Müezzinler Aysel, Mons Ute, Gellert Carolin, Schöttker Ben, Jansen Eugène, Kee Frank, O'Doherty Mark G, Kuulasmaa Kari, Freedman Neal D, Abnet Christian C, Wolk Alicja, Håkansson Niclas, Orsini Nicola, Wilsgaard Tom, Bueno-de-Mesquita Bas, van der Schouw Yvonne T, Peeters Petra H M, de Groot Lisette C P G M, Peters Annette, Orfanos Philippos, Linneberg Allan, Pisinger Charlotta, Tamosiunas Abdonas, Baceviciene Migle, Luksiene Dalia, Bernotiene Gailute, Jousilahti Pekka, Petterson-Kymmer Ulrika, Jansson Jan Håkan, Söderberg Stefan, Eriksson Sture, Jankovic Nicole, Sánchez María-José, Veronesi Giovanni, Sans Susana, Drygas Wojciech, Trichopoulou Antonia, Boffetta Paolo, Brenner Hermann
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Network Aging Research, University of Heidelberg, Heidelberg, Germany.
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Am J Prev Med. 2015 Nov;49(5):e53-e63. doi: 10.1016/j.amepre.2015.04.004. Epub 2015 Jul 15.
Smoking is known to be a major cause of death among middle-aged adults, but evidence on its impact and the benefits of smoking cessation among older adults has remained limited. Therefore, we aimed to estimate the influence of smoking and smoking cessation on all-cause mortality in people aged ≥60 years.
Relative mortality and mortality rate advancement periods (RAPs) were estimated by Cox proportional hazards models for the population-based prospective cohort studies from Europe and the U.S. (CHANCES [Consortium on Health and Ageing: Network of Cohorts in Europe and the U.S.]), and subsequently pooled by individual participant meta-analysis. Statistical analyses were performed from June 2013 to March 2014.
A total of 489,056 participants aged ≥60 years at baseline from 22 population-based cohort studies were included. Overall, 99,298 deaths were recorded. Current smokers had 2-fold and former smokers had 1.3-fold increased mortality compared with never smokers. These increases in mortality translated to RAPs of 6.4 (95% CI=4.8, 7.9) and 2.4 (95% CI=1.5, 3.4) years, respectively. A clear positive dose-response relationship was observed between number of currently smoked cigarettes and mortality. For former smokers, excess mortality and RAPs decreased with time since cessation, with RAPs of 3.9 (95% CI=3.0, 4.7), 2.7 (95% CI=1.8, 3.6), and 0.7 (95% CI=0.2, 1.1) for those who had quit <10, 10 to 19, and ≥20 years ago, respectively.
Smoking remains as a strong risk factor for premature mortality in older individuals and cessation remains beneficial even at advanced ages. Efforts to support smoking abstinence at all ages should be a public health priority.
吸烟是中年成年人死亡的主要原因之一，但关于吸烟对老年人的影响以及戒烟益处的证据仍然有限。因此，我们旨在评估吸烟和戒烟对60岁及以上人群全因死亡率的影响。
通过Cox比例风险模型对来自欧洲和美国的基于人群的前瞻性队列研究（CHANCES [欧洲和美国健康与老龄化队列联盟]）估计相对死亡率和死亡率进展期（RAPs），随后通过个体参与者荟萃分析进行汇总。统计分析于2013年6月至2014年3月进行。
纳入了来自22项基于人群的队列研究的489,056名基线年龄≥60岁的参与者。总体而言，记录了99,298例死亡。与从不吸烟者相比，当前吸烟者的死亡率增加了2倍，既往吸烟者增加了1.3倍。这些死亡率的增加分别转化为6.4（95%CI = 4.8, 7.9）年和2.4（95%CI = 1.5, 3.4）年的RAPs。观察到当前吸烟支数与死亡率之间存在明显的正剂量反应关系。对于既往吸烟者，自戒烟以来，额外死亡率和RAPs随时间下降，戒烟时间<10年、10至19年和≥20年的人的RAPs分别为3.9（95%CI = 3.0, 4.7）、2.7（95%CI = 1.8, 3.6）和0.7（95%CI = 0.2, 1.1）。
吸烟仍然是老年人过早死亡的一个强有力的危险因素，即使在高龄时戒烟仍然有益。支持各年龄段戒烟的努力应成为公共卫生的优先事项。
