Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Population Health Science and Policy, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Biomarkers. 2021 Feb;26(1):45-54. doi: 10.1080/1354750X.2020.1853810. Epub 2020 Dec 7.
Biochemical verification of self-reported smoking status is not common among the population eligible for lung cancer screening (LCS). We used urinary NNAL (4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol and its glucuronides) and serum cotinine as the gold standard to determine the validity and reliability of self-reported smoking status from the 2007-2014 National Health and Nutrition Examination Survey (NHANES). We found 2.3% (n = 652, equivalent to 5.3 million weighted population) of adults eligible for LCS according to the current United States Preventive Services Task Force guideline. Self-reported current smoking status performed similarly against NNAL and cotinine: sensitivity [89.7% (95%CI: 84.9%-94.5%) vs. 89.5% (95%CI: 84.8%-94.3%)]; specificity [99.7% (95%CI: 99.2%-100.0%) vs. 100% (95%CI:100%-100%)]; positive predictive value (PPV) and negative predictive value (NPV) were 99.8% (95%CI:99.4%-100.0%) versus 100% (95%CI:100%-100%) and 85.3% (95%CI: 79.1%-91.5%) versus 85.1% (95%CI: 79.1%-1.0%), respectively; and Kappa [86.5% (95%CI:80.5%-92.5%) vs. 86.5% (95%CI:80.6%-92.3%)]. Performance measures were better among females than males; worst among the non-Hispanic white and best among other race/ethnicity group. The validity and reliability of self-reported smoking status increased with increasing cutpoint levels of both NNAL and cotinine. Self-reported smoking status among people who are at high risk of lung cancer is reasonably reliable. The difference between using NNAL and cotinine appears to be minimal.
在有资格接受肺癌筛查 (LCS) 的人群中，生物化学验证自我报告的吸烟状况并不常见。我们使用尿液 NNAL（4-（甲基亚硝氨基）-1-（3-吡啶基）-1-丁醇及其葡萄糖醛酸苷）和血清可替宁作为金标准，以确定 2007-2014 年全国健康和营养检查调查（NHANES）中自我报告的吸烟状况的有效性和可靠性。我们发现，根据目前美国预防服务工作组的指南，有 2.3%（n=652，相当于加权人口的 530 万）的成年人有资格接受 LCS。自我报告的当前吸烟状况与 NNAL 和可替宁的结果相似：灵敏度[89.7%（95%CI：84.9%-94.5%）与 89.5%（95%CI：84.8%-94.3%）]；特异性[99.7%（95%CI：99.2%-100.0%）与 100%（95%CI：100%-100%）]；阳性预测值（PPV）和阴性预测值（NPV）分别为 99.8%（95%CI：99.4%-100.0%）与 100%（95%CI：100%-100%）和 85.3%（95%CI：79.1%-91.5%）与 85.1%（95%CI：79.1%-1.0%）；Kappa 值为[86.5%（95%CI：80.5%-92.5%）与 86.5%（95%CI：80.6%-92.3%）]。女性的表现指标优于男性；非西班牙裔白人的表现最差，其他种族/族裔群体的表现最好。随着 NNAL 和可替宁的截断值水平的升高，自我报告的吸烟状况的有效性和可靠性也随之增加。在患肺癌风险较高的人群中，自我报告的吸烟状况相当可靠。使用 NNAL 和可替宁之间的差异似乎很小。
