Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland, USA.
Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Tob Control. 2017 Nov;26(6):674-682. doi: 10.1136/tobaccocontrol-2016-053245. Epub 2016 Nov 21.
There is limited information about the hazards of cigarettes, smokeless tobacco and waterpipe in the Middle East. The aim of this study was to determine the association between different types of tobacco use and earlier death in the Golestan Cohort Study.
The Study includes 50 045 adults (aged 40-75 years) from north eastern Iran. The baseline questionnaire (2004-2008) assessed information about use of cigarettes, chewing tobacco (nass) and waterpipe. To assess the use of each type of tobacco compared with never tobacco users, we used Cox regression models adjusted for age, socioeconomic status, area of residence, education and other tobacco used, and stratified by sex, ethnicity and opium use.
17% of participants reported a history of cigarette smoking, 7.5% chewing tobacco (nass) and 1.1% smoking waterpipe, and these figures declined in the later birth cohorts. During a median follow-up of 8 years, 4524 deaths occurred (mean age 64.8+9.9 years). Current (HR=1.44; 95% CI 1.28 to 1.61) and former (HR=1.35; 95% CI 1.16 to 1.56) cigarette smokers had higher overall mortality relative to never tobacco users. The highest cigarette-associated risk was for cancer death among current heavy smokers (HR=2.32; 95% CI 1.66 to 3.24). Current nass chewing was associated with overall mortality (HR=1.16; 95% CI 1.01 to 1.34), and there was a 61% higher risk of cancer death in people chewing nass more than five times a day. We observed an association between the cumulative lifetime waterpipe use (waterpipe-years≥28) and both overall (HR=1.66; 95% CI 1.11 to 2.47), and cancer mortality (HR=2.82; 95% CI 1.30 to 6.11).
Regular use of cigarettes, smokeless tobacco and waterpipe were associated with the risk of earlier death (particularly from cancer) in our cohort.
中东地区关于香烟、无烟烟草和水烟危害的信息有限。本研究旨在确定戈勒斯坦队列研究中不同类型的烟草使用与早逝之间的关联。
该研究包括来自伊朗东北部的 50045 名成年人（年龄 40-75 岁）。基线问卷（2004-2008 年）评估了使用香烟、咀嚼烟草（nass）和水烟的信息。为了评估与从未使用过烟草的人相比，每种类型的烟草使用情况，我们使用 Cox 回归模型进行调整，包括年龄、社会经济地位、居住地、教育程度和其他烟草使用情况，并按性别、族裔和鸦片使用情况进行分层。
17%的参与者报告有吸烟史，7.5%咀嚼烟草（nass），1.1%吸烟水烟，这些数字在后来的出生队列中有所下降。在中位数为 8 年的随访期间，有 4524 人死亡（平均年龄 64.8+9.9 岁）。当前（HR=1.44；95%CI 1.28 至 1.61）和既往（HR=1.35；95%CI 1.16 至 1.56）吸烟者的总死亡率高于从未吸烟者。当前重度吸烟者的癌症死亡率与吸烟相关的风险最高（HR=2.32；95%CI 1.66 至 3.24）。当前咀嚼 nass 与总死亡率相关（HR=1.16；95%CI 1.01 至 1.34），每天咀嚼 nass 超过五次的人患癌症死亡的风险增加 61%。我们观察到累积终生水烟使用（水烟年≥28）与总死亡率（HR=1.66；95%CI 1.11 至 2.47）和癌症死亡率（HR=2.82；95%CI 1.30 至 6.11）之间存在关联。
在我们的队列中，定期使用香烟、无烟烟草和水烟与早逝（特别是癌症死亡）的风险相关。
