Division of Pulmonary and Critical Care Medicine, University of Vermont, Burlington, VT, USA; Larner College of Medicine, University of Vermont, Burlington, VT, USA.
Department of Psychiatry, University of Vermont, Burlington, VT, USA; Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA.
Prev Med. 2024 Nov;188:108113. doi: 10.1016/j.ypmed.2024.108113. Epub 2024 Aug 28.
Cigarette smoking prevalence has declined slower among women than men, and smoking-related pulmonary disease (PD) has risen among women. Given these trends, there is a critical need to understand and mitigate PD risk among women who smoke. The purpose of this narrative review and commentary is to highlight important evidence from the literature on smoking and PD among women.
This review focuses broadly on examining cigarette smoking and PD among women within six topic areas: (1) demographic characteristics and prevalence of smoking, (2) smoking behavior, (3) lung cancer, (4) obstructive PD, (5) diagnostic and treatment disparities, and (6) gaps in the literature and potential directions for future research and treatment.
Growing evidence indicates that compared to men, women are at increased risk for developing smoking-related PD and poorer PD outcomes. Gender disparities in smoking-related PD may be largely accounted for by genetic differences and sex hormones contributing to PD pathogenesis and presentation, smoking behavior, nicotine dependence, and pathogen/carcinogen clearance. Moreover, gender disparities in smoking-related PD may be exacerbated by important social determinants (e.g., women with less formal education and those from minoritized groups may be at especially high risk for poor PD outcomes due to higher rates of smoking).
Rising rates of smoking-related PD among women risk widening diagnostic and treatment disparities. Ongoing research is needed to explore potentially complex relationships between sex, gender, and smoking-related PD processes and outcomes, and to improve smoking-cessation and PD treatment for women.
与男性相比，女性的吸烟率下降速度较慢，且女性的与吸烟相关的肺部疾病（PD）发病率上升。鉴于这些趋势，迫切需要了解和减轻吸烟女性的 PD 风险。本叙述性综述和评论的目的是强调有关女性吸烟和 PD 的文献中的重要证据。
本综述广泛关注六个主题领域内的吸烟与 PD 之间的关系：（1）吸烟的人口统计学特征和流行率，（2）吸烟行为，（3）肺癌，（4）阻塞性 PD，（5）诊断和治疗差异，以及（6）文献中的差距和未来研究与治疗的潜在方向。
越来越多的证据表明，与男性相比，女性罹患与吸烟相关的 PD 以及 PD 结局较差的风险增加。与吸烟相关的 PD 方面的性别差异可能在很大程度上归因于遗传差异和性激素，这些因素会导致 PD 的发病机制和表现、吸烟行为、尼古丁依赖性以及病原体/致癌物的清除。此外，与吸烟相关的 PD 中的性别差异可能会因重要的社会决定因素而加剧（例如，受教育程度较低的女性和来自少数民族群体的女性由于吸烟率较高，因此罹患 PD 不良结局的风险特别高）。
女性中与吸烟相关的 PD 发病率上升，可能会扩大诊断和治疗方面的差异。需要进行持续的研究，以探索性别、性别与与吸烟相关的 PD 过程和结果之间潜在的复杂关系，并改善女性的戒烟和 PD 治疗。
