Holford T R, Zhang Z, Zheng T, McKay L A
Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT 06510, USA.
Stat Med. 1996 Mar 30;15(6):565-80. doi: 10.1002/(SICI)1097-0258(19960330)15:6<565::AID-SIM185>3.0.CO;2-T.
Population based data on smoking history derived from NCHS surveys were used to develop a model for lung cancer incidence in Connecticut. Trends in smoking prevalence suggest that, while the prevalence in men increased earlier than women, more male smokers have quit than their female counterparts. These trends in smoking prevalence suggest striking gender differences in a period effect for the smoking prevalence. Estimates of the proportion of current smokers, ex-smokers, and the mean duration of smoking were used in a model for the lung cancer incidence rates. The form for the relationship between smoking history and the incidence rate for these subgroups was based on information from cohort studies. The models represented a mixture of the smoking subgroups where the effect of smoking was considered to be either a multiplicative effect on the underlying age distribution, or a separate effect in which the level of exposure was the sole contribution to risk among smokers. The multiplicative model explained more than 80 per cent of the deviance for the period and cohort effects, while the non-multiplicative model could only account for trends in females. Hence, these results suggest that a sizeable portion of the period and cohort contributions to the lung cancer incidence trends in Connecticut can be attributed to the multiplicative model that utilizes this smoking information, although the lack of more detailed information is a limiting factor in developing the model.
利用来自美国国家卫生统计中心（NCHS）调查的基于人群的吸烟史数据，建立了康涅狄格州肺癌发病率模型。吸烟流行趋势表明，虽然男性吸烟流行率比女性更早上升，但戒烟的男性吸烟者比女性吸烟者更多。这些吸烟流行趋势表明，在吸烟流行率的时期效应方面存在显著的性别差异。当前吸烟者、已戒烟者的比例估计值以及吸烟的平均持续时间被用于肺癌发病率模型。这些亚组吸烟史与发病率之间关系的形式基于队列研究的信息。模型代表了吸烟亚组的混合情况，其中吸烟的影响被认为要么是对潜在年龄分布的乘法效应，要么是一种单独效应，即暴露水平是吸烟者中风险的唯一贡献因素。乘法模型解释了超过80%的时期和队列效应偏差，而非乘法模型仅能解释女性的趋势。因此，这些结果表明，尽管缺乏更详细的信息是模型开发中的一个限制因素，但在康涅狄格州肺癌发病率趋势中，相当一部分时期和队列贡献可归因于利用这些吸烟信息的乘法模型。
