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Smoking and airway disorders in an urban population -special references to gender and socioeconomic status

Ekberg, Marie LU (2006)
Abstract
The Malmö Preventive Project, a preventive, case-finding programme for cardiovascular risk factors and alcohol abuse was created in 1974 at the Department of Preventive Medicine of Malmö University Hospital. Between 1974-1992, a total of 22 444 men (mean age 44 years range 27 - 61) and 10 902 women (mean age 50 years, range 28 - 58) attended the programme, with an overall attendance rate of 70% (range 64-78). This thesis, which is based on the Malmö Preventive Project, deals with the long term morbidity and mortality risks associated with smoking and airway disorders incorporating gender and socio-economic aspects. This thesis, which is based on the Malmö Preventive Project deals with the long term morbidity and mortality risks associated... (More)
The Malmö Preventive Project, a preventive, case-finding programme for cardiovascular risk factors and alcohol abuse was created in 1974 at the Department of Preventive Medicine of Malmö University Hospital. Between 1974-1992, a total of 22 444 men (mean age 44 years range 27 - 61) and 10 902 women (mean age 50 years, range 28 - 58) attended the programme, with an overall attendance rate of 70% (range 64-78). This thesis, which is based on the Malmö Preventive Project, deals with the long term morbidity and mortality risks associated with smoking and airway disorders incorporating gender and socio-economic aspects. This thesis, which is based on the Malmö Preventive Project deals with the long term morbidity and mortality risks associated with smoking and airway disorders incorporating gender and socio-economic aspects.



Increased mortality risks have convincingly been shown among men. It has been suggested that women might run a higher risk of mortality in diseases associated with smoking. In Study I, as for men, heavy-smoking women showed a two to almost threefold increased mortality risk as compared to women who had never smoked. Furthermore they also showed increased risks of smoking- related cancers and an approximately three to fourfold increased cardiovascular mortality risks. Socio-economic status showed limited influence on these findings. Associations between low socio-economic status and an increased lung cancer incidence and mortality have been reported, and it is believed that these differences are caused by an increased prevalence of smoking in low socio-economic groups. Few studies have assessed the influence of smoking habits on differences in lung cancer risk between socio-economic groups and no previous study has incorporated histological subtype. In Study II men and women who smoked, with low socio-economic status, showed an increased lung cancer risk. The relative risks were in men 1.39 (95% confidence interval; 1.11-1.73) the corresponding figures for women were 1.56 (1.04-2.34) after adjustments for age and smoking habits. Moreover, among smokers, low socio-economic status was associated with an increased risk of squamous cell carcinoma. These risks were almost doubled among men and increased sevenfold among women. The Global initiative for Obstructive Lung Disease (GOLD) guidelines introduced a stage 0 (at risk) defined as the presence of symptoms of chronic bronchitis in individuals with preserved normal pulmonary function. An increased mortality risk associated with symptoms of chronic bronchitis has been reported. In Study III and IV, individuals with normal pulmonary function and those with mild to moderate chronic obstructive pulmonary disease with symptoms of chronic bronchitis showed an increased mortality risk as compared to those without such symptoms. Symptoms of chronic bronchitis conveyed also a substantial morbidity with increased hospital admission rates due to all causes, obstructive pulmonary disease and cardiovascular disease. Studies on long-term morbidity and mortality among individuals with airflow limitation based on general populations are scarce. In Study III and IV, signs of airflow limitation corresponding to mild to severe chronic obstructive pulmonary disease conveyed an increased total mortality risk as well as a substantial morbidity with increased hospital admission rates due to all causes, obstructive lung disease and cardiovascular disease as compared to those without airflow limitation. (Less)
Abstract (Swedish)
Popular Abstract in Swedish

Delarbetena i denna avhandling, som baseras på en befolkningsstudie från Malmö, studerar sjuklighet och dödlighet associerad till rökning och kroniska luftrörssjukdomar med hänsyn till köns och socioekonomiska aspekter.



