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Original Research: COPD |

Secondhand Smoke Exposure Predicted COPD and Other Tobacco-Related Mortality in a 17-Year Cohort Study in ChinaSecondhand Smoke, COPD, Tobacco-Related Mortality

Yao He, MD, PhD; Bin Jiang, MD, PhD; Liang Shou Li, MD; Lan Sun Li, MD; Lisanne Ko, PhD; Lei Wu, MB; Dong Ling Sun, MD, PhD; Shu Fang He, MD; Bao Qing Liang, MD; Frank B. Hu, MD, PhD; Tai Hing Lam, MD
Author and Funding Information

From the Institute of Geriatrics (Drs Y. He, Wu, and Sun), Department of Acupuncture (Dr Jiang), and State Key Laboratory of Kidney Disease (Dr Y. He), Chinese PLA General Hospital, Beijing, China; Department of Epidemiology (Dr Liang Shou Li) and Department of Cardiology (Dr Lan Sun Li), 4th Military Medical University, Xi’an, China; Sau Po Centre on Ageing (Dr Ko), The University of Hong Kong, Hong Kong, China; Department of Medicine (Drs S. F. He and Liang), Kun Lun Machinery Factory Hospital, Xi’an, China; Department of Nutrition (Dr Hu), Harvard School of Public Health, Boston MA; and School of Public Health and Department of Community Medicine (Dr Lam), The University of Hong Kong, Hong Kong, China.

Correspondence to: Yao He, MD, PhD, Institute of Geriatrics, Chinese PLA General Hospital, 28 Fuxing Rd, Beijing, 100853, China; e-mail: yhe301@x263.net


Drs Y. He and Jiang contributed equally to this work.

Funding/Support: This study was supported by research grants from the National Natural Science Foundation of China [81072355], Ministry of Science and Technology of China [2009BAI86B01], and National Department Public Benefit Research Foundation by Ministry of Health of China [201002011]. Dr Y. He was partly supported by the Sun Yat-Sen, Gordon Wu, and Cheng Yu Tung Exchange Professorships in the Li Ka Shing Faculty of Medicine and Sino-British Fellowship Trust at the University of Hong Kong.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(4):909-918. doi:10.1378/chest.11-2884
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Background:  Prospective evidence on the association between secondhand smoke (SHS) and COPD and ischemic stroke is scarce.

Methods:  We prospectively examined the relationship between SHS and major tobacco-related deaths, particularly COPD and stroke, in 910 Chinese (439 men, 471 women) who never smoked from a 17-year follow-up study in Xi’an, China. SHS exposure was defined as exposure to another person’s tobacco smoke at home or in the workplace.

Results:  At baseline among the 910 subjects, 44.2% were exposed to SHS at home, 52.9% in the workplace, and 67.1% at home, work, or both. From March 1, 1994, to July 1, 2011, 249 (150 men, 99 women) died within 14,016 person-years. Those who were exposed to SHS had increased mortality due to coronary heart disease (adjusted relative risk [RR], 2.15; 95% CI, 1.00-4.61), ischemic stroke (RR, 2.88; 95% CI, 1.10-7.55), lung cancer (RR, 2.00; 95% CI, 0.62-6.40), COPD (RR, 2.30; 95% CI, 1.06-5.00), and all causes (RR, 1.72; 95% CI, 1.29-2.20), with significant dose-response relationships between cumulative SHS exposure at home and work and the increased risk of cause-specific and total mortality (P for linear trend ranged from .045 to <.001).

Conclusions:  This study shows dose-response relationships between SHS and major tobacco-related mortality and provides new evidence to support causation for COPD and ischemic stroke.

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