Medical College, Qingdao University, Qingdao, Shandong Province, China.
Qingdao Municipal Center for Disease Control and Prevention, Qingdao, Shandong Province, China.
PLoS One. 2018 Sep 20;13(9):e0204221. doi: 10.1371/journal.pone.0204221. eCollection 2018.
Cigarette smoking is among the most important public health concerns worldwide and the leading preventable cause of illness and death associated with cancer, chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD). Although Qingdao, China implemented smoking control measures in 2007 and smoke-free legislation in 2013, smoking-attributable cancer mortality remains at a high level. The present study aimed to facilitate changes in policy-making, intervention implementation, monitoring and evaluation by estimating and comparing the burden of smoking-attributable cancers in Qingdao during 2005, 2010 and 2015.
This study used the disease list from the Global Burden of Disease (GBD) study to quantify the burden of smoking-related cancer. Sex and age-specific smoking-attributable mortality data were collected from the Qingdao Municipal Center for Disease Control and Prevention using an online reporting system. The population-attributable fractions (PAFs) of smoking and smoking-attributable cancer mortality in 2005, 2010 and 2015 were estimated using the smoking impact ratio (SIR) and relative risks (RRs) and by multiplying the smoking-attributable fraction by total cancer mortality, respectively.
The numbers of smoking-attributable cancer deaths increased from 2484 in 2005 to 2999 in 2010 and 4148 in 2015, with corresponding PAFs of 26.41%, 25.76% and 29.13%, respectively. The PAFs were higher among men (vs. women) for all cancers except cervical cancer. In 2005, lung, liver, esophageal and stomach cancers were most frequently associated with smoking-associated cancer mortality, and lung cancer had the greatest PAF, followed by nasopharyngeal, oral and esophageal cancers. Similar patterns were observed in 2010 and 2015. In 2015, 1 in 3 and 1 in 5 cancer deaths in men and women, respectively, were attributable to smoking, and 95% of these deaths were associated with lung, liver, esophageal or stomach cancer. Over time, downward and upward trends in smoking-attributable cancer deaths were respectively observed among people younger than and older than 50 years.
The smoking-attributable cancer burden in Qingdao remains considerable, despite the implementation of tobacco control and smoke-free measures. Tobacco control efforts should remain a major public health priority.
吸烟是全球最重要的公共卫生关注点之一，也是与癌症、慢性阻塞性肺疾病（COPD）和心血管疾病（CVD）相关的可预防疾病和死亡的主要原因。尽管中国青岛在 2007 年实施了控烟措施，并在 2013 年实施了无烟立法，但归因于吸烟的癌症死亡率仍处于较高水平。本研究旨在通过估计和比较 2005 年、2010 年和 2015 年青岛归因于吸烟的癌症负担，为政策制定、干预实施、监测和评估提供便利。
本研究使用全球疾病负担（GBD）研究的疾病清单来量化与吸烟相关的癌症负担。使用在线报告系统从青岛市疾病预防控制中心收集了特定性别和年龄的归因于吸烟的死亡率数据。使用吸烟影响比（SIR）和相对风险（RR）分别估计 2005 年、2010 年和 2015 年的吸烟归因于癌症死亡率的人群归因分数（PAF），并分别将吸烟归因于癌症死亡率的 PAF 乘以总癌症死亡率。
归因于吸烟的癌症死亡人数从 2005 年的 2484 例增加到 2010 年的 2999 例和 2015 年的 4148 例，相应的 PAF 分别为 26.41%、25.76%和 29.13%。除宫颈癌外，所有癌症的 PAF 均高于男性（女性）。2005 年，肺癌、肝癌、食管癌和胃癌与吸烟相关的癌症死亡率最为相关，肺癌的 PAF 最高，其次是鼻咽癌、口腔癌和食管癌。2010 年和 2015 年也观察到类似的模式。2015 年，男性和女性归因于吸烟的癌症死亡人数中，各有 1/3 和 1/5，这些死亡人数中 95%与肺癌、肝癌、食管癌或胃癌有关。随着时间的推移，50 岁以下和 50 岁以上人群归因于吸烟的癌症死亡人数分别呈下降和上升趋势。
尽管实施了控烟和无烟措施，但青岛归因于吸烟的癌症负担仍然相当大。控烟工作应继续作为主要的公共卫生重点。
