A Study of the association between husband′s smoking and wife′s risk of hypertension
ZENG Shuai and DUAN Xinyun contribution equally to this work
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摘要:
目的 分析丈夫吸烟与妻子高血压患病风险之间的关联。 方法 选取2010―2019年2次参加国家免费孕前优生健康检查项目的2 612 479例计划妊娠女性作为研究对象，以其丈夫2次参检时日均及累积吸烟量作为暴露，妻子2次参检时患高血压病为结局，利用logistic回归分析模型和限制性立方样条模型估计丈夫吸烟与妻子患高血压风险的OR值及其95% CI，使用敏感性分析检验结果的稳定性。 结果 丈夫日均吸烟量5~10、＞10~15、＞15~20、>20支者妻子患高血压风险分别是丈夫不吸烟者的1.20(95% CI: 1.12~1.28)、1.27(95% CI: 1.16-1.40)、1.69(95% CI: 1.54-1.86)和2.07(95% CI: 1.68~2.54)倍(均P<0.05)，丈夫吸烟累积暴露量为＞2.0~4.0、＞4.0~6.0、>6.0 (包·年)者妻子高血压患病风险分别比丈夫不吸烟者高24%(95% CI: 11%~39%)、60%(95% CI: 39%~84%)和66%(95% CI: 48%~87%)(均P<0.05)，且患病风险随丈夫吸烟暴露量增加而增大(P趋势<0.01)。 结论 丈夫吸烟量与妻子高血压患病风险呈正相关，提示加强以家庭为单位的烟草控制和高血压管理，提高育龄女性心脑血管健康水平。 Abstract:Objective This study aimed to analyze the potential association between a husband′s smoking habits and the risk of hypertension in their wives. Methods The study included 2 612 479 women with planned pregnancies who participated in the National Free Pre-pregnancy Checkups Project twice between 2010 and 2019.The mean daily and cumulative smoking of their husbands at the time of the two examinations were used as the exposure. And the wives′ hypertensive disease at the time of the two examinations were used as the outcome. The ratio of husband′s smoking to wife′s risk of hypertension and its 95% confidence interval were estimated using logistic regression models and restricted cubic spline models, and the stability of the results was tested using sensitivity analysis. Results The risk of hypertension for wives whose husbands smoked > 5-10, > 10-15, > 15-20, and >20 cigarettes per day was 1.20(95% CI: 1.12-1.28), 1.27(95% CI: 1.16-1.40), 1.69(95% CI: 1.54-1.86) and 2.07(95% CI: 1.68-2.54) times higher (all P<0.05), respectively, and the risk of hypertension was 24%(95% CI: 11%-39%), 60%(95% CI: 39%-84%), and 66%(95% CI: 48%-87%) higher for wives whose husbands were with cumulatively exposed to smoking of > 2.0-4.0, > 4.0-6.0, and >6.0 pack×years, respectively, compared to those whose husbands were nonsmokers (all P<0.05). The risk increased with increasing escalating exposure to husbands′ smoking (Ptrend<0.01). Conclusions A husband′s smoking is associated with an increased risk of hypertension in his wife. Strengthening family-based tobacco control and hypertension management could improve the health of women of childbearing age. -
Key words:
- Hypertension /
- Smoking /
- Risk exposure
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图 1 丈夫吸烟与妻子高血压患病风险的暴露反应关系
A：丈夫日均吸烟量；B：丈夫吸烟累积暴露量。
Figure 1. Exposure-response relationship of husband′s smoking and wife′s risk of hypertension
A: husband smoking amount; B: cumulative exposure of husband smoking.
表 1 研究对象的基线特征比较
Table 1. Comparison of baseline characteristics
特征 Characteristics 非高血压[人数(占比/%)]
Normotensive [Number of people(proportion /%)]
(n=2 604 698)高血压[人数(占比/%)]
Hypertension [Number of people(proportion /%)]
(n=7 781)P值
value年龄组/岁 Age group/years <0.01 ＞19~24 672 164(25.81) 979(12.58) ＞24~29 1 337 072(51.33) 2 504(32.18) ＞29~34 412 204(15.82) 1 741(22.38) ＞34~49 183 258(7.04) 2 557(32.86) 高中及以上文化程度 Senior high school or above <0.01 是 Yes 1 072 221(41.16) 2 526(32.46) 否 No 1 497 910(57.51) 5 098(65.52) 缺失 Missing 34 567(1.33) 157(2.02) 民族 Ethnics <0.01 汉族 Han 2 182 203(83.78) 6 281(80.72) 少数民族 Minority 409 937(15.74) 1 462(18.79) 缺失 Missing 12 558(0.48) 38(0.49) 户籍类型 Residency type <0.01 农村 Rural 2 514 493(96.54) 7 259(93.29) 城镇 Urban 90 197(3.46) 522(6.71) 缺失 Missing 8(0) 0(0) 职业 Occupation <0.01 农民 Farmer 2 102 315(80.71) 5 994(77.03) 工人 Worker 244 019(9.37) 779(10.01) 其他 Others 202 894(7.79) 792(10.18) 缺失 Missing 55 470(2.13) 216(2.78) BMI/(kg·m-2) <0.01 低体重 Underweight 204 867(7.87) 297(3.82) 正常 Normal weight 2 003 895(76.96) 3 523(45.28) 超重 Overweight 333 341(12.80) 2 367(30.42) 肥胖 Obese 61 717(2.37) 1 571(20.19) 缺失 Missing 878(0) 23(0.29) 饮酒/(mL·d-1) Drinking/(mL·d-1) <0.01 0 2 564 249(98.45) 7 499(96.38) ＞0~10 19 016(0.73) 100(1.29) ＞10~50 11 423(0.44) 85(1.09) ＞50 3 422(0.13) 44(0.56) 缺失 Missing 6588(0.25) 53(0.68) 妻子被动吸烟/(min·d-1) Maternal passive smoking/(min·d-1) <0.01 0 2 424 766(93.09) 6 847(88.00) ＞0~15 153 542(5.90) 694(8.92) ＞15 26 322(1.01) 239(3.07) 缺失 Missing 68(0) 1(0.01) 丈夫被动吸烟/(min·d-1) Paternal passive smoking/(min·d-1) <0.01 0 2 230 800(85.65) 6 224(79.99) ＞0~15 282 193(10.83) 1 043(13.41) ＞15 91 008(3.49) 502(6.45) 缺失 Missing 697(0.03) 12(0.15) 注：使用χ2检验比较组间差异。
Note: χ2 tests are used to compare the difference between groups.
