Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland.
United States Census Bureau, Suitland, Maryland.
JAMA Intern Med. 2018 Apr 1;178(4):469-476. doi: 10.1001/jamainternmed.2017.8625.
Tobacco products have changed in recent years. Contemporary mortality risk estimates of combustible tobacco product use are needed.
To investigate the mortality risks associated with current and former use of cigars, pipes, and cigarettes.
DESIGN, SETTING, AND PARTICIPANTS: The National Longitudinal Mortality Study is a longitudinal population-based, nationally representative health survey with mortality follow-up that includes demographic and other information from the Current Population Survey, tobacco product use information from the Tobacco Use Supplement, and mortality data from the National Death Index. In this study, participants provided tobacco use information at baseline in surveys starting from 1985 and were followed for mortality through the end of 2011. The study includes 357 420 participants who reported exclusively using cigar, pipes, or cigarettes or reported never using any type of tobacco product.
Current or former exclusive use of any cigar (little cigar, cigarillos, large cigar), traditional pipe, or cigarette and never tobacco use. Information on current daily and nondaily use was also collected. Estimates adjusted for age, sex, race/ethnicity, education, and survey year.
All-cause and cause-specific mortality as identified as the primary cause of death from death certificate information.
Of the 357 420 persons included in the analysis, the majority of current and former cigar and pipe smokers were male (79.3%-98.0%), and smokers were more evenly divided by sex (46% of current daily smokers were male). There were 51 150 recorded deaths during follow-up. Exclusive current cigarette smokers (hazard ratio [HR], 1.98; 95% CI, 1.93-2.02) and exclusive current cigar smokers (HR, 1.20; 95% CI, 1.03-1.38) had higher all-cause mortality risks than never tobacco users. Exclusive current cigarette smokers (HR, 4.06; 95% CI, 3.84-4.29), exclusive current cigar smokers (HR, 1.61; 95% CI, 1.11-2.32), and exclusive current pipe smokers (HR, 1.58; 95% CI, 1.05-2.38) had an elevated risk of dying from a tobacco-related cancer (including bladder, esophagus, larynx, lung, oral cavity, and pancreas). Among current nondaily cigarette users, statistically significant associations were observed with deaths from lung cancer (HR, 6.24; 95% CI, 5.17-7.54), oral cancer (HR, 4.62; 95% CI, 1.84-11.58), circulatory death (HR, 1.43; 95% CI, 1.30-1.57), cardiovascular death (HR, 1.24; 95% CI, 1.11-1.39), cerebrovascular death (stroke) (HR, 1.39; 95% CI, 1.12-1.74), and chronic obstructive pulmonary disease (HR, 7.66; 95% CI, 6.09-9.64) as well as for daily smokers.
This study provides further evidence that exclusive use of cigar, pipes, and cigarettes each confers significant mortality risks.
近年来，烟草产品发生了变化。需要对可燃烟草制品使用的近期死亡率风险进行评估。
调查雪茄、烟斗和香烟的当前和既往使用与死亡率风险之间的关系。
设计、地点和参与者：国家纵向死亡率研究是一项基于人群的纵向全国性健康调查，具有死亡率随访，包括来自当前人口调查的人口统计学和其他信息、来自烟草使用补充调查的烟草使用信息以及来自国家死亡指数的死亡率数据。在这项研究中，参与者在从 1985 年开始的调查中提供了烟草使用信息，并通过 2011 年底的死亡率进行了随访。该研究包括 357420 名参与者，他们报告仅使用雪茄、烟斗或香烟，或报告从未使用过任何类型的烟草产品。
当前或既往独家使用任何雪茄（小雪茄、小雪茄、大雪茄）、传统烟斗或香烟，从不使用任何烟草制品。还收集了关于当前每日和非每日使用的信息。估计值根据年龄、性别、种族/民族、教育程度和调查年份进行了调整。
全因死亡率和特定原因死亡率，这些死因是根据死亡证明信息确定的主要死因。
在纳入分析的 357420 人中，大多数当前和既往的雪茄和烟斗吸烟者为男性（79.3%-98.0%），吸烟者的性别分布更为均衡（当前每日吸烟者中 46%为男性）。随访期间记录了 51150 例死亡。与从不吸烟的人相比，当前独家使用香烟的吸烟者（危险比[HR]，1.98；95%置信区间[CI]，1.93-2.02）和当前独家使用雪茄的吸烟者（HR，1.20；95% CI，1.03-1.38）的全因死亡率风险更高。当前独家使用香烟的吸烟者（HR，4.06；95% CI，3.84-4.29）、当前独家使用雪茄的吸烟者（HR，1.61；95% CI，1.11-2.32）和当前独家使用烟斗的吸烟者（HR，1.58；95% CI，1.05-2.38）患与烟草相关的癌症（包括膀胱癌、食管癌、喉癌、肺癌、口腔癌和胰腺癌）的风险增加。在当前非每日使用香烟的人群中，与肺癌（HR，6.24；95% CI，5.17-7.54）、口腔癌（HR，4.62；95% CI，1.84-11.58）、循环系统死亡（HR，1.43；95% CI，1.30-1.57）、心血管死亡（HR，1.24；95% CI，1.11-1.39）、脑血管死亡（中风）（HR，1.39；95% CI，1.12-1.74）和慢性阻塞性肺疾病（HR，7.66；95% CI，6.09-9.64）以及每日吸烟者的死亡风险均存在统计学显著关联。
本研究进一步证明，雪茄、烟斗和香烟的单独使用均会带来显著的死亡率风险。
