海南省成年人吸烟与心血管疾病发病风险的前瞻性研究

目的 探讨海南省成年人吸烟与各类心血管疾病发病风险的关联。方法 利用中英合作项目“中国慢性病前瞻性研究”项目海南省人群数据,剔除基线调查时自报患有冠心病、脑卒中和恶性肿瘤的个体后,纳入基线年龄为30～79岁的研究对象共28 940人,利用Cox回归分析计算非吸烟者、戒烟者和当前吸烟者的心血管疾病发病风险HR值和95%CI。结果 研究人群平均随访6.2年,累积随访177 279人年。随访期间男性1 310人,女性2 200人发病。男性吸烟率（47.0%）远高于女性吸烟率（0.3%）。多因素调整后,与非吸烟者相比,吸烟人群心血管疾病的发病风险有所增加,HR值(95%CI)分别为急性冠心病1.63(1.12～2.38)和缺血性心脏病1.53(1.22～1.91)。在当前吸烟者中,每天吸烟量多于30支的人群急性冠心病、缺血性脑卒中和出血性脑卒中的发病风险最高。结论 吸烟能够增加心血管疾病的发病风险,应基于不同心血管疾病风险制定吸烟者戒烟目标和全人群控烟措施。     

中国台湾省35～74岁健检人群慢性肾病5年发病风险预测模型

目的构建中国台湾省35～74岁健检人群慢性肾病(CKD)5年发病风险(个体化)预测模型。方法选择1996～2006年初次参加台湾省美兆健检的35～74岁人群19 987人,将其中基线未患CKD者18 275人分为建模队列(用于建立5年发病预测模型)和验证队列(用于评估模型外部效度)。采用logistic回归构建预测模型,以ROC曲线下面积(AUC)评价拟合优度,并将人群的预测风险概率进行风险等级划分。结果去除基线患者后CKD5年发病率为5.24%(958/18275)。纳入5年发病风险预测模型的变量包括年龄、教育程度、糖尿病、高血压、低密度脂蛋白胆固醇、甘油三酯和血肌酐水平7个指标。建模队列建立的预测模型的ROC曲线下面积(AUC)约为0.734(95%CI:0.714～0.754),验证队列外部效度验证结果AUC=0.768(95%CI:0.734～0.801)。将建模队列划分为4个风险等级后,显示中危(占14.1%)和高危(占5.4%)的个体5年内发生CKD的危险分别比一般人群高2.0倍和4.8倍。结论利用中国台湾省美兆健检纵向数据建立的CKD 5年个体风险预测模型效应与信度均较高,且简单实用,对于今后CKD风险个体评价及群体监测均有较大的应用价值。     

肺癌筛查与吸烟行为改变的关联研究

1 314名四川省肺癌筛查及早诊早治项目地区肺癌高危人群的戒烟率从基线时的22.37%增至筛查后的41.78%(χ²=227.97,P<0.001),持续吸烟者的吸烟量从20支/d降至15支/d(t=11.76,P<0.001);肺癌筛查中出现阳性结果者更倾向于戒烟或持续保持戒烟状态,男性、年龄较小、教育程度较低将增加持续吸烟或复吸的风险(P<0.05)。     

基线高敏C-反应蛋白水平与男性吸烟人群肺癌发病风险队列研究

目的 探讨高敏C-反应蛋白（high sensitivity C-reactive protein,hsCRP）与男性吸烟人群肺癌发病的关联性。方法 以参加2006年7月开滦集团体检的男性吸烟人群建立队列,收集基线调查资料和hsCRP实验室检测结果。通过每2年1次的体检和每年1次的目标人群健康状况相关信息数据库检索,收集肺癌发病和死亡等结局信息。采用多因素Cox比例风险回归模型分析男性吸烟人群基线hsCRP水平与肺癌发病风险,调整变量包括年龄、吸烟程度、饮酒、体质指数和糖尿病史情况。结果 至2014年12月31日,纳入队列38 099人,随访期内共收集新发肺癌333例。hsCRP<1 mg/L组、hsCRP 1~3 mg/L组和hsCRP >3 mg/L组中新发肺癌8年累积发病率分别为727/10万、995/10万和1 344/10万,组间差异具有统计学意义（χ2=23.79,P<0.001）。调整年龄、吸烟程度、饮酒、体质指数和糖尿病史后,hsCRP 1~3 mg/L组和hsCRP>3 mg/L组患者肺癌发病风险分别是hsCRP< 1 mg/L组的1.37倍和1.69倍,差异均有统计学意义（95% CI:1.06~1.77,P=0.017;95% CI:1.29~2.23,P<0.001）。结论 基线hsCRP水平升高增加了男性吸烟人群肺癌发病风险。     