Studier av män har övertygande visat en ökad mortalitetsrisk associerat med tobaksrökning. Emellertid har endast ett fåtal studier undersökt långtidseffekter av tobaksrökning på kvinnors mortalitet vilket delvis beror på att kvinnor har rökt mindre och under kortare tid än män. Tidigare studier har visat att kvinnor kan ha en ökad mortalitet i sjukdomar orsakade av tobaksrökning. Studie I visade en två- till- trefaldigt ökad mortalitetsrisk bland rökande kvinnor... (More)
Popular Abstract in Swedish

Delarbetena i denna avhandling, som baseras på en befolkningsstudie från Malmö, studerar sjuklighet och dödlighet associerad till rökning och kroniska luftrörssjukdomar med hänsyn till köns och socioekonomiska aspekter.



Studier av män har övertygande visat en ökad mortalitetsrisk associerat med tobaksrökning. Emellertid har endast ett fåtal studier undersökt långtidseffekter av tobaksrökning på kvinnors mortalitet vilket delvis beror på att kvinnor har rökt mindre och under kortare tid än män. Tidigare studier har visat att kvinnor kan ha en ökad mortalitet i sjukdomar orsakade av tobaksrökning. Studie I visade en två- till- trefaldigt ökad mortalitetsrisk bland rökande kvinnor jämfört med kvinnor som aldrig rökt. De rökande kvinnorna uppvisade dessutom en ökad risk för mortalitet i lungcancer, annan cancer orsakad av rökning, samt kardiovaskulär sjukdom. Dessa risker kvarstod även efter justering för socialgruppstillhörighet och civilstatus.



I tidigare studier har man funnit en association mellan låg socialgrupp och en ökad risk för lungcancer. Denna riskökning har tillskrivits den ökade förekomsten av tobaksrökning i lägre socialgrupper. Endast ett fåtal studier har studerat lungcancer risk i relation till socialgrupp med justering för skillnader i rökvanor mellan socialgrupperna. Ingen tidigare studie har undersökt skillnader i lungcancer incidens relaterat till histologisk undergrupp av lungcancer.



Studie II visade en ökad lungcancer risk hos rökare från låg socialgrupp jämfört med rökare från hög socialgrupp. Även de män från låg socialgrupp som aldrig rökt uppvisade en ökad lungcancer risk. De relativa riskerna var för män; 1.39 (95% konfidens-intervall: 1.11-1.73), för kvinnor; 1.56 (1.04-2.34) samt för män som aldrig rökt 3.43 (1.59-7.41) efter justering för ålder och rökvanor. Bland rökande män och kvinnor av låg socialgrupp sågs en ökad risk för skivepitelcancer: Denna risk var dubbelt så stor för män och sjufaldigt ökad för kvinnor.



År 2001 publicerades den internationella GOLD klassifikationen för kroniskt obstruktiv lungsjukdom. I dessa riktlinjer introduceras ett ?risk-stadium? stadium 0, definierat som kronisk bronkitsymptom hos individer med normal lungfunktion. Tidigare studier har visat en ökad mortalitetsrisk hos individer med kronisk bronkit. Studie III och IV visade en ökad mortalitetsrisk associerad med kronisk bronkit hos rökare med normal lungfunktion jämfört med individer utan dessa symptom. Även hos individer med mild till medelsvår kroniskt obstruktiv lungsjukdom var förekomst av kronisk bronkit förenad med en ökad mortalitetsrisk. Dessutom påvisades en ökad frekvens av sjukhusinläggningar (alla diagnoser förutom kroniskt obstruktiv lungsjukdom), samt sjukhusinläggningar orsakade av obstruktiv lungsjukdom och kardiovaskulär sjukdom hos individer med kronisk bronkit jämfört med individer utan dessa symptom.



