本文選題：吸煙 + 二手煙��； 參考：《北京協(xié)和醫(yī)學(xué)院》2017年碩士論文

【摘要】：研究目的分析吸煙和家庭二手煙暴露與結(jié)直腸癌死亡的相關(guān)關(guān)系。材料與方法數(shù)據(jù)選自1986-1988年人口死因和吸煙調(diào)查資料,調(diào)查內(nèi)容包括死者的基本信息和吸煙史信息,死者配偶的吸煙情況。選取30-79歲的結(jié)直腸癌死者和存活配偶作為研究對象。本研究不吸煙女性結(jié)直腸癌死者的配偶吸煙率(城市53.56%、農(nóng)村66.84%)遠(yuǎn)高于男性結(jié)直腸癌(城市9.18%,農(nóng)村5.54%),故研究家庭二手煙時(shí)以女性為主。研究設(shè)計(jì):(1)生態(tài)學(xué)研究:為保證統(tǒng)計(jì)功效,女性選取23個(gè)城市為研究地區(qū),計(jì)算家庭吸煙情況與結(jié)直腸癌死亡的相關(guān)性。(2)病例對照研究:1.吸煙與結(jié)直腸癌死亡:全部結(jié)直腸癌死者為病例組,按性別、年齡±5歲、地區(qū)1:2匹配選取存活配偶為對照組。2.家庭二手煙暴露與結(jié)直腸癌死亡關(guān)系:以不吸煙女性結(jié)直腸癌死者為病例組,按上述條件選取不吸煙存活配偶為對照組。統(tǒng)計(jì)分析:利用Spearman秩相關(guān)計(jì)算相關(guān)系數(shù)。病例對照研究采用非條件Logistic回歸計(jì)算吸煙和二手煙暴露者的結(jié)直腸癌死亡風(fēng)險(xiǎn)及95%可信區(qū)間。研究結(jié)果(1)生態(tài)學(xué)研究:對23個(gè)城市2684例結(jié)直腸癌死者研究發(fā)現(xiàn),丈夫吸煙年限≥40年與女性結(jié)直腸癌死亡率具有顯著正相關(guān)性(r=0.48,P=0.02)。分層分析顯示,丈夫吸煙≥20包年與30～39歲結(jié)直腸癌死亡率呈正相關(guān)(r=0.44,P=0.04);丈夫日吸煙量10～19支、吸煙年限30年與50～59歲結(jié)直腸癌死亡率相關(guān)系數(shù)分別為0.552、0.551,P0.05;丈夫開始吸煙年齡20歲、吸煙年限30年、吸煙10包年與70～79歲結(jié)直腸癌死亡率相關(guān)系數(shù)分別為0.51、0.46、0.59,P0.05。(2)病例對照研究:1.吸煙與結(jié)直腸癌死亡風(fēng)險(xiǎn):男性:城市病例入選3971例,對照7942例;農(nóng)村分別為1157例和2314例。調(diào)整年齡后,城市男性吸煙與結(jié)直腸癌死亡具有顯著相關(guān)性,OR=1.136(95%CI:1.051-1.228);農(nóng)村OR值為1.445(95%CI:1.236-1.689)。城市男性日吸煙量≥20支為1.217(95%CI:1.103-1.343),吸煙年限≥40年為1.114(95%CI:1.009-1.231),吸煙≥20包年為 1.197(95%CI:1.088-1.317),農(nóng)村高于城市分別為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,對照5596例;農(nóng)村分別為685例和1370例。調(diào)整年齡后城市女性吸煙結(jié)直腸癌死亡OR值為1.020(95%CI:0.896-1.161),農(nóng)村為1.106(95%CI:0.801-1.526)。城市女性吸香煙≥40年結(jié)直腸癌死亡風(fēng)險(xiǎn)為1.306(95%CI:1.022-1.669);農(nóng)村均未發(fā)現(xiàn)女性吸煙指標(biāo)與結(jié)直腸癌死亡具有顯著相關(guān)關(guān)系。2.家庭二手煙暴露與不吸煙女性的結(jié)直腸癌死亡風(fēng)險(xiǎn):城市:入選病例2160例,對照4320例。調(diào)整年齡后,家庭二手煙暴露者的不吸煙女性結(jié)直腸癌死亡風(fēng)險(xiǎn)為0.677(95%CI:0.610-0.752);丈夫吸煙年限20年的OR值為0.876(95%CI:0.696-1.103),吸煙年限≥40年的OR值為0.598(95%CI:0.518-0.690);丈夫吸煙多20 包年OR值為0.638(95%CI:0.560-0.727)。農(nóng)村:入選病例567例,對照1134例。調(diào)整年齡后,丈夫吸煙的不吸煙女性結(jié)直腸癌死亡OR值為0.831(95%CI:0.668-1.035)。均未發(fā)現(xiàn)丈夫不同吸煙指標(biāo)與結(jié)直腸死亡具有顯著相關(guān)性。研究結(jié)論吸煙是男性結(jié)直腸癌死亡的重要危險(xiǎn)因素,城市女性吸香煙≥40年結(jié)直腸癌死亡風(fēng)險(xiǎn)增加。生態(tài)學(xué)研究發(fā)現(xiàn)女性家庭二手煙暴露與結(jié)直腸癌死亡具有顯著的正相關(guān)性,但病例對照研究未發(fā)現(xiàn)家庭二手煙暴露可顯著增加女性的結(jié)直腸死亡風(fēng)險(xiǎn),可能由于未對其他結(jié)直腸癌危險(xiǎn)因素進(jìn)行調(diào)整,城市地區(qū)家庭二手煙暴露為不吸煙女性結(jié)直腸死亡的保護(hù)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.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.3

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