矽肺对肺癌及总死亡影响的回顾性队列研究

目的 利用香港矽肺患者队列的资料进行分析,探讨矽尘、矽肺与肺癌的关系.方法 选择1981年1月1日至1998年12月31日期间在香港尘肺诊所登记的2789例男性矽肺病例为研究对象,取用同时期一般男性人群作为对照.用人年的方法估计各死因的标化死亡比(SMR),用Axelson's法间接调整吸烟的混杂影响.矽尘与肺癌的剂量-效应关系采用多因素p-spline平滑法模型来拟合最佳风险模型.结果 该组研究队列人数为2789,共观察24 992.6人年,失访率仅为2.9%.该队列主要工种为建筑工人(5 1.09%)和地下沉箱操作工人(37.54%).队列总死亡人数为853人,平均死亡年龄为(63.8±10.27)岁,整个队列中86例死于肺癌.全死因及全癌的SMR均明显上升,首位死因是呼吸道疾病,肺癌的5MR明显增加(SMR:1.69,95%CI:1.35～2.09).去除年龄、时期和吸烟的混杂因素的影响,矽肺对肺癌的相对危险度下降到1.12(95%CI:0.89～1.38).间接调整吸烟的混杂影响后建筑工人及地下沉箱工人肺癌的相对危险度分别为1.09(95%CI:0.82～1.42)和1.56(0.98～2.36).多因素p-spline平滑法风险模型分析显示,肺癌与累积呼吸性矽尘总量或平均矽尘浓度的关系无剂量-效应关系.结论 队列研究未发现接触矽尘或矽肺能增加肺癌死亡的危险,平滑法模型拟合的风险模型并不支持矽尘与肺癌死亡之间存在剂量-效应关系.     

中国10个地区成年人慢性肾脏病流行情况及其生活方式影响因素

目的描述中国慢性病前瞻性研究(CKB)项目人群的慢性肾脏病(CKD)分布, 分析生活方式与CKD发病风险的前瞻性关联。方法数据来源于CKB基线调查及随访监测(截至2018年12月31日), 描述CKD发病的地区和人群分布差异, 使用Cox比例风险回归模型分析生活方式因素与CKD的关联。结果研究纳入505 147名研究对象, 平均随访11.26年, 期间共有4 920例发病病例, 发病率为83.43/10万人年, 肾小球肾病为最主要亚型。CKD发病率在城市、男性、年龄≥60岁人群中更高, 分别为87.83/10万人年、86.37/10万人年、132.06/10万人年。相比于从不或偶尔吸烟者, 当前吸烟男性CKD风险增加(HR=1.18, 95%CI:1.05～1.31)。以非肥胖人群为参照组, 由BMI判定的全身性肥胖(HR=1.19, 95%CI:1.10～1.29)和腰围判定的中心性肥胖(HR=1.27, 95%CI:1.19～1.35)均与更高的CKD发病风险相关。结论 CKB项目人群CKD发病率存在明显的地区和人群差异, 且其发病风险受到生活方式多因素的影响。     

