Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut.
Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor.
JAMA. 2014 Jan 8;311(2):164-71. doi: 10.1001/jama.2013.285112.
January 2014 marks the 50th anniversary of the first surgeon general's report on smoking and health. This seminal document inspired efforts by governments, nongovernmental organizations, and the private sector to reduce the toll of cigarette smoking through reduced initiation and increased cessation.
To model reductions in smoking-related mortality associated with implementation of tobacco control since 1964.
DESIGN, SETTING, AND PARTICIPANTS: Smoking histories for individual birth cohorts that actually occurred and under likely scenarios had tobacco control never emerged were estimated. National mortality rates and mortality rate ratio estimates from analytical studies of the effect of smoking on mortality yielded death rates by smoking status. Actual smoking-related mortality from 1964 through 2012 was compared with estimated mortality under no tobacco control that included a likely scenario (primary counterfactual) and upper and lower bounds that would capture plausible alternatives.
National Health Interview Surveys yielded cigarette smoking histories for the US adult population in 1964-2012.
Number of premature deaths avoided and years of life saved were primary outcomes. Change in life expectancy at age 40 years associated with change in cigarette smoking exposure constituted another measure of overall health outcomes.
In 1964-2012, an estimated 17.7 million deaths were related to smoking, an estimated 8.0 million (credible range [CR], 7.4-8.3 million, for the lower and upper tobacco control counterfactuals, respectively) fewer premature smoking-related deaths than what would have occurred under the alternatives and thus associated with tobacco control (5.3 million [CR, 4.8-5.5 million] men and 2.7 million [CR, 2.5-2.7 million] women). This resulted in an estimated 157 million years (CR, 139-165 million) of life saved, a mean of 19.6 years for each beneficiary (111 million [CR, 97-117 million] for men, 46 million [CR, 42-48 million] for women). During this time, estimated life expectancy at age 40 years increased 7.8 years for men and 5.4 years for women, of which tobacco control is associated with 2.3 years (CR, 1.8-2.5) (30% [CR, 23%-32%]) of the increase for men and 1.6 years (CR, 1.4-1.7) (29% [CR, 25%-32%]) for women.
Tobacco control was estimated to be associated with avoidance of 8 million premature deaths and an estimated extended mean life span of 19 to 20 years. Although tobacco control represents an important public health achievement, efforts must continue to reduce the effect of smoking on the nation's death toll.
2014 年 1 月标志着第一份关于吸烟与健康的总医官报告发表 50 周年。这份开创性的文件激发了政府、非政府组织和私营部门的努力，通过减少吸烟的开始和增加戒烟来减少吸烟的危害。
模拟自 1964 年以来实施烟草控制措施与吸烟相关死亡率降低之间的关系。
设计、设置和参与者：根据实际发生的出生队列的吸烟史和可能情况下如果没有出现烟草控制的情况下的吸烟史进行了估计。从分析吸烟对死亡率影响的研究中得出的国家死亡率和死亡率比估计值，根据吸烟状况得出了死亡率。将 1964 年至 2012 年期间的实际与吸烟相关的死亡人数与包括可能情况（主要反事实）和可能替代方案的上限和下限在内的无烟草控制情况下的估计死亡人数进行了比较。
全国健康访谈调查提供了 1964-2012 年美国成年人的吸烟史。
避免的过早死亡人数和延长的寿命是主要结果。与吸烟暴露变化相关的 40 岁时预期寿命的变化构成了总体健康结果的另一个衡量标准。
1964-2012 年，估计有 1770 万人的死亡与吸烟有关，与替代方案相比，估计有 800 万人（可信区间[CR]，分别为 740 万至 830 万）的过早与吸烟相关的死亡人数减少，因此与烟草控制有关（530 万[CR，480 万至 550 万]男性和 270 万[CR，250 万至 270 万]女性）。这导致估计有 1.57 亿年（CR，1.39 亿至 1.65 亿年）的生命被挽救，每位受益者的平均寿命延长了 19.6 年（1.11 亿[CR，9700 万至 1.17 亿]男性，4600 万[CR，4200 万至 4800 万]女性）。在此期间，男性的 40 岁时预期寿命增加了 7.8 岁，女性增加了 5.4 岁，其中烟草控制与增加的 2.3 岁（CR，1.8-2.5）（30%[CR，23%-32%]）有关，女性增加了 1.6 岁（CR，1.4-1.7）（29%[CR，25%-32%]）。
估计烟草控制措施避免了 800 万例过早死亡，预计平均寿命延长了 19 至 20 年。尽管烟草控制是一项重要的公共卫生成就，但必须继续努力减少吸烟对国家死亡人数的影响。
