Department of Primary Care and Public Health Sciences, King's College London, London, UK.
Queen Mary, Centre for Primary Care and Public Health, University of London, London, UK.
NPJ Prim Care Respir Med. 2017 Sep 4;27(1):50. doi: 10.1038/s41533-017-0052-8.
Chronic obstructive pulmonary disease risk is lower in black and south Asian people than white people, when adjusting for age, sex, deprivation and smoking status. The role of smoking intensity was assessed for its contribution to ethnic differences in chronic obstructive pulmonary disease risk, a relationship not previously investigated. This cross-sectional study included routinely collected primary care data from four multi-ethnic London boroughs. Smoking intensity (estimated by cigarettes per day) was compared between ethnic groups. Chronic obstructive pulmonary disease risk was compared between ethnic groups using multiple logistic regression, controlling for age, sex, deprivation, asthma and both smoking status and smoking intensity, examined independently. In all, 1,000,388 adults were included. Smoking prevalence and intensity were significantly higher in the white British/Irish groups than other ethnic groups. Higher smoking intensity was associated with higher chronic obstructive pulmonary disease risk. Chronic obstructive pulmonary disease risk was significantly lower in all ethnic groups compared with white British/Irish after adjustment for either smoking status or smoking intensity, with lowest risk in black Africans (odds ratio 0.33; confidence interval 0.28-0.38). Ethnic differences in chronic obstructive pulmonary disease risk were not explained in this study by ethnic differences in smoking prevalence or smoking intensity. Other causes of ethnic differences in chronic obstructive pulmonary disease risk should be sought, including ethnic differences in smoking behaviour, environmental factors, repeated respiratory infections, immigrant status, metabolism and addictiveness of nicotine and differential susceptibility to the noxious effects of cigarette smoke.COPD: SMOKING INTENSITY NOT BEHIND ETHNIC DIFFERENCES IN DISEASE RISK: Lower smoking intensity among blacks and south Asians does not explain their lower risk for chronic obstructive pulmonary disease (COPD). A UK team led by Alexander Gilkes from Kings College London analysed primary care data from more than a million people living in four multi-ethnic boroughs of the British capital. The researchers found that smoking status and intensity (as measured by number of cigarettes smoked per day) were both significantly higher in white British or Irish groups than in other ethnic populations. Even after statistically adjusting for smoking status or smoking intensity, however, the researchers couldn't account for the fact that people of south Asian or African descent had much lower prevalence rates of COPD, a lung disease linked to smoking. The findings suggest that other explanations of ethnic differences are still needed.
慢性阻塞性肺疾病（COPD）的风险在黑人及南亚人群中低于白人，在调整年龄、性别、贫困程度和吸烟状况后也是如此。本研究评估了吸烟强度在 COPD 发病风险的种族差异中的作用，这是一个此前尚未研究过的关系。这项横断面研究纳入了来自伦敦四个多族裔区的常规初级保健数据。比较了不同种族群体之间的吸烟强度（通过每天吸烟量来估计）。使用多元逻辑回归比较了不同种族群体之间的 COPD 发病风险，控制了年龄、性别、贫困程度、哮喘以及吸烟状况和吸烟强度，并分别进行了检查。共有 1000388 名成年人纳入研究。白种英国人/爱尔兰人的吸烟流行率和吸烟强度显著高于其他种族群体。较高的吸烟强度与较高的 COPD 发病风险相关。在调整吸烟状况或吸烟强度后，所有种族群体的 COPD 发病风险均显著低于白种英国人/爱尔兰人，其中非洲黑人的风险最低（比值比 0.33；95%置信区间 0.28-0.38）。本研究中，吸烟流行率或吸烟强度的种族差异并不能解释 COPD 发病风险的种族差异。应寻找 COPD 发病风险的其他种族差异原因，包括吸烟行为、环境因素、反复呼吸道感染、移民身份、尼古丁的代谢和成瘾性以及对香烟烟雾的有害影响的不同敏感性方面的种族差异。
