Jin Zi-Yi, Liu Kuangyu, Wallar Gina, Zhou Jin-Yi, Mu Li-Na, Liu Xing, Li Li-Ming, He Na, Wu Ming, Zhao Jin-Kou, Zhang Zuo-Feng
Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.
Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China.
Int J Cancer. 2025 Apr 15;156(8):1552-1562. doi: 10.1002/ijc.35254. Epub 2024 Nov 18.
Esophageal cancer continues to pose a significant public health issue in areas with increased incidence rates such as China. Although involuntary smoking was defined as a group 1 carcinogen for lung cancer, few studies have explored the impact of environmental tobacco smoking (ETS) on esophageal cancer. In this paper, we examined the association between ETS and esophageal cancer in high-risk groups in Jiangsu Province, China. Epidemiologic data were collected for 2969 newly diagnosed cases and 8019 population controls including exposure to active/passive smoking and risk factors. The unconditional logistic regression model and the semi-Bayes (SB) method were applied to assess adjusted odds ratios (ORs) and confidence intervals (CIs). ETS exposure (ever vs. never) was positively associated with esophageal cancer with an SB-adjusted OR (95% CI) of 1.44 (1.31-1.58) among overall population, and 1.56 (1.35-1.82) among non-smokers (i.e., non-active smokers), with corresponding population attributable fractions of 15.0% (95% CI: 10.3%-18.9%) and 12.1% (95% CI: 8.8%-19.8%), respectively. The association was more prominent in men at work and in women at home, with SB-adjusted OR (95% CI) of 1.36 (1.17-1.58) and 1.61 (1.35-1.58), respectively. A dose-response relationship between ETS exposure and the disease was detected across the entire population as well as in non-smokers. This is the largest population-based case-control study of ETS and esophageal cancer and the first study to evaluate such association among non-smokers in a Chinese population. We recommend strengthening the ongoing anti-tobacco public health initiatives in China with a particular emphasis on creating a tobacco-free work/home environment.
在中国等发病率上升的地区，食管癌仍然是一个重大的公共卫生问题。尽管非自愿吸烟被定义为肺癌的1类致癌物，但很少有研究探讨环境烟草烟雾（ETS）对食管癌的影响。在本文中，我们研究了中国江苏省高危人群中ETS与食管癌之间的关联。收集了2969例新诊断病例和8019名人群对照的流行病学数据，包括主动/被动吸烟暴露情况和危险因素。应用无条件逻辑回归模型和半贝叶斯（SB）方法评估调整后的比值比（OR）和置信区间（CI）。ETS暴露（曾经暴露与从未暴露）与食管癌呈正相关，总体人群中SB调整后的OR（95%CI）为1.44（1.31 - 1.58），非吸烟者（即非主动吸烟者）中为1.56（1.35 - 1.82），相应的人群归因分数分别为15.0%（95%CI：10.3% - 18.9%）和12.1%（95%CI：8.8% - 19.8%）。这种关联在工作中的男性和家中的女性中更为显著，SB调整后的OR（95%CI）分别为1.36（1.17 - 1.58）和1.61（1.35 - 1.58）。在整个人群以及非吸烟者中均检测到ETS暴露与疾病之间存在剂量反应关系。这是基于人群的关于ETS与食管癌的最大病例对照研究，也是首次在中国人群中评估非吸烟者之间这种关联的研究。我们建议加强中国正在进行的控烟公共卫生倡议，特别强调营造无烟的工作/家庭环境。
