【摘要】 目的探讨吸烟与食管癌死亡危险的关系,验证在死因调查中同时进行病例对照研究方法的可行性与科学性。方法分别采用非随机和随机方式在中国选择24个大中城市以及79个农村县进行死因调查,并同时开展以人群为基础的病例对照方法学研究。病例为1986至1988年调查地区内的死于食管癌、年龄≥35岁的男性患者,同时设置两组对照,对照组Ⅰ为同期死于其他消化道疾病、年龄≥35岁的男性患者;对照组Ⅱ为同期死亡的女性患者(全死因)的存活配偶,并且他们在其妻死亡时的年龄≥35岁。主要测定指标为按地区分别计算吸烟与不吸烟人群中食管癌绝对死亡率以及吸烟与食管癌死亡风险的关系。结果(1)在病例与对照组Ⅰ中:非吸烟者/吸烟者食管癌绝对死亡率(1/千人)城市为0.39/0.63,内陆农村为1.06/1.24,沿海农村为1.18/1.55。对照组Ⅱ与对照组Ⅰ的趋势相同;每日吸烟支数与食管癌的死亡风险存在显著的剂量反应关系。每日吸烟<10、10～、20～支的相对危险度值在对照组Ⅰ中为1.42、1.82、2.22,在对照组Ⅱ中为1.57、1.95、3.18。吸烟年限与食管癌的死亡风险同样存在显著的剂量反应关系。(2)采用不同的对照,所得出的结果具有较好的一致性。结论吸烟是食管癌重要的致病因素,在死因调查中进行病例对照研究是一种创新的、科学而易行的研究方法。更多还原

【Abstract】 Objective To examine the relationship between smoking and risk of esophageal cancer (EC),and present a theoretical framework of control selection in population-based case-control study which was incorporated into a nationwide retrospective survey of mortality in China.Methods A large-scale population-based case-control study was incorporated into the nationwide retrospective survey of mortality conducted 1989-1991 in 24 urban cities selected by non-random sampling and 79 rural counties selected from 3000 counties included in the 1973-1975 cancer distribution survey by random sampling during. A questionnaire survey was conducted by home visit to investigate the death causes and smoking history of 19 734 deceased male adults who died of esophageal cancer during 1986-1988 at the age ≥35. Two control groups were set up to undergo questionnaire survey by home visit to investigate the smoking history of the deceased persons and the informants. Control group Ⅰ included the surviving spouses or other informants of 31 989 male adults who died of non-malignant digestive diseases during 1986-1988 at the age ≥35, and control group Ⅱ included 104 846 male spouses of the deceased female adults who died of different causes during 1986-1989 at the age ≥35. The relative risks and population smoking attributable risks for EC were calculated using non-conditional logistic model, and the results were compared for consistency between the analyses using two different control groups. Results The EC absolute death rates were higher in the smokers than in the non-smokers in all urban and rural area groups. The total EC absolute death rate per 1000 among the non-smokers vs. smokers was 0.37:0.65 in the urban areas, 0.99:1.29 in the inland rural areas, and 1.09:1.62 in the coastal rural areas in the control groupⅠ, and there was a similar trend in the control group Ⅱ. There was a significant dose-response relation between the period of smoking and the death risk of EC and between the daily cigarette consumption and the death risk of EC. The risk ratios, for example, for cigarette per day <10, 10-, and 20- in the urban men were 1.42, 1.82, 2.22 in the control group Ⅰ (trend test P<0.01), and 1.57, 1.95, and 3.18 in the control group Ⅱ (trend test P<0.01). Conclusion Smoking is an important risk factor for mortality from EC in China. Investigating the surviving spouses of the deceased patients is a creative, effective, and feasible trial, with the prerequisite of whole population-based survey, in study of the main types of death and the relevant risk factors.更多还原