Zhao Jiaying, Pachanee Cha-Aim, Yiengprugsawan Vasoontara, Seubsman Sam-Ang, Sleigh Adrian
National Centre for Epidemiology and Population Health and Global Health Division, Research School of Population Health, The Australian National University, Canberra, Australia.
International Health and Policy Program, Bureau of Policy and Strategy, Ministry of Public Health, Nonthaburi, Thailand.
Popul Health Metr. 2015 Oct 27;13:30. doi: 10.1186/s12963-015-0062-0. eCollection 2015.
Smoking is a strong risk factor for mortality in both the developed and the developing world. However, there is still limited research to examine the impact of smoking cessation and mortality in middle-income Southeast Asian populations.
We use longitudinal data from a large Thai cohort of adult Open University students residing nationwide, linked with official death records to assess the association of smoking status and mortality risks during a 7-year follow-up. The log-rank test was used to evaluate the statistical probability of differential survival according to baseline smoking status. Multivariate hazard ratios (HR) were reported for smoking status and all-cause and cause-specific mortality.
From 2005 baseline to 2012, current smokers were more likely to die than cohort members who ceased smoking and never smokers (1.9 vs 1.3 vs 0.6 %, p < 0.05). The hazard of all-cause mortality increased with the daily amount of cigarette consumption among both current and former smokers. Cause of death analyses showed that current male smokers had a significantly increased risk of cardiovascular disease related mortality (HR 3.9 [95 % CI 1.8-8.1]). Former male smokers had a moderate increase in risk of dying from cardiovascular diseases compared to never smokers (HR 1.6 [95 % CI 0.7-3.4]). Current male smokers between 2005 and 2009 experienced highest subsequent mortality hazards during the period 2009-2012 compared to never smokers (HR 2.1 [95 % CI 1.4-3.4]). The higher risk of dying reduced if people quit smoking during the 2005-2009 follow-up period (HR 1.5 [95 % CI 0.7-3.3]). Risk for mortality fell even further among long-term quitters (HR 1.4 [95 % CI 0.9-2.2]).
Among a large nationwide cohort of Thai adults, current smokers were at a significantly and substantially higher risk of all-cause mortality, especially cardiovascular-related mortality. The higher risk of dying fell if people quit smoking and the risk for mortality was even lower among long-term quitters. Promotion of smoking cessation will contribute substantially to the reduction in avoidable mortality in Thailand.
在发达国家和发展中国家，吸烟都是导致死亡的重要风险因素。然而，关于戒烟对东南亚中等收入人群死亡率影响的研究仍然有限。
我们使用了来自泰国一个大型成年开放大学学生队列的纵向数据，这些学生居住在全国各地，并与官方死亡记录相链接，以评估在7年随访期间吸烟状况与死亡风险之间的关联。对数秩检验用于评估根据基线吸烟状况的差异生存的统计概率。报告了吸烟状况以及全因死亡率和特定病因死亡率的多变量风险比（HR）。
从2005年基线到2012年，当前吸烟者比戒烟者和从不吸烟者更有可能死亡（1.9%对1.3%对0.6%，p<0.05）。当前吸烟者和既往吸烟者的全因死亡风险随着每日吸烟量的增加而增加。死因分析表明，当前男性吸烟者心血管疾病相关死亡率的风险显著增加（HR 3.9[95%CI 1.8-8.1]）。与从不吸烟者相比，既往男性吸烟者死于心血管疾病的风险适度增加（HR 1.6[95%CI 0.7-3.4]）。与从不吸烟者相比，2005年至2009年期间的当前男性吸烟者在2009年至2012年期间经历了最高的后续死亡风险（HR 2.1[95%CI 1.4-3.4]）。如果人们在2005-2009年随访期间戒烟，死亡风险会降低（HR 1.5[95%CI 0.7-3.3]）。长期戒烟者的死亡风险进一步下降（HR 1.4[95%CI 0.9-2.2]）。
在泰国全国范围内的一个大型成年人群队列中，当前吸烟者全因死亡率的风险显著且大幅更高，尤其是心血管相关死亡率。如果人们戒烟，死亡风险会降低，长期戒烟者的死亡风险更低。促进戒烟将对降低泰国可避免的死亡率做出重大贡献。
