Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
권호 표지
DOI QR코드

DOI QR Code

The Attributable Risk of Smoking on All-Cause Mortality in Korean: A Study Using KNHANES IV-VI (2007-2015) with Mortality Data

  • Park, Young Sik (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital) ;
  • Park, Sangshin (Department of Pediatrics, Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University) ;
  • Lee, Chang-Hoon (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital)
  • Received : 2020.02.05
  • Accepted : 2020.06.09
  • Published : 2020.10.31
Download PDF
⟨ Previous Next ⟩

Abstract

Background: It is not evident that the attributable risk of smoking on mortality in Korea has decreased. We investigated the impact of smoking on all-cause mortality and estimated the attributable risk of smoking in Korean adults. Methods: Those aged ≥20 years with smoking history in the Korean National Health and Nutrition Examination Surveys (KNHANES) 2007-2015 were enrolled. We categorized the participants into three groups as follows: never smoker, <20 pack-years (PY) smokers, and ≥20 PY smokers. We applied inverse probability weighting using propensity scores to control various confounders between the groups. All-cause mortality risks were compared between the groups using the Kaplan-Meier log-rank test. The effects of smoking-attributable risks (ARs) on mortality were also calculated. Results: A total of 50,458 participants were included. Among them, 19,334 (38.3%) were smokers and 31,124 (61.7%) were never smokers. Those with a smoking history of 20 PY or more (≥20 PY smokers), those with a smoking history of less than 20 PY (<20 PY smokers), and never smokers were 18.1%, 20.2%, and 61.7%, respectively, of the study population. Smokers had a higher risk of all-cause mortality compared to never smokers (log-rank test p<0.01). The ARs of smoking were 21.8% (95% confidence interval [CI], 5.7%-37.9%) and 9.0% (95% CI, 6.1%-12.0%) in males and females, respectively. ARs decreased from 24.2% to 19.5% in males and from 9.5% to 4.1% in females between 2007-2010 and 2011-2015. Conclusion: Our study using KNHANES IV-VI data demonstrated that smoking increased the risk of all-cause mortality in a dose-response manner and the ARs of smoking on mortality were 21.8% in males and 9.0% in females during 2007-2015. This suggests that the ARs of smoking on mortality have decreased since around 2010.

Keywords

References

  1. U.S. Department of Health and Human Servies. The health consequences of smoking: 50 years of progress. A report of the surgeon general. Rockville, MD: U.S. Department of Health and Human Servies; 2014.
  2. GBD 2015 Tobacco Collaborators. Smoking prevalence and attributable disease burden in 195 countries and territories, 1990-2015: a systematic analysis from the Global Burden of Disease Study 2015. Lancet 2017;389:1885-906. https://doi.org/10.1016/S0140-6736(17)30819-X
  3. Korean Insitute of Tuberculosis; The Korean National Tuberculosis Association. Surveys on the smoking habits in Korea: 1980 and 1985. Tuberc Respir Dis 1987;34:109-23. https://doi.org/10.4046/trd.1987.34.2.109
  4. Meng KH. Smoking-attributable mortality among Korean adults. Korean J Epidemiol 1988;10:138-45.
  5. Statistics Korea. 2018 Social survey (family, education, health, safety and environment) [Internet]. Daejeon: Statistics Korea; 2018 [cited 2020 Apr 16]. Available from: http://kostat.go.kr/portal/eng/pressReleases/1/index.board?bmode=read&aSeq=372014.
  6. Kweon S, Kim Y, Jang MJ, Kim Y, Kim K, Choi S, et al. Data resource profile: the Korea National Health and Nutrition Examination Survey (KNHANES). Int J Epidemiol 2014;43:69-77. https://doi.org/10.1093/ije/dyt228
  7. Kim Y. The Korea National Health and Nutrition Examination Survey (KNHANES): current status and challenges. Epidemiol Health 2014;36:e2014002. https://doi.org/10.4178/epih/e2014002
  8. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.
  9. Mansournia MA, Altman DG. Population attributable fraction. BMJ 2018;360:k757. https://doi.org/10.1136/bmj.k757
  10. Public Health Information for Scotland. Tobacco use: smoking attributable deaths [Internet]. Glasgow: Scottish Public Health Observatory; 2020 [cited 2020 Apr 16]. Available from: https://www.scotpho.org.uk/behaviour/tobacco-use/data/smoking-attributable-deaths/.
  11. Wang YY, Zhang W, Li HL, Gao J, Tan YT, Gao YT, et al. Population attributable risks of cigarette smoking for deaths of all causes, all cancers and other chronic diseases among adults aged 40-74 years in urban Shanghai, China. Chin J Cancer Res 2015;27:59-65.
  12. Riely GJ, Yu HA. EGFR: the paradigm of an oncogene-driven lung cancer. Clin Cancer Res 2015;21:2221-6. https://doi.org/10.1158/1078-0432.CCR-14-3154
  13. Jee SH, Lee JK, Kim IS. Smoking-attributable mortality among Korean adults: 1981-2003. Korean J Epidemiol 2006;28:92-9.
  14. Jung KJ, Yun YD, Baek SJ, Jee SH, Kim IS. Smoking-attributable mortality among Korean adults, 2012. J Health Info Stat 2013;38:36-48.

Cited by

  1. Smoking, as a Death Messenger vol.83, pp.4, 2020, https://doi.org/10.4046/trd.2020.0092
  2. Environment and lung diseases vol.64, pp.4, 2020, https://doi.org/10.5124/jkma.2021.64.4.240
  3. Nicotine Dependence and Stress Susceptibility in E-Cigarette Smokers: The Korea National Health and Nutrition Examination Survey 2013-2017 vol.84, pp.2, 2020, https://doi.org/10.4046/trd.2020.0166
  4. Reliability of Portable Spirometry Performed in the Korea National Health and Nutrition Examination Survey Compared to Conventional Spirometry vol.84, pp.4, 2021, https://doi.org/10.4046/trd.2021.0016
  5. Association of Mixed Use of Electronic and Conventional Cigarettes and Exposure to Secondhand Smoke With Prediabetes vol.107, pp.1, 2020, https://doi.org/10.1210/clinem/dgab558