Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK.
BMC Public Health. 2018 Mar 19;18(1):348. doi: 10.1186/s12889-018-5227-x.
Active smoking is an important risk factor for all-cause mortality and peripheral arterial disease (PAD). In contrast, published studies on the associations with secondhand smoke (SHS) are limited. The aim of this study was to examine the associations between SHS exposure and incident PAD, as well as mortality, among middle-aged non-smokers.
We undertook a retrospective, cohort study using record linkage of the Scottish Health Surveys between 1998 and 2010 to hospital admissions and death certificates. Inclusion was restricted to participants aged > 45 years. Cox proportional hazard models were used to examine the association between SHS exposure and incident PAD (hospital admission or death) and all-cause mortality, with adjustment for potential confounders.
Of the 4045 confirmed non-smokers (self-reported non-smokers with salivary cotinine concentrations < 15 ng/mL), 1163 (28.8%) had either moderate or high exposure to SHS at baseline. In men, high exposure to SHS (cotinine ≥2.7 ng/mL) was associated with increased risk of all-cause mortality (fully adjusted hazard ratio [HR] 1.54, 95% CI 1.07-2.22, p = 0.020) with evidence of a dose-relationship (p for trend = 0.004). In men, high exposure to SHS was associated with increased risk of incident PAD over the first five years of follow-up (fully adjusted HR 4.29, 95% CI 1.14-16.10, p = 0.031) but the association became non-significant over longer term follow-up.
SHS exposure was independently associated with all-cause mortality and may be associated with PAD, but larger studies, or meta-analyses, are required to confirm the latter.
主动吸烟是全因死亡率和外周动脉疾病（PAD）的一个重要危险因素。相比之下，关于二手烟（SHS）暴露与 PAD 之间关联的研究则很有限。本研究旨在探讨中年不吸烟者中 SHS 暴露与 PAD 发病以及全因死亡率之间的关系。
我们采用苏格兰健康调查（1998 年至 2010 年）的记录链接进行了一项回顾性队列研究，以调查医院入院和死亡证明。纳入标准为年龄>45 岁的参与者。使用 Cox 比例风险模型，在校正潜在混杂因素后，研究 SHS 暴露与 PAD 发病（住院或死亡）和全因死亡率之间的关联。
在 4045 名确定的不吸烟者（自我报告的非吸烟者，唾液可替宁浓度<15ng/mL）中，有 1163 名（28.8%）基线时存在中度或高度 SHS 暴露。在男性中，高 SHS 暴露（可替宁≥2.7ng/mL）与全因死亡率升高相关（完全调整后的风险比 [HR] 1.54，95%CI 1.07-2.22，p=0.020），且存在剂量相关性（趋势检验 p=0.004）。在男性中，高 SHS 暴露与随访前五年内 PAD 的发病风险增加相关（完全调整后的 HR 4.29，95%CI 1.14-16.10，p=0.031），但随着随访时间的延长，这种关联变得不显著。
SHS 暴露与全因死亡率独立相关，可能与 PAD 相关，但需要更大规模的研究或荟萃分析来证实后者。
