Wang Wen-Yuan-Yue, Ye Xiao-Fei, Miao Chao-Ying, Zhang Wei, Sheng Chang-Sheng, Huang Qi-Fang, Wang Ji-Guang
School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Department of Cardiovascular Medicine, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
J Geriatr Cardiol. 2023 Aug 28;20(8):567-576. doi: 10.26599/1671-5411.2023.08.005.
To investigate the association between current and former smoking and the risk of mortality in elderly Chinese men.
Our study participants were elderly (≥ 60 years) men recruited in a suburban town of Shanghai. Cigarette smoking status was categorized as never smoking, remote (cessation > 5 years) and recent former smoking (cessation ≤ 5 years), and light-to-moderate (≤ 20 cigarettes/day) and heavy current smoking (> 20 cigarettes/day). Cox proportional hazards models and restricted cubic splines were used to examine the associations of interest.
The 1568 participants had a mean age of 68.6 ± 7.1 years. Of all participants, 311 were never smokers, 201 were remote former smokers, 133 were recent former smokers, 783 were light-to-moderate current smokers and 140 were heavy current smokers. During a median follow-up of 7.9 years, all-cause, cardiovascular and non-cardiovascular deaths occurred in 267, 106 and 161 participants, respectively. Heavy current smokers had the highest risk of all-cause and non-cardiovascular mortality, with an adjusted hazard ratio (HR) of 2.30 (95% CI: 1.34-4.07) and 3.98 (95% CI: 2.03-7.83) versus never smokers, respectively. Recent former smokers also had a higher risk of all-cause (HR = 1.62, 95% CI: 1.04-2.52) and non-cardiovascular mortality (HR = 2.40, 95% CI: 1.32-4.37) than never smokers. Cox regression restricted cubic spline models showed the highest risk of all-cause and non-cardiovascular mortality within 5 years of smoking cessation and decline thereafter. Further subgroup analyses showed interaction between smoking status and pulse rate (≥ 70 beats/min < 70 beats/min) in relation to the risk of all-cause and non-cardiovascular mortality, with a higher risk in current versus never smokers in those participants with a pulse rate below 70 beats/min.
Cigarette smoking in elderly Chinese confers significant risks of mortality, especially when recent former smoking is considered together with current smoking.
探讨当前吸烟及既往吸烟与中国老年男性死亡风险之间的关联。
我们的研究参与者为在上海一个郊区城镇招募的老年（≥60岁）男性。吸烟状况分为从不吸烟、远期戒烟（戒烟超过5年）和近期戒烟（戒烟≤5年），以及轻度至中度吸烟（≤20支/天）和重度当前吸烟（>20支/天）。使用Cox比例风险模型和受限立方样条来检验感兴趣的关联。
1568名参与者的平均年龄为68.6±7.1岁。在所有参与者中，311人从不吸烟，201人是远期戒烟者，133人是近期戒烟者，783人是轻度至中度当前吸烟者，140人是重度当前吸烟者。在中位随访7.9年期间，分别有267、106和161名参与者发生全因死亡、心血管死亡和非心血管死亡。重度当前吸烟者的全因和非心血管死亡风险最高，与从不吸烟者相比，调整后的风险比（HR）分别为2.30（95%CI：1.34 - 4.07）和3.98（95%CI：2.03 - 7.83）。近期戒烟者的全因死亡风险（HR = 1.62，95%CI：1.04 - 2.52）和非心血管死亡风险（HR = 2.40，95%CI：1.32 - 4.37）也高于从不吸烟者。Cox回归受限立方样条模型显示，戒烟后5年内全因和非心血管死亡风险最高，此后风险下降。进一步的亚组分析显示，吸烟状况与脉搏率（≥70次/分钟 <70次/分钟）之间在全因和非心血管死亡风险方面存在交互作用，脉搏率低于70次/分钟的参与者中，当前吸烟者与从不吸烟者相比风险更高。
中国老年男性吸烟会带来显著的死亡风险，尤其是将近期戒烟者与当前吸烟者一并考虑时。