台湾地区35～74岁健康体检人群代谢综合征发病风险预测模型的建立

目的 构建台湾地区35～74岁健康体检人群代谢综合征5年发病风险(个体化)预测模型。方法在1997-2006年初次参加台湾美兆自动化健康体检机构(美兆健检)的35～74岁人群中,将随访满5年基线时无代谢综合征13 973人作为随访队列,并分为建模队列(用于建立5年发病预测模型)和验证队列(用于评估模型外部效度),采用logistic回归构建预测模型。以ROC曲线下面积(AUC)评价拟合优度,并将人群的预测风险概率进行风险等级划分。结果 去除基线患者后研究人群5年代谢综合征患病率为11．7％。纳入发病风险预测模型变量有年龄、糖尿病家族史、收缩压、空腹血糖、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、总胆固醇、体重指数和血尿酸,建模队列建立预测模型的AUC为0．827(95％CI：0．814～0．839),验证队列的AUC分别为0．813(O．789～0．837)、0．826(0．800～0．852)、0．794(0．768～0．820)。将建模队列划分为4个风险等级后,提示个体发病概率≥17．6％者为中危人群,发病概率≥59．0％者为高危人群。结论 由美兆健检纵向数据库建立的5年代谢综合征个体风险预测模型有较高的验证效度,对于体检人群5年代谢综合征发病预测具有实用、可行的特点,预测模型对评估代谢综合征个体发病和群体监测均有较高应用价值。     

天津市2016年35~79岁居民吸烟归因死亡及戒烟效果分析

目的 分析吸烟对天津市35~79岁居民死亡的影响以及戒烟效果。方法 收集2016年天津市35~79岁居民死亡病例39 499例,调整5岁年龄组、受教育程度、婚姻状况后,分析吸烟导致不同疾病死亡的风险和超额死亡,以及不同年份戒烟的效果。结果 35~79岁男性死亡者中,有13.56%（1 589例）的死亡是由于吸烟所引起,其中吸烟引起肺癌的超额死亡百分比最高（47.60%）;吸烟者肺癌的死亡风险是不吸烟者的2.75（95% CI：2.47~3.06）倍;女性死亡中,有7.29%（183例）的死亡是由于吸烟所引起,其中吸烟引起肺癌的超额死亡百分比最高（28.90%）;吸烟者肺癌的死亡风险是不吸烟者的4.04（95% CI：3.49~4.68）倍。男性死亡中,戒烟者患病的危险为吸烟者的0.80（95% CI：0.72~0.90）倍,男性戒烟≥ 10年者其OR值（0.74,95% CI：0.63~0.86）小于戒烟年限为1~9年者（OR=0.85,95% CI：0.74~0.98）,差异无统计学意义。结论 吸烟是导致天津市居民死亡的重要危险因素之一。戒烟可以明显起到保护作用。     

北京60岁及以上老年人吸烟状况与死亡风险的关联研究

目的分析北京城乡老年人群吸烟状况与相关死亡风险间的关联。方法基于北京城乡老年人群健康综合研究2009—2014年的队列数据, 纳入符合标准的60岁及以上老年人群4 499名, 随访其生存与死亡结局。采用Cox比例风险模型分析吸烟状态、吸烟指数、戒烟年数与死亡风险间的关联。结果 4 499名研究对象年龄M(IQR)为70.00(10.00)岁, 其中男性1 814名(40.32%);从不吸烟者、戒烟者和现在吸烟者分别有69.50%(3 127/4 499)、13.20%(594/4 499)和17.30%(778/4 499)。多因素Cox回归分析结果显示, 调整人口社会学特征、生活方式等混杂因素后, 以从不吸烟者为参照, 戒烟者全因死亡风险增加30.6%[HR(95%CI):1.306(1.043～1.636)];现在吸烟者全因、恶性肿瘤和肺癌死亡风险的HR(95%CI)分别增加50.0%[HR(95%CI):1.500(1.199～1.877)]、80.3%[HR(95%CI):1.803(1.226～2.652)]和212.6%[HR(95%CI):3.126(1.626～6.01...     

