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Environmental tobacco smoke exposure and lung cancer:A systematic review

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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