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目的 前瞻性探讨男性老年人吸烟及戒烟与烟草有关疾病死亡的相互关系。方法 研究对象为 1987年西安市 2 2个军队干休所的全部男性离休干部 ,共计 12 6 8人。基线调查时 ,388人为不吸烟者 ,4 19人为吸烟者 ,4 6 1人为戒烟者。终点指标为全死因和与烟草有关疾病死亡。结果 截止 1999年 ,共观察 14 16 3人年 ,平均随访 11年。共死亡 2 99人 ,94 3人存活 ,2 6人失访。在调整了年龄、血压、体重指数、总胆固醇、甘油三酯、饮酒、体育锻炼和既往病史等因素后 ,多元Cox生存分析模型显示 :既往吸烟与该人群相关死亡的相对危险度 (95 %CI)分别为总死亡 1.34(1.0 2～ 1.76 )、慢性阻塞性肺病 (COPD) 3.2 3(0 .95～ 10 .91)、肺癌 2 .31(0 .95～ 5 .6 1)、冠心病 1.6 0 (0 .81～ 3.19)。其死亡危险性随既往吸烟量的增多和吸烟年限的延长而升高 ,存在明确的剂量反应关系。与继续吸烟者相比 ,戒烟者总死亡和冠心病死亡的危险性分别下降 5 6 %和 93% ,但COPD的死亡危险却升高了174 %。结论 (1)吸烟是中国男性老年人的主要死因之一 ,而戒烟可以降低总死亡和心血管病死亡 ;(2 )戒烟者COPD死亡危险高于继续吸烟者的原因可能与“无病吸烟者作用”和“因病戒烟作用”有关。
Objective To prospectively explore the relationship between smoking and smoking cessation and death of tobacco-related diseases in male elders. Methods The object of study was all male retired cadres in 222 military retired cadres in Xi’an in 1987, totaling 126 68 people. In the baseline survey, 388 were non-smokers, 4-19 were smokers and 461 were smokers. The end point was all-cause and tobacco-related illness deaths. Results As of 1999, 14,163 person-years were observed, with an average follow-up of 11 years. A total of 2 99 deaths, 94 3 survived and 26 lost. After adjusting for factors such as age, blood pressure, body mass index, total cholesterol, triglycerides, alcohol consumption, physical activity and past medical history, the multivariate Cox survival analysis model showed a relative risk of previous smoker-related deaths (95% CI ) Were 1.34 (1.02 ~ 1.76), COPD 3.2 3 (0.95 ~ 10.91), lung cancer 2.31 (0.95 ~ 5.61), coronary heart disease 1.6 0 (0.81 ~ 3.19). The risk of death increased with the increase of previous smoking and smoking duration, there is a clear dose-response relationship. Compared with continuing smokers, total smoker deaths and coronary heart disease risk decreased by 56% and 93%, respectively, but the risk of death from COPD increased by 174%. Conclusions (1) Smoking is one of the major causes of death in Chinese male elderly, and smoking cessation can reduce the total death and cardiovascular death; (2) The reason for exacerbation of COPD in smokers who are at higher risk of death than continuing smokers may be related to “ Role ”and“ quit smoking due to illness ”related.