基于全基因组关联研究的中国人群肺癌风险预测模型

目的 联合使用遗传因素和吸烟信息构建中国汉族人群的肺癌风险预测模型。方法 基于中国汉族人群全基因组关联研究(GWAS)数据,根据样本地区来源将样本分为训练集(南京与上海:1 473 名病例vs. 1 962 名对照)和测试集(北京与武汉:858 名病例vs. 1 115 名对照)。系统整理已报道肺癌易感位点,在训练集中用逐步后退法筛选具有独立效应的位点,并通过加权法估算个体遗传得分用于建模。在训练集中分别构建基于吸烟信息、遗传得分和联合使用吸烟与遗传信息的3 种风险预测模型(吸烟模型、遗传效应模型和联合模型),并根据受试者工作特征(ROC)曲线、曲线下面积(AUC)、净分类指数(NRI)和整体鉴别指数(IDI)评价模型对肺癌风险预测的效能。对于构建的模型,进一步在测试集中进行验证。结果 在训练集中,联合模型、吸烟模型和遗传效应模型AUC分别为0.69(0.67~0.71)、0.65(0.63~0.66)和0.60(0.59~0.62)。在训练集和测试集中联合模型的风险预测效能高于吸烟模型或遗传模型,差异有统计学意义(P<0.001)。重分类结果显示,联合模型与吸烟模型相比,在训练集中NRI 增加4.57%(2.23%~6.91%),IDI 增加3.11%(2.52%~3.69%)。在测试集中,NRI和IDI 分别增加2.77%和3.16%。结论 遗传得分可以显著提高肺癌传统风险模型的预测效能。联合使用遗传因素和吸烟信息构建的中国汉族人群肺癌风险预测模型可用于筛选中国汉族人群中肺癌发病的高危人群。     

Cohort analysis of cigarette smoking and lung cancer incidence among Norwegian women

BACKGROUND: Cancer registries have for decades surveyed the development of cancer diseases. Data on incident cases includes demographic variables. Knowledge of the temporal distribution of risk factors on the same variables makes it possible to model the relationship between disease and risk factor. The results of such analyses might be difficult to interpret since they are based on aggregated data. But the availability of these data sources should encourage further exploration of its possibilities and limitations. METHODS: The temporal pattern of smoking habits in 5-year birth cohorts from 1890-1949 was established, with data on the proportions of current smokers, former smokers and non-smokers and estimated average daily consumption of tobacco and average duration of smoking. The lung cancer incidence among the cohorts in 1953-1992 was analysed by a model which included an additive excess risk for smokers that depended on daily dose and duration of smoking. RESULTS: The lung cancer incidence in later decades was adequately described by the model, which showed a simple relationship with smoking behaviour in the cohorts. For both current smokers and former smokers, the excess risk was about proportional to the daily amount smoked and the 4.5 power of duration of smoking. The age-specific rates for non-smokers were close to a fifth-power curve of age. CONCLUSIONS: Even if lung cancer incidence is not determined separately for groups with known smoking habits, plausible estimates of the effect of smoking can be derived if appropriate information is available on temporal smoking habits in the population.     

基于遗传和环境危险因素构建的风险评分在结直肠肿瘤分级筛查中的应用评价

目的评价利用遗传与环境危险因素构建的结直肠肿瘤风险评分的人群高危分层效果及其在分级筛查中的应用效果。方法基于一项全国多中心结直肠癌筛查随机对照研究, 纳入2 160例接受结肠镜检查的研究对象。采用MassARRAY技术检测20个结直肠癌相关的遗传易感位点并构建遗传风险评分。个体环境风险评分采用亚太结直肠筛查评分系统计算。使用logistic回归分别评估遗传风险单独和遗传联合环境风险与结直肠肿瘤之间的关联。构建基于遗传和/或环境风险评分的分级筛查方案(即高风险者接受单次结肠镜筛查, 低风险者接受每年一次的定量粪便免疫化学检测, 其结果阳性者接受结肠镜检查), 并与全部接受结肠镜方案进行效果比较。结果与低遗传风险评分组相比, 高遗传风险评分组发生结直肠肿瘤的风险增加了26%(OR=1.26, 95%CI:1.03～1.54, P=0.026)。遗传和环境风险评分均最高的研究对象患进展期肿瘤(包括结直肠癌、进展期腺瘤和进展期锯齿状息肉)的风险是两评分均最低研究对象的3.03倍(95%CI:1.87～4.90, P<0.001)。多轮筛查效果评价方面, 当进行到第3轮筛查时, 基于遗传联...     

