Department of Maternal and Child Health, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, China.
Am J Prev Med. 2021 Apr;60(4):504-512. doi: 10.1016/j.amepre.2020.11.003.
Smoking remains a strong risk factor for premature death. This study examines the associations of nondaily smoking, daily smoking, and smoking cessation with the risks of mortality from all causes, cardiovascular disease, and cancer.
This study used data from the National Health and Nutrition Examination Survey, a population-based, cross-sectional study. Data analysis was conducted in the U.S. from January to October 2020. Cox proportional hazard regression models were used to obtain adjusted hazard ratios.
During 255,100 person-years of follow-up, 2,008 participants died (347 from cardiovascular diseases and 501 from cancer). A significant increase in the risk of all-cause mortality was observed for nondaily smokers (hazard ratio=1.50, 95% CI=1.08, 2.08) compared with that for those who had never smoked. For daily smokers, the adjusted hazard ratios for all-cause mortality were 1.54 (95% CI=1.24, 1.90) for those smoking <20 cigarettes per day, 2.09 (95% CI=1.65, 2.63) for those smoking 20-40 cigarettes per day, and 2.78 (95% CI=1.75, 4.43) for those smoking ≥40 cigarettes per day. An increased risk of cardiovascular disease and cancer mortality was also observed for daily smokers. Former smokers with ≥5 years since cessation had a lower risk of all-cause mortality than current smokers.
This study suggests that nondaily smokers have a higher risk of all-cause mortality. The association of daily smoking with the risk of mortality increased as the number of cigarettes smoked per day increased. Among former smokers, the risk decreased with longer cessation. Tobacco control efforts should be targeted not only toward daily smokers but also toward nondaily smokers to reduce the risk of premature death owing to smoking.
吸烟仍然是导致早逝的一个重要危险因素。本研究探讨了非吸烟、每日吸烟和戒烟与全因死亡率、心血管疾病死亡率和癌症死亡率的相关性。
本研究使用了国家健康和营养调查的数据，这是一项基于人群的横断面研究。数据分析于 2020 年 1 月至 10 月在美国进行。采用 Cox 比例风险回归模型获得调整后的风险比。
在 255100 人年的随访期间，有 2008 名参与者死亡（347 人死于心血管疾病，501 人死于癌症）。与从不吸烟的人相比，非吸烟者全因死亡率的风险显著增加（风险比=1.50，95%可信区间=1.08，2.08）。对于每日吸烟者，全因死亡率的调整风险比分别为：每天吸烟<20 支者为 1.54（95%可信区间=1.24，1.90），每天吸烟 20-40 支者为 2.09（95%可信区间=1.65，2.63），每天吸烟≥40 支者为 2.78（95%可信区间=1.75，4.43）。每日吸烟者的心血管疾病和癌症死亡率风险也有所增加。戒烟≥5 年的前吸烟者全因死亡率低于当前吸烟者。
本研究表明，非吸烟者全因死亡率风险较高。随着每天吸烟支数的增加，每日吸烟与死亡率风险的相关性增加。在戒烟者中，随着戒烟时间的延长，风险降低。烟草控制工作不仅应针对每日吸烟者，还应针对非吸烟者，以降低因吸烟导致的早逝风险。
