Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia.
Lancet. 2013 Aug 24;382(9893):685-93. doi: 10.1016/S0140-6736(13)61610-4.
The full eventual effects of current smoking patterns cannot yet be seen in Africa. In South Africa, however, men and women in the coloured (mixed black and white ancestry) population have smoked for many decades. We assess mortality from smoking in the coloured, white, and black (African) population groups.
In this case-control study, 481,640 South African notifications of death at ages 35-74 years between 1999 and 2007 yielded information about age, sex, population group, education, smoking 5 years ago (yes or no), and underlying disease. Cases were deaths from diseases expected to be affected by smoking; controls were deaths from selected other diseases, excluding only HIV, cirrhosis, unknown causes, external causes, and mental disorders. Disease-specific case-control comparisons yielded smoking-associated relative risks (RRs; diluted by combining some ex-smokers with the never-smokers). These RRs, when combined with national mortality rates, yielded smoking-attributed mortality rates. Summation yielded RRs and smoking-attributed numbers for overall mortality.
In the coloured population, smoking prevalence was high in both sexes and smokers had about 50% higher overall mortality than did otherwise similar non-smokers or ex-smokers (men, RR 1·55, 95% CI 1·43-1·67; women, 1·49, 1·38-1·60). RRs were similar in the white population (men, 1·37, 1·29-1·46; women, 1·51, 1·40-1·62), but lower among Africans (men, 1·17, 1·15-1·19; women, 1·16, 1·13-1·20). If these associations are largely causal, smoking-attributed proportions for overall male deaths at ages 35-74 years were 27% (5608/20,767) in the coloured, 14% (3913/28,951) in the white, and 8% (20,398/264,011) in the African population. For female deaths, these proportions were 17% (2728/15,593) in the coloured, 12% (2084/17,899) in the white, and 2% (4038/205,623) in the African population. Because national mortality rates were also substantially higher in the coloured than in the white population, the hazards from smoking in the coloured population were more than double those in the white population.
The highest smoking-attributed mortality rates were in the coloured population and the lowest were in Africans. The substantial hazards already seen among coloured South Africans suggest growing hazards in all populations in Africa where young adults now smoke.
South African Medical Research Council, UK Medical Research Council, Cancer Research UK, British Heart Foundation, New South Wales Cancer Council.
目前的吸烟模式的最终全面影响在非洲还无法看到。然而，在南非，有色人种（混血儿，有黑人和白人的血统）中的男性和女性已经吸烟多年。我们评估了吸烟对有色人种、白人和黑人（非洲人）人群的死亡率的影响。
在这项病例对照研究中，1999 年至 2007 年期间，南非有 481640 例年龄在 35-74 岁之间的死亡通知，这些通知提供了有关年龄、性别、人群组别、教育程度、5 年前是否吸烟（是或否）以及潜在疾病的信息。病例是预期受吸烟影响的疾病导致的死亡；对照是由其他特定疾病导致的死亡，排除了仅 HIV、肝硬化、不明原因、外部原因和精神障碍。针对特定疾病的病例对照比较得出了与吸烟相关的相对风险（RR；将一些戒烟者与从不吸烟者混合稀释）。这些 RR 与全国死亡率相结合，得出了归因于吸烟的死亡率。求和得出了整体死亡率的 RR 和归因于吸烟的人数。
在有色人种中，两性的吸烟率都很高，吸烟者的总死亡率比其他不吸烟或戒烟者高出约 50%（男性，RR 1.55，95%CI 1.43-1.67；女性，1.49，1.38-1.60）。白人人群中的 RR 相似（男性，1.37，1.29-1.46；女性，1.51，1.40-1.62），但在非洲人中较低（男性，1.17，1.15-1.19；女性，1.16，1.13-1.20）。如果这些关联在很大程度上是因果关系，那么在 35-74 岁年龄段的男性总死亡人数中，有色人种归因于吸烟的比例为 27%（5608/20767），白人人群为 14%（3913/28951），非洲人群为 8%（20/264011）。对于女性死亡人数，有色人种中归因于吸烟的比例为 17%（2728/15593），白人人群为 12%（2084/17899），非洲人群为 2%（4038/205623）。由于有色人种的全国死亡率也明显高于白人，因此有色人种人群中吸烟的危害是白人的两倍多。
最高的归因于吸烟的死亡率出现在有色人种中，而最低的出现在非洲人。南非有色人种中已经出现的大量危害表明，在非洲所有年轻成年人现在吸烟的人群中，危害正在不断增加。
南非医学研究理事会、英国医学研究理事会、英国癌症研究中心、英国心脏基金会、新南威尔士癌症理事会。
