Centre for Health Systems and Safety Research, Australia Institute of Health and Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
Centre for Workforce Futures, Macquarie Business School, Macquarie University, Sydney, Australia.
BMC Geriatr. 2024 Aug 8;24(1):663. doi: 10.1186/s12877-024-05007-z.
Middle-aged and older adults smoking for years are afflicted by smoking-related diseases and functional limitations; however, little is known about the effect of smoking on nonfatal conditions in middle and later life. This study aims to investigate the impact of smoking on both total life expectancy (TLE) and disability-free life expectancy (DFLE) and the variations in such effects by educational level in China.
Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS), 2011-2018, with a total sample of 16,859 individuals aged 45 years or older involved in the final analysis. The Activities of Daily Living (ADL) scale was used to measure disability, and the population-based multistate life table method was used to estimate the differences in TLE and DFLE by smoking status and educational attainment.
At baseline, 28.9% of participants were current smokers, 8.5% were former smokers, and 62.6% never smoked. Approximately 5.6% were identified with ADL disability. Both current smokers and former smokers experienced lower TLE and DFLE than never smokers, and such differences were particularly prominent among men. Intriguingly, former smokers manifested a lower DFLE for both sexes and a lower TLE among women, though a longer TLE among men, compared with current smokers. Similar differences in TLE and DFLE by smoking status were observed for groups with different levels of education.
Never smokers live longer and healthier than current smokers and persons who quit smoking. Smoking was associated with greater reductions in TLE and DFLE among men. However, educational attainment might not moderate the adverse effect of smoking on both fatal and nonfatal conditions in the context of China. These findings have implications for disability prevention, aged care provision and informing policies of healthy aging for China and elsewhere.
长期吸烟的中年和老年烟民患有与吸烟有关的疾病和功能障碍；然而，对于吸烟对中年和晚年非致命疾病的影响知之甚少。本研究旨在调查吸烟对总预期寿命（TLE）和无残疾预期寿命（DFLE）的影响，以及在中国，这种影响因教育程度的不同而有所不同。
数据来自中国健康与退休纵向研究（CHARLS），2011-2018 年，共有 16859 名年龄在 45 岁或以上的个体参与了最终分析。日常生活活动（ADL）量表用于衡量残疾程度，基于人群的多状态生命表方法用于估计吸烟状况和教育程度对 TLE 和 DFLE 的差异。
在基线时，28.9%的参与者是当前吸烟者，8.5%是前吸烟者，62.6%从不吸烟。大约有 5.6%的人存在 ADL 残疾。与从不吸烟者相比，当前吸烟者和前吸烟者的 TLE 和 DFLE 都较低，这种差异在男性中尤为明显。有趣的是，与当前吸烟者相比，前吸烟者的男女两性的 DFLE 较低，而女性的 TLE 较低，但男性的 TLE 较长。在不同教育程度的人群中，吸烟状况对 TLE 和 DFLE 的差异也相似。
从不吸烟者比当前吸烟者和戒烟者活得更长、更健康。吸烟与男性 TLE 和 DFLE 的减少更为相关。然而，在中国的背景下，教育程度可能并不能调节吸烟对致命和非致命疾病的不利影响。这些发现对中国和其他地区的残疾预防、老年护理提供和健康老龄化政策制定具有启示意义。
