title: Cigarette smoking and risk of stroke in the chinese adult population.
abstract: OBJECTIVE
  We studied the relationship between cigarette smoking and stroke incidence and mortality in the Chinese adult population.
  
  
  METHODS
  We conducted a prospective cohort study in a nationally representative sample of 169 871 Chinese men and women aged 40 years and older. Data on cigarette smoking and other covariables were collected at a baseline examination in 1991 using a standard protocol. Follow-up evaluation was conducted in 1999 to 2000, with a response rate of 93.4%.
  
  
  RESULTS
  During an average of 8.3 years follow-up, a total of 6780 stroke events (3979 fatal strokes) were observed. The multivariate-adjusted relative risks (95% confidence interval) of stroke incidence and mortality associated with present cigarette smoking were 1.28 (1.19 to 1.37) and 1.13 (1.03 to 1.25) in men and 1.25 (1.13 to 1.37) and 1.19 (1.04 to 1.36) in women, respectively. The corresponding population attributable risks were 14.2% and 7.1% in men and 3.1% and 2.4% in women. Compared to never-smokers, the multivariate-adjusted relative risks of stroke incidence (95% confidence interval) were 1.21 (1.12 to 1.31), 1.21 (1.11 to 1.32), and 1.36 (1.25 to 1.47) for those who smoked 1 to 9, 10 to 19, and >/=20 cigarettes per day; and 1.18 (1.09 to 1.28), 1.25 (1.15 to 1.35), and 1.34 (1.24 to 1.44) for those who smoked 1 to 11, 12 to 26, and >26 pack-years, respectively (both P<0.0001 for linear trends).
  
  
  CONCLUSIONS
  Our study identified a positive and dose-response relationship between cigarette smoking and risk of stroke. Smoking prevention and cessation programs should be an important strategy for reducing the burden of stroke in Chinese adults.
authors.affiliation: Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1430 Tulane Avenue SL18, New Orleans, LA 70112, USA.
authors.forename: Tanika N
authors.initials: TN
authors.lastname: Kelly
authors.forename: Dongfeng
authors.initials: D
authors.lastname: Gu
authors.forename: Jing
authors.initials: J
authors.lastname: Chen
authors.forename: Jian-Feng
authors.initials: JF
authors.lastname: Huang
authors.forename: Ji-Chun
authors.initials: JC
authors.lastname: Chen
authors.forename: Xiufang
authors.initials: X
authors.lastname: Duan
authors.forename: Xigui
authors.initials: X
authors.lastname: Wu
authors.forename: Chung-Shiuan
authors.initials: CS
authors.lastname: Chen
authors.forename: Jiang
authors.initials: J
authors.lastname: He
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D015984:Causality; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000009:adverse effects; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D040242:Risk Reduction Behavior; D017678:Sex Distribution; D012907:Smoking / Q000401:mortality*; D020521:Stroke / Q000401:mortality*
chemical_list: D009538:Nicotine