吸烟和家庭二手烟暴露与结直肠癌死亡关系的研究

发布时间：2018-05-31 02:44

本文选题：吸烟 + 二手烟　；参考：《北京协和医学院》2017年硕士论文

【摘要】：研究目的分析吸烟和家庭二手烟暴露与结直肠癌死亡的相关关系。材料与方法数据选自1986-1988年人口死因和吸烟调查资料,调查内容包括死者的基本信息和吸烟史信息,死者配偶的吸烟情况。选取30-79岁的结直肠癌死者和存活配偶作为研究对象。本研究不吸烟女性结直肠癌死者的配偶吸烟率(城市53.56%、农村66.84%)远高于男性结直肠癌(城市9.18%,农村5.54%),故研究家庭二手烟时以女性为主。研究设计:(1)生态学研究:为保证统计功效,女性选取23个城市为研究地区,计算家庭吸烟情况与结直肠癌死亡的相关性。(2)病例对照研究:1.吸烟与结直肠癌死亡:全部结直肠癌死者为病例组,按性别、年龄±5岁、地区1:2匹配选取存活配偶为对照组。2.家庭二手烟暴露与结直肠癌死亡关系:以不吸烟女性结直肠癌死者为病例组,按上述条件选取不吸烟存活配偶为对照组。统计分析:利用Spearman秩相关计算相关系数。病例对照研究采用非条件Logistic回归计算吸烟和二手烟暴露者的结直肠癌死亡风险及95%可信区间。研究结果(1)生态学研究:对23个城市2684例结直肠癌死者研究发现,丈夫吸烟年限≥40年与女性结直肠癌死亡率具有显著正相关性(r=0.48,P=0.02)。分层分析显示,丈夫吸烟≥20包年与30～39岁结直肠癌死亡率呈正相关(r=0.44,P=0.04);丈夫日吸烟量10～19支、吸烟年限30年与50～59岁结直肠癌死亡率相关系数分别为0.552、0.551,P0.05;丈夫开始吸烟年龄20岁、吸烟年限30年、吸烟10包年与70～79岁结直肠癌死亡率相关系数分别为0.51、0.46、0.59,P0.05。(2)病例对照研究:1.吸烟与结直肠癌死亡风险:男性:城市病例入选3971例,对照7942例;农村分别为1157例和2314例。调整年龄后,城市男性吸烟与结直肠癌死亡具有显著相关性,OR=1.136(95%CI:1.051-1.228);农村OR值为1.445(95%CI:1.236-1.689)。城市男性日吸烟量≥20支为1.217(95%CI:1.103-1.343),吸烟年限≥40年为1.114(95%CI:1.009-1.231),吸烟≥20包年为 1.197(95%CI:1.088-1.317),农村高于城市分别为1.662(95%CI:1.366-2.022)、1.510(95%CI:1.247-1.829).1.478(95%CI:1.209-1.808)。女性:城市病例2798例,对照5596例;农村分别为685例和1370例。调整年龄后城市女性吸烟结直肠癌死亡OR值为1.020(95%CI:0.896-1.161),农村为1.106(95%CI:0.801-1.526)。城市女性吸香烟≥40年结直肠癌死亡风险为1.306(95%CI:1.022-1.669);农村均未发现女性吸烟指标与结直肠癌死亡具有显著相关关系。2.家庭二手烟暴露与不吸烟女性的结直肠癌死亡风险:城市:入选病例2160例,对照4320例。调整年龄后,家庭二手烟暴露者的不吸烟女性结直肠癌死亡风险为0.677(95%CI:0.610-0.752);丈夫吸烟年限20年的OR值为0.876(95%CI:0.696-1.103),吸烟年限≥40年的OR值为0.598(95%CI:0.518-0.690);丈夫吸烟多20 包年OR值为0.638(95%CI:0.560-0.727)。农村:入选病例567例,对照1134例。调整年龄后,丈夫吸烟的不吸烟女性结直肠癌死亡OR值为0.831(95%CI:0.668-1.035)。均未发现丈夫不同吸烟指标与结直肠死亡具有显著相关性。研究结论吸烟是男性结直肠癌死亡的重要危险因素,城市女性吸香烟≥40年结直肠癌死亡风险增加。生态学研究发现女性家庭二手烟暴露与结直肠癌死亡具有显著的正相关性,但病例对照研究未发现家庭二手烟暴露可显著增加女性的结直肠死亡风险,可能由于未对其他结直肠癌危险因素进行调整,城市地区家庭二手烟暴露为不吸烟女性结直肠死亡的保护因素。
[Abstract]:The purpose of this study was to analyze the correlation between smoking and family secondhand smoke exposure and colorectal cancer death. Materials and methods were selected from the data of the 1986-1988 year population and smoking survey, including the basic information and smoking history of the deceased, the smoking status of the deceased spouse. The 30-79 year old colorectal cancer deceased and surviving spouses were selected. For the study, the smoking rate of the spouses of non smoking female colorectal cancer (city 53.56%, rural 66.84%) was far higher than that of male colorectal cancer (city 9.18%, rural 5.54%), so the study of family secondhand smoke was dominated by women. (1) ecological research: to ensure statistical efficiency, women selected 23 cities as research areas. The correlation between family smoking and colorectal cancer death (2) case control study: 1. smoking and colorectal cancer death: all colorectal cancer deaths as case group, sex, age of + 5 years, regional 1:2 match selection of survival spouses as control group.2. family second-hand smoke exposure and colorectal cancer death: non smoking female colorectal cancer deceased For the case group, the non smoking surviving spouses were selected as the control group according to the above conditions. Statistical analysis: the correlation coefficient of Spearman rank correlation was used to calculate the correlation coefficient. The case control study used non conditional Logistic regression to calculate the risk of colorectal cancer death and the 95% confidence interval of the smokers and second-hand smoke exposed persons. The results of the study (1) the ecological study: 2684 of the 23 cities. The study of the