Yuan J M, Ross R K, Wang X L, Gao Y T, Henderson B E, Yu M C
Shanghai, Cancer Institute, University of Southern California, Los Angeles.
JAMA. 1996 Jun 5;275(21):1646-50.
To evaluate prospectively the health risk of cigarette smoking in middle-aged men in Shanghai, China.
Prospective cohort study with annual follow-up.
A total of 18 244 male residents of Shanghai, China, enrolled in the study during January 1, 1986, through September 30, 1989, and actively followed via annual visits.
By September 30, 1993, 852 deaths and 554 incident cancer cases were identified during the follow-up period, which averaged 5.4 years per subject. The overall incidence rate for cancer was 568 per 100 000 man-years, with the 3 leading sites being lung (146/100 000), stomach (116/100 000), and liver (81/100 000). Forty-one percent of all deaths were from cancer. Stroke was the most frequent cause of death unrelated to cancer, with an age-adjusted rate 4.2 times higher than that of US white men (201/100 000 vs 48/100 000), followed by ischemic heart disease, with an age-adjusted rate one-fifth that of US white men (69/100 000 vs 366/100 000). Compared with lifelong nonsmokers, the relative risks in heavy smokers (20 or more cigarettes per day) after adjustment for alcohol consumption were 2.2 for any incident cancer, 9.4 for incident lung cancer, 6.7 for head and neck cancer, and 1.8 for liver cancer. In terms of mortality, heavy smokers were at a 60% greater risk of death relative to lifelong nonsmokers; there was a 2.3-fold excess risk of death from cancer and 2-fold to 3-fold excess risk of death from heart disease.
Cigarette smoking is an important predictor of risk of cancer and mortality in men in Shanghai. Among the study subjects, 36% of all cases of cancer and 21% of all deaths could be attributed to cigarette smoking.
前瞻性评估中国上海中年男性吸烟的健康风险。
每年进行随访的前瞻性队列研究。
1986年1月1日至1989年9月30日期间，共有18244名中国上海男性居民参与本研究，并通过年度随访进行积极跟踪。
到1993年9月30日，随访期间共确定852例死亡和554例新发癌症病例，每位受试者的平均随访时间为5.4年。癌症的总体发病率为每10万人年568例，前三位发病部位为肺癌（146/10万）、胃癌（116/10万）和肝癌（81/10万）。所有死亡病例中有41%死于癌症。中风是与癌症无关的最常见死因，其年龄调整后的发病率比美国白人男性高4.2倍（201/10万对48/10万），其次是缺血性心脏病，其年龄调整后的发病率是美国白人男性的五分之一（69/10万对366/10万）。与终生不吸烟者相比，在调整饮酒因素后，重度吸烟者（每天吸20支或更多香烟）发生任何新发癌症的相对风险为2.2，发生肺癌的相对风险为9.4，发生头颈癌的相对风险为6.7，发生肝癌的相对风险为1.8。在死亡率方面，重度吸烟者相对于终生不吸烟者的死亡风险高60%；癌症死亡风险高出2.3倍，心脏病死亡风险高出2至3倍。
吸烟是上海男性癌症风险和死亡率的重要预测因素。在研究对象中，所有癌症病例的36%和所有死亡病例的21%可归因于吸烟。