Tobacco use amongst high school students in the Czech Republic

OBJECTIVE: We were interested in the prevalence of smoking amongst teen-age students, its possible causes, and their understanding of its associated health risks. METHODS: We constructed a questionnaire that was responded to by a total of 419 students from 5 high schools in Prague, Czech Republic. Students were classified as non-smokers, mild (1-10 cigarettes daily), moderate (11-20 cigarettes daily), and severe smokers (>20 cigarettes daily). The survey also contained questions about passive smoking, motivation for smoking, the understanding of its associated health risks, alcohol consumption, and drugs. RESULTS: We found that amongst 16-20 years old high school students there are 37.5% smokers (38.0% men, and 37.0% women). The majority are mild smokers (82.3%), 15.8% moderate smokers and 1.9% heavy smokers. 29.0% of non-smokers reported passive smoking; i.e. that 65.7% of students are exposed to harmful effect of tobacco smoke. The average onset of smoking is at 14 years of age. The youngest smoker started smoking at the age of 5 years. Parents of 52.0% of students smoke (69.4% of smokers and 41.6% of non-smokers). Most of students know about the risk of lung cancer and cardiovascular diseases (86-99%). CONCLUSIONS: The prevalence of active and passive smoking among high school students is high. Parents smoking is significantly more frequent in teen-age smokers than in non-smokers. We consider the "teen-age" population together with their parents to be the key target for a successful antismoking campaign.     

肺癌危险因素及交互作用研究

目的探讨肺癌的影响因素及其交互作用。方法采用病例对照研究设计,收集781例肺癌病例,并按性别、年龄(±3岁)进行1:1匹配,通过调查问卷获取生活饮食习惯等信息。构建决策树及非条件Logistic回归模型,计算OR值及其95%CI,分析影响因素间的交互作用。结果肺癌的危险因素有吸烟(轻度吸烟OR=1.67,重度吸烟OR=7.27)、被动吸烟(轻度被动吸烟OR=2.63,重度被动吸烟OR=6.25)、居住地污染(吸烟者OR=2.26,不吸烟者OR=1.72)、肺癌家族史(吸烟者OR=15.94);保护因素有常吃水果(吸烟者OR=0.69,不吸烟者OR=0.44)、锻炼(吸烟者OR=0.50)、饮茶(不吸烟者OR=0.57)。吸烟与居住地污染、肺癌家族史存在交互作用,重度吸烟与不锻炼存在交互作用。结论吸烟、被动吸烟、居住地污染、肺癌家族史可增加肺癌风险,常吃水果、锻炼、饮茶有助于预防肺癌。肺癌影响因素间的协同作用应予重视。     

Attitudes toward tobacco cessation and lung cancer screening in two South African communities

ABSTRACT

Among men in South Africa, the prevalence of tobacco smoking is as high as 33%. Although smoking is responsible for most lung cancer in South Africa, occupational and environmental exposures contribute greatly to risk. We conducted a tobacco and lung cancer screening needs assessment and administered surveys to adults who smoked >100 cigarettes in their lifetime in Johannesburg (urban) and Kimberley (rural). We compared tobacco use, risk exposure, attitudes toward and knowledge of, and receptivity to cessation and screening, by site. Of 324 smokers, nearly 85% of current smokers had a <30 pack-year history of smoking; 58.7% had tried to stop smoking ≥1 time, and 78.9% wanted to quit. Kimberley smokers more often reported being advised by a healthcare provider to stop smoking (56.5% vs. 37.3%, p=0.001) than smokers in Johannesburg but smokers in Johannesburg were more willing to stop smoking if advised by their doctor (72.9% vs. 41.7%, p<0.001). Findings indicate that tobacco smokers in two geographic areas of South Africa are motivated to stop smoking but receive no healthcare support to do so. Developing high risk criteria for lung cancer screening and creating tobacco cessation infrastructure may reduce tobacco use and decrease lung cancer mortality in South Africa.     

