.29-1.89]; 1.58 [1.30-1.93]). Former smoking men had an increased risk for all-cause (1.16 [1.03-1.31]) and cancer death (1.35 [1.10-1.65]). Multivariate adjustment only slightly modified the association between smoking and mortality. Overall, 7,153 deaths per year could be attributed to smoking.
Smoking is an important avoidable health burden in Switzerland, and its consequences may persist for decades after quitting. This stresses the need for putting more efforts in strategies aimed at preventing the onset of smoking.
在瑞士，吸烟相关死亡的估计是基于国外队列的年龄和性别调整后的风险比（HR）得出的，因此无法考虑到国家的具体情况，也无法进行混杂因素的调整。为了克服这一问题，我们分析了瑞士最近可用的个人数据。
我们纳入了 17861 名年龄≥16 岁的个体，他们于 1977-1993 年期间参加了健康研究，并与瑞士国家队列进行了匿名链接。使用调整后的 Cox 回归计算死亡率 HR。基线时的吸烟状况分为从不吸烟者、前吸烟者和当前轻度或重度吸烟者（<20 或≥20 支/天）。作为协变量，我们选择了教育、婚姻状况、生活方式、饮酒量和体重指数。我们区分了心血管疾病（CVD）、癌症和非癌症非 CVD 死亡。使用基于 HR 的方法以及 2007 年的特定年龄流行率和死亡率估计值来估计吸烟相关死亡。
吸烟的男性和女性不仅所有原因（HR 和 95%置信区间与从不吸烟者相比：1.71 [1.53-1.90]；1.54 [1.36-1.75]）、心血管疾病（1.72 [1.43-2.06]；1.50 [1.19-1.90]）和癌症（1.87 [1.56-2.25]；1.58 [1.30-1.93]）死亡风险增加，而且非癌症非 CVD 死亡风险也增加（1.57 [1.29-1.89]；1.58 [1.30-1.93]）。前吸烟的男性所有原因（1.16 [1.03-1.31]）和癌症死亡（1.35 [1.10-1.65]）的风险增加。多变量调整仅略微改变了吸烟与死亡率之间的关联。总体而言，每年有 7153 人死于吸烟。
在瑞士，吸烟是一个重要的可避免的健康负担，其后果可能在戒烟后持续数十年。这强调了需要在预防吸烟的策略上投入更多的努力。
