非吸烟女性中的环境烟草烟雾与肺癌。一项多中心研究。

Environmental tobacco smoke and lung cancer in nonsmoking women. A multicenter study.

作者信息

Fontham E T, Correa P, Reynolds P, Wu-Williams A, Buffler P A, Greenberg R S, Chen V W, Alterman T, Boyd P, Austin D F

机构信息

Department of Pathology, Louisiana State University Medical Center, New Orleans 70112-1393.

出版信息

JAMA. 1994 Jun 8;271(22):1752-9.

PMID:8196118

Abstract

OBJECTIVE

To determine the relative risk (RR) of lung cancer in lifetime never smokers associated with environmental tobacco smoke (ETS) exposure.

DESIGN

Multicenter population-based case-control study.

SETTING

Five metropolitan areas in the United States: Atlanta, Ga, Houston, Tex, Los Angeles, Calif, New Orleans, La, and the San Francisco Bay Area, Calif.

PATIENTS OR OTHER PARTICIPANTS

Female lifetime never smokers: 653 cases with histologically confirmed lung cancer and 1253 controls selected by random digit dialing and random sampling from the Health Care Financing Administration files for women aged 65 years and older.

MAIN OUTCOME MEASURE

The RR of lung cancer, estimated by adjusted odds ratio (OR) with 95% confidence interval (CI), associated with ETS exposure.

RESULTS

Tobacco use by spouse(s) was associated with a 30% excess risk of lung cancer: all types of primary lung carcinoma (adjusted OR = 1.29; P < .05), pulmonary adenocarcinoma (adjusted OR = 1.28; P < .05), and other primary carcinomas of the lung (adjusted OR = 1.37; P = .18). An increasing RR of lung cancer was observed with increasing pack-years of spousal ETS exposure (trend P = .03), such that an 80% excess risk of lung cancer was observed for subjects with 80 or more pack-years of exposure from a spouse (adjusted OR = 1.79; 95% CI = 0.99 to 3.25). The excess risk of lung cancer among women ever exposed to ETS during adult life in the household was 24%; in the workplace, 39%; and in social settings, 50%. When these sources were considered jointly, an increasing risk of lung cancer with increasing duration of exposure was observed (trend P = .001). At the highest level of exposure, there was a 75% increased risk. No significant association was found between exposure during childhood to household ETS exposure from mother, father, or other household members; however, women who were exposed during childhood had higher RRs associated with adult-life ETS exposures than women with no childhood exposure. At the highest level of adult smoke-years of exposure, the ORs for women with and without childhood exposures were 3.25 (95% CI, 2.42 to 7.46) and 1.77 (95% CI, 0.98 to 3.19), respectively.

CONCLUSION

Exposure to ETS during adult life increases risk of lung cancer in lifetime nonsmokers.

摘要

目的

确定终生不吸烟者中与环境烟草烟雾（ETS）暴露相关的肺癌相对风险（RR）。

设计

基于人群的多中心病例对照研究。

地点

美国的五个大都市地区：佐治亚州亚特兰大市、得克萨斯州休斯敦市、加利福尼亚州洛杉矶市、路易斯安那州新奥尔良市以及加利福尼亚州旧金山湾区。

患者或其他参与者

终生不吸烟的女性：653例经组织学确诊的肺癌病例以及1253名对照，通过随机数字拨号和从医疗保健财务管理局65岁及以上女性档案中随机抽样选取。

主要观察指标

通过调整后的比值比（OR）及95%置信区间（CI）估算与ETS暴露相关的肺癌RR。

结果

配偶吸烟与肺癌风险增加30%相关：所有类型的原发性肺癌（调整后的OR = 1.29；P <.05）、肺腺癌（调整后的OR = 1.28；P <.05）以及其他原发性肺癌（调整后的OR = 1.37；P =.18）。随着配偶ETS暴露包年数增加，观察到肺癌RR升高（趋势P =.03），因此，配偶ETS暴露达到80包年及以上的受试者肺癌风险增加80%（调整后的OR = 1.79；95% CI = 0.99至3.25）。成年期在家中曾暴露于ETS的女性肺癌额外风险为24%；在工作场所为39%；在社交场合为50%。当综合考虑这些暴露源时，观察到肺癌风险随暴露持续时间增加而升高（趋势P =.001）。在最高暴露水平下，风险增加75%。未发现儿童期暴露于母亲、父亲或其他家庭成员的家庭ETS与肺癌之间存在显著关联；然而，儿童期暴露的女性与成年期ETS暴露相关的RR高于未经历儿童期暴露的女性。在成年期最高吸烟年暴露水平下，有儿童期暴露和无儿童期暴露女性的OR分别为3.（此处原文有误，应改为3.25）（95% CI，2.42至7.46）和1.77（95% CI，0.98至3.19）。