Wells A J
J Am Coll Cardiol. 1998 Jan;31(1):1-9. doi: 10.1016/s0735-1097(97)00432-4.
This review sought to determine whether passive smoking in the workplace has roughly the same association with heart disease as passive smoking at home and to update a previous 1994 review on the effects of home-based passive exposure on the heart.
To predict the effects of passive smoking at work on heart disease, public agencies have had to assume that workplace exposure to tobacco smoke was equivalent to home exposure. With the availability of more workplace exposure data, it is now possible to make a direct comparison.
The odds ratios and relative risks (RRs) of the eight studies that contained data on workplace exposure (1,699 cases) were arranged in what was believed to be the order of the quality of their tobacco smoke exposure measurements. A meta-analysis was performed to obtain combined RRs. Data from seven new studies on largely home-based exposure and heart disease that were not included in the 1994 review were also evaluated.
The combined RR for the three top-rated workplace studies was 1.50 (95% confidence interval [CI] 1.12 to 2.01). Adding four lower rated studies reduced the RR to 1.35 (95% CI 1.09 to 1.67). Adding the largest study but the one with questionable exposure history reduced the combined RR to 1.18 (95% CI 1.04 to 1.34). Adding the seven new, largely home-based studies increased the home-based morbidity RR to 1.49 (95% CI 1.29 to 1.72) compared with 1.42 in 1994 while leaving the mortality RR unchanged at 1.23 (95% CI 1.14 to 1.32).
The RRs for heart disease from passive smoking at work are roughly equal to those from home-based exposure.
本综述旨在确定工作场所的被动吸烟与心脏病之间的关联是否与在家中的被动吸烟大致相同，并更新1994年之前关于家庭被动暴露对心脏影响的综述。
为预测工作场所被动吸烟对心脏病的影响，公共机构不得不假定工作场所接触烟草烟雾等同于家庭接触。随着更多工作场所暴露数据的可得性，现在可以进行直接比较。
八项包含工作场所暴露数据（1699例）的研究的比值比和相对风险（RRs），按照其烟草烟雾暴露测量质量的顺序排列。进行荟萃分析以获得合并RRs。还评估了七项新的、主要基于家庭暴露与心脏病关系的研究数据，这些研究未纳入1994年的综述。
三项评级最高的工作场所研究的合并RR为1.50（95%置信区间[CI]1.12至2.01）。加入四项评级较低的研究后，RR降至1.35（95%CI1.09至1.67）。加入最大的但暴露史有疑问的研究后，合并RR降至1.18（95%CI1.04至1.34）。加入七项新的、主要基于家庭的研究后，家庭发病率RR增至1.49（95%CI1.29至1.72），而1994年为1.42，死亡率RR保持不变，为1.23（95%CI1.14至1.32）。
工作场所被动吸烟导致心脏病的RRs与家庭被动暴露大致相等。
