Group of Evaluation of Health Determinants and Health Policies, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain.
Cancer Epidemiology and Cancer Prevention Program, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Environ Res. 2019 Dec;179(Pt A):108594. doi: 10.1016/j.envres.2019.108594. Epub 2019 Jul 19.
Lung cancer accounts for nearly 2 million deaths per year worldwide, the majority of cases due to smoking as the main risk factor associated. The aim of this study was to assess the relation between the level of implementation of tobacco control policies and the population at high risk of lung cancer in the European Union (EU).
The Special Eurobarometer 458 "Attitudes of Europeans towards tobacco and electronic cigarettes", conducted in 2017, and the Tobacco Control Scale (TCS) 2010, 2013, and 2016 were the sources of our data. High risk of lung cancer was defined by the inclusion criteria in the National Lung Screening Trial (NLST) and the Dutch-Belgian Lung Cancer Screening Trial (NELSON), the largest lung cancer screening trials carried out in the US and the EU. We calculated Spearman's rank correlation coefficients (r) and fitted multilevel generalized linear mixed models using the quasi-Poisson family to assess the correlation at the national level and analyze the association at the individual level, respectively, between the scores in the TCS (higher scores means better implementation of tobacco control policies) and the proportion of individuals at high risk of lung cancer in member states of the EU.
The scores in the TCS 2010 were statistically negatively correlated with the current proportion of ever and former smokers at high risk according to NELSON criteria (-0.41; 95%CI -0.68, -0.04 and -0.49; 95%CI -0.73, -0.13, respectively). We observed statistically significant inverse associations between the scores in the TCS 2010 for the highest quartiles and the proportion of individuals at high risk of lung cancer according to both criteria. Non-statistically significant negative correlations and inverse associations were observed with other TCS.
There is a lag between the implementation of tobacco control policies and the reduction of the rates of high risk of lung cancer. Member states should reinforce comprehensive tobacco control policies to reduce the population at high risk of lung cancer in the EU.
肺癌每年在全球造成近 200 万人死亡，大多数病例是由于吸烟这一主要危险因素导致的。本研究旨在评估欧盟（EU）内烟草控制政策实施水平与肺癌高危人群之间的关系。
我们的数据来源于 2017 年进行的“欧洲民意调查机构 458 号特别调查——欧洲人对烟草和电子烟的态度”和 2010 年、2013 年和 2016 年的“烟草控制量表（TCS）”。肺癌高危人群的定义是符合美国和欧盟最大规模肺癌筛查试验（NLST 和荷兰-比利时肺癌筛查试验[NELSON]）的纳入标准。我们计算了 TCS 得分（分数越高意味着烟草控制政策的实施越好）与欧盟成员国中肺癌高危人群比例之间的 Spearman 秩相关系数（r），并使用拟泊松家族拟合多水平广义线性混合模型，分别在国家层面评估相关性，在个体层面分析关联。
TCS 2010 得分与根据 NELSON 标准的当前高风险吸烟者和前吸烟者的比例呈统计学负相关（-0.41；95%CI-0.68，-0.04 和-0.49；95%CI-0.73，-0.13）。我们观察到 TCS 2010 得分的最高四分位数与两个标准下的肺癌高危人群比例之间存在统计学显著的负相关。对于其他 TCS，观察到非统计学显著的负相关和负向关联。
烟草控制政策的实施与肺癌高危人群比例的降低之间存在滞后。成员国应加强全面的烟草控制政策，以减少欧盟的肺癌高危人群。