deceased colorectal cancer found that the age of the husband smoking longer than 40 years had a significant positive correlation with the mortality of female colorectal cancer (r=0.48, P=0.02). The stratified analysis showed that the death rate of the husband smoking more than 20 years was positively correlated with the death rate of colorectal cancer (r=0.44, P=0.04), the smoking volume of the husband's husband day was 10~19, the years of smoking were 30 years and 50~59 years old. The correlation coefficient of colon cancer mortality was 0.552,0.551, P0.05, the husband started smoking age 20 years, smoking age 30 years, smoking 10 years and 70~79 year old colorectal cancer mortality correlation coefficient was 0.51,0.46,0.59, P0.05. (2) case control study: 1. smoking and colorectal cancer death risk: male: 3971 cases in urban cases, 7942 cases; There were 1157 cases and 2314 cases in rural areas. After the adjustment of age, urban male smoking was significantly correlated with colorectal cancer death, OR=1.136 (95%CI:1.051-1.228); OR in rural areas was 1.445 (95%CI:1.236-1.689). Urban male daily smoking was 1.217 (95%CI:1.103-1.343), smoking age was 1.114 (95%CI:1.009-1.231), and smoking was more than 20 packs. The year was 1.197 (95%CI:1.088-1.317), and the rural areas were 1.662 (95%CI:1.366-2.022), 1.510 (95%CI:1.247-1.829).1.478 (95%CI:1.209-1.808) higher than the cities, women: 2798 urban cases, 5596 controls, 685 rural and 1370 cases in rural areas. The OR value of urban female smoking colorectal cancer was 1.020 (95%CI:0.896-1.161) after adjusting for age (95%CI:0.896-1.161), and rural areas were 1.020 (95%CI:0.896-1.161). For 1.106 (95%CI:0.801-1.526). The risk of colorectal cancer death in urban women smoked more than 40 years was 1.306 (95%CI:1.022-1.669). There was no significant correlation between smoking and colorectal cancer deaths in rural areas. The risk of colorectal cancer death in family secondhand smoke exposure and non smoking women in rural areas.2.: Urban: 2160 cases of selected cases and 4320 control After adjusting for age, the risk of colorectal cancer death for non-smoking women from second-hand smoke exposed in the family was 0.677 (95%CI:0.610-0.752); the OR value of the husband's smoking year was 0.876 (95%CI:0.696-1.103) for 20 years, and the OR value of smoking years for 40 years was 0.598 (95%CI:0.518-0.690) and 0.638 (95%CI:0.560-0.727) for the 20 pack years of the husband smoking (95%CI:0.560-0.727). There were 567 cases and 1134 cases of control. The OR value of colorectal cancer death was 0.831 (95%CI:0.668-1.035) when the age was adjusted. No significant correlation between the different smoking indicators and colorectal death was found. Conclusion smoking is an important risk factor for the death of colorectal cancer in males, and the urban women smoking cigarettes for more than 40 years The risk of rectal cancer death increased. The ecological study found a significant positive correlation between second-hand smoke exposure in female families and colorectal cancer deaths, but case control studies did not find that second-hand smoke exposure in the family could significantly increase the risk of colorectal death in women, possibly due to no adjustment to other risk factors for colorectal cancer, in urban areas Secondhand smoke exposure is a protective factor for colorectal cancer deaths in non-smoking women.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.3

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