Rökare med eller utan kronisk bronkit har en ökad risk för att utveckla kroniskt obstruktiv lungsjukdom. Globalt orsakar diagnostiserad kroniskt obstruktiv lungsjukdom en betydande dödlighet. Kroniskt obstruktiv lungsjukdom är en underdiagnostiserad sjukdom. Det finns endast ett fåtal populationsbaserade långtidsuppföljningar med avseende på morbiditet och mortalitet hos individer med lungfunktionsnedsättning svarande till kroniskt obstruktiv lungsjukdom. I Studie III och IV var kroniskt obstruktiv lungsjukdom associerat med ökad mortalitetsrisk och en ökad frekvens av sjukhusinläggningar (alla diagnoser förutom kroniskt obstruktiv lungsjukdom) samt sjukhusinläggningar orsakade av kardiovaskulär sjukdom samt obstruktiv lungsjukdom jämfört med individer med normal lungfunktion. Morbiditet och mortalitet hos individer med kronisk bronkit och kroniskt obstruktiv lungsjukdom är sannolikt underestimerad. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Dr Med Lange, Peter, Department of Respiratory Medicine,Hvidovre University Hospital Denmark
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Folkhälsa, epidemiology, Public health, Andningsorganen, Respiratory system, gender, COPD, hospital admissions, lung cancer, Medicine (human and vertebrates), tobacco, socio-economic status, smoking, population-based, morbidity, mortality, epidemiologi, lung function, Medicin (människa och djur), women
publisher
Respiratory Medicine and Allergology, Lund University
defense location
Segerfalkssalen, Biomedicinskt centrum, Sölvegatan 19, Lund
defense date
2006-11-24 13:00:00
ISBN
91-85559-52-0
language
English
LU publication?
yes
additional info
id
637d492f-a3f6-4946-91fd-0b8f313b07b0 (old id 547507)
date added to LUP
2016-04-01 16:59:40
date last changed
2018-11-21 20:45:46
@phdthesis{637d492f-a3f6-4946-91fd-0b8f313b07b0,
  abstract     = {The Malmö Preventive Project, a preventive, case-finding programme for cardiovascular risk factors and alcohol abuse was created in 1974 at the Department of Preventive Medicine of Malmö University Hospital. Between 1974-1992, a total of 22 444 men (mean age 44 years range 27 - 61) and 10 902 women (mean age 50 years, range 28 - 58) attended the programme, with an overall attendance rate of 70% (range 64-78). This thesis, which is based on the Malmö Preventive Project, deals with the long term morbidity and mortality risks associated with smoking and airway disorders incorporating gender and socio-economic aspects. This thesis, which is based on the Malmö Preventive Project deals with the long term morbidity and mortality risks associated with smoking and airway disorders incorporating gender and socio-economic aspects.<br/><br>
<br/><br>
Increased mortality risks have convincingly been shown among men. It has been suggested that women might run a higher risk of mortality in diseases associated with smoking. In Study I, as for men, heavy-smoking women showed a two to almost threefold increased mortality risk as compared to women who had never smoked. Furthermore they also showed increased risks of smoking- related cancers and an approximately three to fourfold increased cardiovascular mortality risks. Socio-economic status showed limited influence on these findings. Associations between low socio-economic status and an increased lung cancer incidence and mortality have been reported, and it is believed that these differences are caused by an increased prevalence of smoking in low socio-economic groups. Few studies have assessed the influence of smoking habits on differences in lung cancer risk between socio-economic groups and no previous study has incorporated histological subtype. In Study II men and women who smoked, with low socio-economic status, showed an increased lung cancer risk. The relative risks were in men 1.39 (95% confidence interval; 1.11-1.73) the corresponding figures for women were 1.56 (1.04-2.34) after adjustments for age and smoking habits. Moreover, among smokers, low socio-economic status was associated with an increased risk of squamous cell carcinoma. These risks were almost doubled among men and increased sevenfold among women. The Global initiative for Obstructive Lung Disease (GOLD) guidelines introduced a stage 0 (at risk) defined as the presence of symptoms of chronic bronchitis in individuals with preserved normal pulmonary function. An increased mortality risk associated with symptoms of chronic bronchitis has been reported. In Study III and IV, individuals with normal pulmonary function and those with mild to moderate chronic obstructive pulmonary disease with symptoms of chronic bronchitis showed an increased mortality risk as compared to those without such symptoms. Symptoms of chronic bronchitis conveyed also a substantial morbidity with increased hospital admission rates due to all causes, obstructive pulmonary disease and cardiovascular disease. Studies on long-term morbidity and mortality among individuals with airflow limitation based on general populations are scarce. In Study III and IV, signs of airflow limitation corresponding to mild to severe chronic obstructive pulmonary disease conveyed an increased total mortality risk as well as a substantial morbidity with increased hospital admission rates due to all causes, obstructive lung disease and cardiovascular disease as compared to those without airflow limitation.},
  author       = {Ekberg, Marie},
  isbn         = {91-85559-52-0},
  language     = {eng},
  publisher    = {Respiratory Medicine and Allergology, Lund University},
  school       = {Lund University},
  title        = {Smoking and airway disorders in an urban population -special references to gender and socioeconomic status},
  year         = {2006},
}