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

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. 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.