Liu Bian, Henschke Claudia I, Flores Raja M, Taioli Emanuela
Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Lung Cancer. 2020 Jun;144:49-56. doi: 10.1016/j.lungcan.2020.04.019. Epub 2020 Apr 23.
Self-reported smoking behavior is widely used in identifying the eligibility for lung cancer screening (LCS). In clinical trials, self-reported smoking status was shown to be a reliable measure, while its effectiveness outside of trial settings remains to be clarified. We aimed to verify self-reported smoking status with serum cotinine levels among LCS-eligible adults from the National Health and Nutrition Examination Survey (NHANES).
From the combined 1999-2018 NHANES data, we selected adults (aged ≥18 years) with complete data on serum cotinine and smoking behavior, and determined their LCS eligibility according to the United States Preventive Services Task Force recommendation. Using established race/ethnicity specific cotinine cutpoints as the gold standard, we verified self-reported current smoking status with five measures: sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and reliability Kappa. We also compared these performance measures in subgroups stratified by sex, race/ethnicity, education, family income to poverty ratio, health insurance, and secondhand smoking exposure (SHS) at home. All analyses took into account the complex survey design.
Approximately 9.3% (n = 2335, equivalent to 8.82 million weighted population) of all adults who currently smoke or formerly smoked were eligible for LCS. The prevalence of current smoking was 52.6% and 60.8% based on self-report and cotinine, respectively. The Se and Sp were 86.4% (95%CI: 83.9%-88.9%) and 99.7% (95%CI: 99.4%-100%), respectively; PPV and NPV were 99.8% (95%CI: 99.6%-100%) and 82.6% (95%CI: 79.4%-85.7%), respectively; and Kappa was 0.83 (95%CI: 0.80-0.86). The reliability Kappa was higher among females than males (0.87 (95%CI: 0.82-0.93)) vs 0.80 (95%CI: 0.77-0.84), the lowest among non-Hispanic white (0.82 (95%CI: 0.78-0.86)), and higher among those with SHS (0.72 (95%CI: 0.63-0.80) vs (0.68 (95%CI: 0.61-0.76)).
Self-reported smoking status is reasonably reliable among adults with high risk for developing lung cancer in the general population.
自我报告的吸烟行为被广泛用于确定肺癌筛查（LCS）的资格。在临床试验中，自我报告的吸烟状况被证明是一种可靠的测量方法，但其在试验环境之外的有效性仍有待阐明。我们旨在通过美国国家健康与营养检查调查（NHANES）中符合LCS条件的成年人的血清可替宁水平来验证自我报告的吸烟状况。
从1999 - 2018年合并的NHANES数据中，我们选择了血清可替宁和吸烟行为数据完整的成年人（年龄≥18岁），并根据美国预防服务工作组的建议确定他们的LCS资格。使用既定的按种族/族裔划分的可替宁切点作为金标准，我们用五项指标验证自我报告的当前吸烟状况：灵敏度（Se）、特异度（Sp）、阳性预测值（PPV）、阴性预测值（NPV）和可靠性Kappa。我们还在按性别、种族/族裔、教育程度、家庭收入与贫困率、医疗保险以及家中二手烟暴露（SHS）分层的亚组中比较了这些性能指标。所有分析都考虑了复杂的调查设计。
所有目前吸烟或曾经吸烟的成年人中，约9.3%（n = 2335，相当于882万加权人口）符合LCS条件。根据自我报告和可替宁检测，当前吸烟的患病率分别为52.6%和60.8%。Se和Sp分别为86.4%（95%CI：83.9% - 88.9%）和99.7%（95%CI：99.4% - 100%）；PPV和NPV分别为99.8%（95%CI：99.6% - 100%）和82.6%（95%CI：79.4% - 85.7%）；Kappa为0.83（95%CI：0.80 - 0.86）。女性的可靠性Kappa高于男性（0.87（95%CI：0.82 - 0.93））对0.80（95%CI：0.77 - 0.84），在非西班牙裔白人中最低（0.82（95%CI：0.78 - 0.86）），在有SHS的人群中较高（0.72（95%CI：0.63 - 0.80）对（0.68（95%CI：0.61 - 0.76））。
在一般人群中，自我报告的吸烟状况在有患肺癌高风险的成年人中具有合理的可靠性。