Residential radon exposure and lung cancer: risk in nonsmokers

Lung cancer is a disease that is almost entirely caused by smoking; hence, it is almost totally preventable. Yet there are a small percentage of cases, perhaps as many as 5 to 15%, where there are other causes. Risk factors identified for this other group include passive smoking, occupational exposure to certain chemicals and ionizing radiation, diet, and family history of cancer. In the United States cigarette smoking is on the decline among adults, occupational exposures are being reduced, and people are being made more aware of appropriate diets. These changes are gradually resulting in a reduced risk for this disease. Lung cancer in the U.S. may, therefore, eventually become largely a disease of the past. It remains important, however, to continue to study the cause(s) of lung cancer in non-smokers, particularly never smokers. Because of our interest in the effects of residential radon exposure on the development of lung cancer in non-smokers, we conducted a critical review of the scientific literature to evaluate this issue in detail. Strict criteria were utilized in selecting studies, which included being published in a peer reviewed journal, including non-smokers in the studied populations, having at least 100 cases, and being of case-control design. A total of 12 individual studies were found that met the criteria, with 10 providing some information on non-smokers. Most of these studies did not find any significant association between radon and lung cancer in non-smokers. Furthermore, data were not presented in sufficient detail for non-smokers in a number of studies. Based on the most recent findings, there is some evidence that radon may contribute to lung cancer risk in current smokers in high residential radon environments. The situation regarding the risk of lung cancer from radon in non-smokers (ex and never) is unclear, possibly because of both the relatively limited sample size of non-smokers and methodological limitations in most of the individual studies. A summary of these studies is provided concerning the state of knowledge of the lung cancer risk from radon, methodological problems with the residential studies, the need for the provision of additional data on non-smokers from researchers, and recommendations for future research in non-smokers.     

Combined effect of asbestos and smoking on mortality from lung cancer and mesothelioma in factory workers

The mortality of over 1250 male and 420 female asbestos factory workers was observed over the period 1971-80. Smoking habits were obtained from the subjects in 1971 before the start of the follow up period. Mortality due to lung cancer and to mesothelioma was related to smoking habits. After allowing for the effect of smoking on lung cancer the relative risk due to asbestos was highest for those who had never smoked, lowest for current smokers, and intermediate for ex-smokers; the trend was statistically significant (p less than 0.05). There was no significant association between smoking and deaths due to mesothelioma. Data from several studies are reviewed, and although overall non-smokers have a relative risk of lung cancer due to asbestos that is 1.8 times that of smokers, there is some uncertainty on the accuracy of this figure because of possible biases and sampling variation. Overall the evidence is that mesothelioma risk is independent of smoking.     

Combined effect of asbestos and smoking on mortality from lung cancer and mesothelioma in factory workers.

The mortality of over 1250 male and 420 female asbestos factory workers was observed over the period 1971-80. Smoking habits were obtained from the subjects in 1971 before the start of the follow up period. Mortality due to lung cancer and to mesothelioma was related to smoking habits. After allowing for the effect of smoking on lung cancer the relative risk due to asbestos was highest for those who had never smoked, lowest for current smokers, and intermediate for ex-smokers; the trend was statistically significant (p less than 0.05). There was no significant association between smoking and deaths due to mesothelioma. Data from several studies are reviewed, and although overall non-smokers have a relative risk of lung cancer due to asbestos that is 1.8 times that of smokers, there is some uncertainty on the accuracy of this figure because of possible biases and sampling variation. Overall the evidence is that mesothelioma risk is independent of smoking.     

浙江省2013年成人吸烟及被动吸烟现状调查

目的 描述2013年浙江省成人吸烟、戒烟和被动吸烟的流行水平及其不同教育水平、职业和地区分布的特点,判断烟草流行变化趋势.方法 采取多阶段分层随机抽样方法,对浙江省45个监测点13 408名15～69岁居民进行入户问卷调查,其中有13 326人合格问卷用于分析.采用总吸烟率、现在吸烟率、常吸烟率、戒烟率、“二手烟”暴露率等指标,根据2010年第六次普查人口进行加权计算.结果 浙江省15～69岁人群中有1 289.65万成年吸烟者(29.59%),其中现在吸烟者998.76万(22.92%),常吸烟者844.72万(19.38%),男性和女性现在吸烟率分别为41.18%和3.69%,男性中45～54岁组最高(51.66%),女性65～69岁组最高(4.62%);人群戒烟率为22.56%,40.19%的现在吸烟者中有戒烟的考虑,选择的主要戒烟方式是“靠自己毅力戒烟”(87.59%);15～69岁人群中有2 276.77万(67.90%) “二手烟”暴露者,以室内场所烟草暴露率最高(62.84%);人群对吸烟、被动吸烟引起其他疾病的认知普遍偏低,对主动吸烟引起3种疾病的知晓率仅为31.52%,对被动吸烟引起3种疾病的知晓率仅为34.04%.结论 浙江省15～69岁居民吸烟和“二手烟”暴露状况严重,对烟草知识的认知率不足.