戒菸降低年長者的死亡風險


  【24drs.com】根據發表於6月11日內科醫學誌的研究,抽菸者在年長時的死亡風險是從未抽菸者的近2倍,與一般觀念不同的是,即使是年齡稍長時才戒菸,也可降低死亡風險。
  
  德國癌症研究中心臨床流行病學與老化研究小組Carolin Gellert醫師等人進行了一篇系統性回顧與統合分析,共納入來自7個國家的17篇出版研究,有關抽菸對60歲以上者之所有原因死亡率的影響;大部份探討抽菸之影響研究包括的是中年人,這篇報告分析了美國、中國、澳洲、日本、英國、法國和西班牙的此類研究。
  
  研究者寫道,在這篇探討抽菸和年長者各種原因死亡率關聯之回顧與統合分析,目前和以前有抽菸者的死亡率風險分別是未曾抽菸者的2倍與1.3倍。
  
  他們指出,這篇回顧與統合分析顯示,即使是年齡稍長才戒菸,戒菸後,死亡率的相對風險明顯降低許多。
  
  此次統合分析引述的這些研究是在1987- 2011年間進行,包括的研究對象數從863人到877,243人。統整這些研究,目前有抽菸者各種原因死亡率比未曾抽菸者高,相對死亡率平均值為1.83 (95%信心區間[CI],1.65 - 2.03)。對於曾經抽菸者,相對死亡率平均值為1.34 (95% CI,1.28 - 1.40)。研究者報告指出,即使是80歲以上者,戒菸的效益仍是顯而易見的,男性和女性的結果一致。
  
  研究者發現,個人抽菸數量與死亡率增加之間有明顯的劑量反應關聯,他們也發現,相對死亡率隨年紀降低,從60-69歲的1.94 (95% CI,1.57 - 2.40)降到70 -79歲的1.86 (95% CI,1.55 - 2.22)與80歲以上的1.66 (95% CI,1.30 - 2.12)。亞洲人的相對死亡率風險低於歐洲、美國和澳洲人。
  
  研究者寫道,就我們所知,這是第一篇探討抽菸對年長者各種原因死亡率之影響的系統性回顧暨統合分析。對這17篇研究世代結果統整結果發現,與未曾抽菸者相比,目前有抽菸者的死亡率增加83%,以前有抽菸者的死亡率增加34%。曾經抽菸者的相對死亡率,自戒菸後隨著時間降低。
  
  香港大學公衛學院的Tai Hing Lamb醫師在編輯評論中寫道,戒菸是相當有價值的。許多年長抽菸者誤以為自己年紀大了、戒菸的話也不會有任何好處。因為反向因果關係、以及看到最近戒菸的老朋友死亡,有些人誤認為戒菸會有害處。亟需一個簡單、直接、有力且有證據基礎的警示。
  
  對於想要提供這類警訊的醫師,Lamb醫師提供了簡稱為AWARD的方法: A(ask)=詢問抽菸史;W(warn)=警示病患可能死於抽菸相關疾病的機會大;A(advise)=建議你的病患戒菸與減少死亡風險;R(refer)=轉介病患進行戒菸;D(do it again)=反覆執行到戒菸為止。
  
  研究者在統合分析中結論表示,抽菸是年長者死亡的強力風險因素。在各年齡組中,目前有抽菸者的抽菸數量和死亡率之間有劑量反應關聯,雖然這類研究報告的資料依舊相當有限。戒菸後的時間越久,這些年長戒菸者的相對死亡率越低;進行有效戒菸的計畫,即便是對於60歲以上的抽菸者,仍有重要的預防效果。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6853&x_classno=0&x_chkdelpoint=Y
  

Quitting Smoking Decreases Death Risk Even in Older People

By Larry Hand
Medscape Medical News

June 11, 2012 — Smokers are at almost twice the risk of dying of any cause at older ages than people who never smoked, and contrary to popular belief, quitting smoking — even at an older age — reduces the risk for death, according to a study published in the June 11 issue of the Archives of Internal Medicine.

Carolin Gellert, from the Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, and colleagues conducted a systematic review and meta-analysis of medical literature and identified 17 published studies from 7 countries with data on how smoking affects all-cause mortality in people aged 60 years and older. Most studies into smoking's effects have involved middle-aged people. The studies analyzed in this report were from the United States, China, Australia, Japan, England, France, and Spain.

"In this review and meta-analysis on the association of smoking and all-cause mortality at older age, current and former smokers showed an approximately 2-fold and 1.3-fold risk for mortality, respectively," the researchers write.

"This review and meta-analysis demonstrates that the relative risk for death notably decreases with time since smoking cessation even at older age," they add.

The studies cited in the meta-analysis were conducted between 1987 and 2011 and involved study populations ranging from 863 to 877,243 participants. Across all of the studies, current smoking was associated with higher all-cause death compared with never smokers, with relative mortality averaging 1.83 (95% confidence interval [CI], 1.65 - 2.03). For former smokers, the relative mortality averaged 1.34 (95% CI, 1.28 - 1.40) compared with never smokers. The researchers report that smoking cessation benefits were evident through the highest ages, including people aged 80 and older, and that results were comparable between men and women.

The researchers found "a clear dose-response relation of increasing mortality with increasing number of cigarettes" smoked by the individuals. They also found that relative mortality decreased with age, from 1.94 (95% CI, 1.57 - 2.40) for people aged 60 to 69 years to 1.86 (95% CI, 1.55 - 2.22) for people aged 70 to 79 years, and to 1.66 (95% CI, 1.30 - 2.12) for people aged 80 years and older. Asian populations had lower relative mortality than European, US, and Australian populations.

"To our knowledge, this is the first systematic review and meta-analysis on the impact of smoking on all-cause mortality focusing on older people," the researchers write. "Summarizing the results from 17 cohort studies, we observed an 83% increased mortality for current smokers and a 34% increased mortality for former smokers compared with never smokers. Relative mortality of former smokers decreased with time since cessation."

In an accompanying editorial, Tai Hing Lamb, MD, from the University of Hong Kong School of Public Health, writes that the smoking cessation finding is especially valuable. "Many older smokers misbelieve that they are too old to quit or too old to benefit from quitting," he writes. "Because of reverse causality and from seeing deaths of old friends who had quit recently, some misbelieve that quitting could be harmful. A simple, direct, strong, and evidence-based warning is needed."

For clinicians who want to provide such a warning now, Dr. Lamb offers the acronym AWARD: A, ask about smoking; W, warn your patients about the great chance of dying from smoking-related disease; A, advise your patients to quit smoking and cut their risk for death; R, refer your patients to smoking cessation; and D, do it again until they quit.

In the meta-analysis, the researchers conclude, "[S]moking is a strong risk factor for premature mortality at older age. A dose-response relationship of the number of currently smoked cigarettes with mortality was observed in all age groups, even though the number of studies reporting such data are still rather limited. The longer the time since smoking cessation, the lower the [relative mortality] of older former smokers; this fact calls for effective smoking cessation programs that are likely to have major preventive effects even for smokers aged 60 years and older."

The study was supported by CHANCES project funded in the FP7 Framework Programme of DG-RESEARCH in the European Commission.The authors and editorialist have disclosed no relevant financial relationships.

Arch Intern Med. 2012;172:837-844, 845-846.

    
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