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Smoking, Quitting, and Mortality in a Chinese Cohort of Retired Men

https://doi.org/10.1016/S1047-2797(01)00258-7Get rights and content

Abstract

PURPOSE: To examine the relationship between smoking, quitting, and mortality in older Chinese men.

DESIGN AND METHODS: A cohort analytic study was carried out in Xi'an, China. A total of 1268 retired male military cadres aged 60 or older were examined in 1987 and followed for 12 years.

RESULTS: At baseline, 388 men were never-smokers, 461 were former smokers, and 419 were current smokers. Through May 1999, a total of 299 had died. The relative risks [95% confidence intervals (CI)] for ever-smoking, after adjusting for age, blood pressure, body mass index, total cholesterol, triglycerides, alcohol drinking, exercise and existing diseases, for deaths resulting from all causes, chronic obstructive pulmonary disease (COPD), lung cancer, and coronary heart disease (CHD) were, respectively, 1.34 (1.02–1.76), 3.23 (0.95–10.91), 2.31 (0.95–5.61), and 1.60 (0.81–3.19). The risks increased significantly with increasing amount and duration of smoking. Compared with current smokers, former smokers had lower risks of total mortality (excess risk reduction of 56%) and from CHD death, but had higher risks for COPD death.

CONCLUSIONS: Smoking is a major cause of death in older Chinese and quitting can save lives. Early recognition of the significance of COPD symptoms followed by prompt quitting should be emphasized in the control of the growing tobacco epidemic.

Introduction

The magnitude of the tobacco-induced epidemic of mortality has been demonstrated in several prospective studies 1, 2, 3, 4 and one large case control study (5) in Mainland China. Prospective data on elderly Chinese are limited (6). Whereas there is strong evidence on the benefits of smoking cessation from prospective studies in the West (7), no clear evidence has been reported from prospective studies in China or other developing countries. It is also a common belief in less developed countries where smoking has become a common habit a few decades latter than the US and UK that smoking in the elderly is not that harmful and quitting after lifelong smoking could produce more harm than good. The objective of this cohort study was to examine the relationship between smoking, quitting smoking and mortality in Chinese retired men after 12 years of follow-up.

Section snippets

Methods

From February to June 1987, a cross-sectional survey of cardiovascular risk factors was carried out in retired military cadres of 22 retirement centres in Xi'an, China. As there were few women, only 1268 men (98% of all eligible) were included. The centre doctors using a standardized questionnaire interviewed the subjects. Height, body weight, and blood pressure were measured by standard methods. Total cholesterol and tryglycerides were measured using the standard enzymatic method and Hontzschs

Results

The study entry date was February 1, 1987. Through May 12, 1999, a total of 943 individuals were alive, 26 were transferred away with unknown vital status (the last date of known survival, which was end of July 1996, was considered as the censored date), and 299 had died. Death certificates were available for all the deaths since they all occurred in hospitals. At baseline, the mean age was 62.9 [standard deviation (SD) 5.2] years. There were 388 never-smokers, 461 former smokers, and 419

Discussion

Results of the present study on the excess risks of mortality and dose-response relationships among ever-smokers shows that smoking is a major cause of death in older Chinese men. Our results are consistent with those from previous prospective studies on Mainland Chinese men 1, 2, 3, 4, and from a Hong Kong study on a Chinese cohort aged 70 and above (6). Moreover, our results showing that stopping smoking was associated with decreased risks of mortality, provide further and strong evidence

Acknowledgements

This study was funded by the Committee on Research and Conference Grants, University of Hong Kong, Hong Kong, China and the Ministry of Public Health of People's Liberation Army, China (98H035). Dr. Yao He was supported by the Sen Yat Sen Visitorship and Cheng Yu Tung Fellowship, Dr. J.Y. Huang by the Sen Yat Sen Visitorship, and Dr Q.L. Shi by Ivy Wu Fellowship, all these visitorships and fellowships were granted by the Faculty of Medicine at the University of Hong Kong. We thank the doctors

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