AIM：无论何时戒烟能降低老人的全因死亡

研究报告指出，吸烟和老年病人致死率升高直接相关。

(Credit: © tuja66 / Fotolia)

近日，刊登在国际著名杂志Archives of Internal Medicine上的一篇研究报告指出，吸烟和老年病人致死率升高直接相关，如果杜绝吸烟将会降低老年人的死亡风险和比例。吸烟是许多慢性疾病如心脑血管疾病、癌症等的重要风险因子。研究者Carolin指出，我们提供了一份全面的综述以及综合分析数据来评估60岁以上老年人的死亡率。研究者从7个国家（中国、美国等国家）分析了17项在1987年至2011年发表的研究报告，而且研究者进行的追踪观察从3至50年，人数设计863至877，243个参与者。

对17篇研究报告分析后，研究者指出当前吸烟者会增加83%的死亡风险，相比从不吸烟的人，原先吸烟的人群只有增加34%的死亡风险。研究者表示，和老年人吸烟以及所有致死相关的综合数据中，当前以及以前的吸烟者表现出2倍和1.3倍死亡风险。研究数据揭示当吸烟被禁止后，相对死亡的风险就会显著降低。

邀请评论：烟草的死亡率风险

在评论中，来自香港大学的医学博士Tai Hing Lam写到：大部分的吸烟者明显低估了他们面临的风险，许多老年抽烟者并不信他们太老而不能成功戒烟或者他们并不相信他们能从戒烟中获益。

因为反向因果性和近日戒烟者死亡的消息，一些不相信的老年抽烟者认为如果戒烟会有某些坏处。一个单一直接的、基于证据的警告对于老年人来说还是必须的。作者最后总结道：如果你帮助两个人，那么你至少挽救了一个人的生命。

doi:10.1001/archinternmed.2012.1397
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Smoking and All-Cause Mortality in Older People：Systematic Review and Meta-analysis

Carolin Gellert; Ben Schöttker, PhD, MPH; Hermann Brenner, MD, MPH

Background Smoking is an established risk factor of premature death. However, most pertinent studies primarily relied on middle-aged adults. We performed a systematic review and meta-analysis of the empirical evidence on the association of smoking with all-cause mortality in people 60 years and older. Methods A systematic literature search was conducted in multiple databases including MEDLINE, EMBASE, and ISI Web of Knowledge and complemented by cross-referencing to identify cohort studies published before July 2011. Core items of identified studies were independently extracted by 2 reviewers, and results were summarized by standard methods of meta-analysis. Results We identified 17 studies from 7 countries. Current smoking was associated with increased all-cause mortality in all studies. Relative mortality (RM) compared with never smokers ranged from 1.2 to 3.4 across studies and was 1.83 (95% CI, 1.65-2.03) in the meta-analysis. A decrease of RM of current smokers with increasing age was observed, but mortality remained increased up to the highest ages. Furthermore, a dose-response relationship of the amount of smoked cigarettes and premature death was observed. Former smokers likewise had an increased mortality (meta-analysis: RM, 1.34; 95% CI, 1.28-1.40), but excess mortality compared with never smokers clearly decreased with duration of cessation. Benefits of smoking cessation were evident in all age groups, including subjects 80 years and older. Conclusions Smoking remains a strong risk factor for premature mortality also at older age. Smoking cessation is beneficial at any age.