吸烟与死亡——超越已知病因。

Smoking and mortality--beyond established causes.

机构信息

From the Epidemiology Research Program, American Cancer Society, Atlanta (B.D.C., M.J.T., E.J.J.); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD (C.C.A., N.D.F., P.H.); the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (D.F., F.E.S.); the Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham (C.E.L.); the Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester (J.K.O.); and the Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle (R.L.P.).

出版信息

N Engl J Med. 2015 Feb 12;372(7):631-40. doi: 10.1056/NEJMsa1407211.

DOI:10.1056/NEJMsa1407211

PMID:25671255

Abstract

BACKGROUND

Mortality among current smokers is 2 to 3 times as high as that among persons who never smoked. Most of this excess mortality is believed to be explained by 21 common diseases that have been formally established as caused by cigarette smoking and are included in official estimates of smoking-attributable mortality in the United States. However, if smoking causes additional diseases, these official estimates may significantly underestimate the number of deaths attributable to smoking.

METHODS

We pooled data from five contemporary U.S. cohort studies including 421,378 men and 532,651 women 55 years of age or older. Participants were followed from 2000 through 2011, and relative risks and 95% confidence intervals were estimated with the use of Cox proportional-hazards models adjusted for age, race, educational level, daily alcohol consumption, and cohort.

RESULTS

During the follow-up period, there were 181,377 deaths, including 16,475 among current smokers. Overall, approximately 17% of the excess mortality among current smokers was due to associations with causes that are not currently established as attributable to smoking. These included associations between current smoking and deaths from renal failure (relative risk, 2.0; 95% confidence interval [CI], 1.7 to 2.3), intestinal ischemia (relative risk, 6.0; 95% CI, 4.5 to 8.1), hypertensive heart disease (relative risk, 2.4; 95% CI, 1.9 to 3.0), infections (relative risk, 2.3; 95% CI, 2.0 to 2.7), various respiratory diseases (relative risk, 2.0; 95% CI, 1.6 to 2.4), breast cancer (relative risk, 1.3; 95% CI, 1.2 to 1.5), and prostate cancer (relative risk, 1.4; 95% CI, 1.2 to 1.7). Among former smokers, the relative risk for each of these outcomes declined as the number of years since quitting increased.

CONCLUSIONS

A substantial portion of the excess mortality among current smokers between 2000 and 2011 was due to associations with diseases that have not been formally established as caused by smoking. These associations should be investigated further and, when appropriate, taken into account when the mortality burden of smoking is investigated. (Funded by the American Cancer Society.).

摘要

背景

目前吸烟者的死亡率是从不吸烟者的 2 到 3 倍。人们普遍认为，这种超额死亡率主要归因于 21 种常见疾病，这些疾病已被正式确认为由吸烟引起，并被纳入美国官方对吸烟相关死亡率的估计中。然而，如果吸烟导致其他疾病，这些官方估计可能会大大低估归因于吸烟的死亡人数。

方法

我们对五项当代美国队列研究的数据进行了汇总，这些研究共纳入了 421378 名男性和 532651 名 55 岁及以上的女性。参与者从 2000 年至 2011 年进行随访，使用 Cox 比例风险模型估算相对风险和 95%置信区间，并对年龄、种族、教育程度、每日饮酒量和队列进行了调整。

结果

在随访期间，有 181377 人死亡，其中包括 16475 名当前吸烟者。总体而言，目前吸烟者的超额死亡率中约有 17%是由于与目前尚未确定与吸烟有关的原因有关。其中包括目前吸烟与肾衰竭（相对风险，2.0；95%置信区间[CI]，1.7 至 2.3）、肠缺血（相对风险，6.0；95%CI，4.5 至 8.1）、高血压性心脏病（相对风险，2.4；95%CI，1.9 至 3.0）、感染（相对风险，2.3；95%CI，2.0 至 2.7）、各种呼吸系统疾病（相对风险，2.0；95%CI，1.6 至 2.4）、乳腺癌（相对风险，1.3；95%CI，1.2 至 1.5）和前列腺癌（相对风险，1.4；95%CI，1.2 至 1.7）的相关性。在曾经吸烟者中，随着戒烟年限的增加，这些结果的相对风险逐渐降低。