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表 2 夫妻吸烟状态与妻子高血压患病风险关联
Table 2. Association between couples′ smoking status and the prevalence of hypertension in female participants.
夫妻吸烟状态
Couples smoking status人数(占比/%)
Number of people(proportion /%)年龄调整① OR值(95% CI)
Age-adjusted ① OR value (95% CI)多因素调整② OR值(95% CI)
Multivariable-adjusted ② OR value (95% CI)夫妻均不吸烟 Neither-smoker 1 609 600(0.27) 1.00 1.00 仅丈夫吸烟 Husband-only 991 109(0.34) 1.28(1.23~1.34) 1.17(1.12~1.22) 仅妻子吸烟 Wife-only 2 510(0.76) 2.03(1.29~3.20) 1.55(0.98~2.46) 夫妻均吸烟 Mixed 9 260(0.60) 1.68(1.29~2.19) 1.15(0.87~1.52) 注：①模型仅对年龄进行调整。②模型进一步对文化程度、民族、户籍类型、职业、BMI和饮酒因素进行调整。
Note: ①Models were adjusted by age. ②Models were additionally adjusted by higher education, ethnics, residency type, occupation, BMI, and alcohol consumption.
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表 3 丈夫吸烟与妻子高血压患病风险关联
Table 3. The association between husband′s smoking and wife′s risk of hypertension
暴露测量 Exposure measurement 人数(占比/%)
Number of people (proportion/%)年龄调整① OR值(95% CI)
Age-adjusted ① OR value (95% CI)多因素调整② OR值(95% CI)
Multivariable-adjusted ② OR value (95% CI)丈夫日均吸烟量③/(支·天-1) Husband smoking amount/(cigarettes·day-1) 0 1 609 600(0.27) 1.00 1.00 ＞0~5 462 567(0.24) 0.99(0.93~1.06) 0.95(0.89~1.01) ＞5~10 325 038(0.36) 1.31(1.23~1.40) 1.20(1.12~1.28) ＞10~15 116 108(0.42) 1.50(1.36~1.64) 1.27(1.16~1.40) ＞15~20 78 284(0.66) 2.07(1.89~2.27) 1.69(1.54~1.86) ＞20 9 112(1.06) 2.58(2.11~3.16) 2.07(1.68~2.54) P趋势 Ptrend <0.01 <0.01 <0.01 丈夫吸烟累计暴露量④/(包·年) Cumulative exposure of husband smoking/(pack·years) 0 918 381(0.29) 1.00 1.00 ＞0~2.0 446 313(0.26) 1.07(1.00~1.15) 1.02(0.95~1.09) ＞2.0~4.0 71 317(0.52) 1.42(1.27~1.58) 1.24(1.11~1.39) ＞4.0~6.0 23 560(0.93) 1.80(1.56~2.07) 1.60(1.39~1.84) ＞6.0 24 160(1.57) 1.95(1.74~2.19) 1.66(1.48~1.87) P趋势 Ptrend <0.01 <0.01 <0.01 注：丈夫吸烟累积暴露量定义为丈夫2次吸烟均值(包)×婚姻持续时长(年)。
①模型仅对年龄进行调整。②模型进一步对文化程度、民族、户籍类型、职业、BMI和饮酒因素进行调整。③模型排除了妻子吸烟的研究对象，共纳入2 600 709人进行分析。④模型排除了妻子吸烟和婚姻持续时长缺失的研究对象，共纳入1 483 731人进行分析。
Note: Cumulative exposure of husband smoking is defined by the product of the average cigarettes husband smoked per day in pack and marital duration in years.
①Models were adjusted by age. ②Models were additionally adjusted by higher education, ethnics, residency type, occupation, BMI, and alcohol consumption. ③After excluding participants with maternal smoking, a total of 2 600 709 participants remained in the analysis. ④After excluding participants with missing maternal smoking and marital duration, a total of 1 483 731 remained in the analysis.
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