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Dose-response relationship of lung cancer to amount smoked, duration and age starting

World Journal of Meta-Analysis 2013年第2期1卷 57-77页

作者： John S Fry Peter N Lee barbara a forey Katharine J Coombs PN Lee Statistics and Computing Ltd.

AIM： To quantify smoking/lung cancer relationships accurately using parametric modelling.METHODS： Using the International Epidemiological Studies on Smoking and Lung Cancer database of all epidemiological studies of 100＋ lung cancer cases published before 2000, we analyzed 97 blocks of data for amount smoked, 35 for duration of smoking, and 27 for age started. Pseudo-numbers of cases and controls （or at risk） estimated from RRs by dose level formed the data modelled. We fitted various models relating loge RR to dose （d）, including βd, βdY and βloge （1 ＋ Wd）, and investigated goodness-of-fit and heterogeneity between studies.0.833 loge [1 ＋（8.1c/10）] for cigarettes/d （c）, 0.792 （y/10）0.74 for years smoked （y） and 0.176 [（70 - a）/10]1.44 for age of start （a）. Each model fitted well overall, though some blocks misfitted. RRs rose from 3.86 to 22.31 between c = 10 and 50, from 2.21 to 13.54 be-tween y = 10 and 50, and from 3.66 to 8.94 between a = 30 and 12.5. Heterogeneity （P 〈 0.001） existed by continent for amount, RRs for 50 cigarettes/d being 7.23 （Asia）, 26.36 （North America） and 22.16 （Europe）. Little heterogeneity was seen for duration of smoking or age ***： The models describe the dose-relation-ships well, though may be biased by factors including misclassification of smoking status and dose.

关键词： Smoking Lung neoplasms Dose-response Meta-analysis Review Amount smoked Duration of smoking Age at starting to smoke

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Environmental tobacco smoke exposure and heart disease:A systematic review

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World Journal of Meta-Analysis 2017年第2期5卷 14-40页

作者： Peter N Lee barbara a forey Jan S Hamling Alison J Thornton P.N.Lee Statistics and Computing Ltd. Independent Consultant in Statistics

AIM To review evidence relating passive smoking to heart disease risk in never smokers. METHODS Epidemiological studies were identified providing estimates of relative risk(RR) of ischaemic heart disease and 95%CI for never smokers for various indices of exposure to environmental tobacco smoke(ETS). "Never smokers" could include those with a minimal smoking experience. The database set up included the RRs and other study details. Unadjusted and confounderadjusted RRs were entered, derived where necessary using standard methods. The fixed-effect and randomeffects meta-analyses conducted for each exposure index included tests for heterogeneity and publication bias. For the main index(ever smoking by the spouse or nearest equivalent, and preferring adjusted to unadjusted data), analyses investigated variation in the RR by sex, continent, period of publication, number of cases, study design, extent of confounder adjustment, availability of dose-response results and biomarkerdata, use of proxy respondents, definitions of exposure and of never smoker, and aspects of disease definition. Sensitivity analyses were also run, preferring current to ever smoking, or unadjusted to adjusted estimates, or excluding certain *** Fifty-eight studies were identified, 20 in North America, 19 in Europe, 11 in Asia, seven in other countries, and one in 52 countries. Twenty-six were prospective, 22 case-control and 10 cross-sectional. Thirteen included 100 cases or fewer, and 11 more than 1000. For the main index, 75 heterogeneous(P < 0.001) RR estimates gave a combined random-effects RR of 1.18(95%CI: 1.12-1.24), which was little affected by preferring unadjusted to adjusted RRs, or RRs for current ETS exposure to those for ever exposure. Estimates for each level of each factor considered consistently exceeded 1.00. However, univariate analyses revealed significant(P < 0.001) variation for some factors. Thus RRs were lower for males, and in North American, larger and prospecti

关键词： Passive smoking Heart disease Dose-response Meta-Analysis Review

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Environmental tobacco smoke exposure and lung cancer:A systematic review

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World Journal of Meta-Analysis 2016年第2期4卷 10-43页

作者： Peter N Lee John S Fry barbara a forey Jan S Hamling Alison J Thornton P.N. Lee Statistics and Computing Ltd. Sutton Surrey SM2 5DA United Kingdom Independent Consultant in Statistics Okehampton EX20 1SG United Kingdom

AIM： To review evidence relating passive smoking to lung cancer risk in never smokers, considering various major sources of ***： Epidemiological prospective or case-control studies were identifed which provide estimates of relative risk （RR） and 95%CI for never smokers for one or more of seven different indices of exposure to environmental tobacco smoke （ETS）： The spouse; household; workplace; childhood; travel; social and other; and total. A wide range of study details were entered into a database, and the RRs for each study, including descriptions of the comparisons made, were entered into a linked database. RRs were derived where necessary. Results were entered, where available, for all lung cancer, and for squamous cell cancer and adenocarcinoma. “Most adjusted” results were entered based on results available, adjusted for the greatest number of potential confounding variables. “Least adjusted” results were also entered, with a preference for results adjusted at least for age for prospective studies. A pre-planned series of fxed-effects and random-effects meta-analyses were conducted. Overall analyses and analyses by continent were run for each exposure index,with results for spousal smoking given by sex, and results for childhood exposure given by source of ETS exposure. For spousal exposure, more extensive analyses provide results by various aspects of study design and defnition of the RR. For smoking by the husband （or nearest equivalent）, additional analyses were carried out both for overall risk, and for risk per 10 cigarettes per day smoked by the husband. These adjusted for uncontrolled confounding by four factors （fruit, vegetable and dietary fat consumption, and education）, and corrected for misclassification of smoking status of the wife. For the confounding adjustment, estimates for never smoking women were derived from publications on the relationship of the four factors to both lung cancer risk and at home ETS exposure, and on the correlati

关键词： Passive smoking Lung neoplasms Dose-response Meta-analysis Review Confounding factors (epidemiology) Misclassifcation

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