title: Secondhand smoke exposure predicted COPD and other tobacco-related mortality in a 17-year cohort study in China.
abstract: BACKGROUND
  Prospective evidence on the association between secondhand smoke (SHS) and COPD and ischemic stroke is scarce.
  
  
  METHODS
  We prospectively examined the relationship between SHS and major tobacco-related deaths, particularly COPD and stroke, in 910 Chinese (439 men, 471 women) who never smoked from a 17-year follow-up study in Xi’an, China. SHS exposure was defi ned as exposure to another person’s tobacco smoke at home or in the workplace.
  
  
  RESULTS
  At baseline among the 910 subjects, 44.2% were exposed to SHS at home, 52.9% in the workplace, and 67.1% at home, work, or both. From March 1, 1994, to July 1, 2011, 249 (150 men,99 women) died within 14,016 person-years. Those who were exposed to SHS had increased mortality due to coronary heart disease (adjusted relative risk [RR], 2.15; 95% CI, 1.00-4.61), ischemic stroke (RR, 2.88; 95% CI, 1.10-7.55), lung cancer (RR, 2.00; 95% CI, 0.62-6.40), COPD (RR, 2.30;95% CI, 1.06-5.00), and all causes (RR, 1.72; 95% CI, 1.29-2.20), with significant dose-response relationships between cumulative SHS exposure at home and work and the increased risk of cause-specific and total mortality (P for linear trend ranged from .045 to , .001).
  
  
  CONCLUSIONS
  This study shows dose-response relationships between SHS and major tobacco-related mortality and provides new evidence to support causation for COPD and ischemic stroke.
authors.affiliation: Institute of Geriatrics, Chinese PLA General Hospital, Beijing, China; State Key Laboratory of Kidney Disease, Chinese PLA General Hospital, Beijing, China. Electronic address: yhe301@x263.net.
authors.forename: Yao
authors.initials: Y
authors.lastname: He
authors.affiliation: Department of Acupuncture, Chinese PLA General Hospital, Beijing, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Jiang
authors.affiliation: Department of Epidemiology, 4th Military Medical University, Xi'an, China; Department of Medicine, Kun Lun Machinery Factory Hospital, Xi'an, China.
authors.forename: Liang Shou
authors.initials: LS
authors.lastname: Li
authors.affiliation: Department of Cardiology, 4th Military Medical University, Xi'an, China.
authors.forename: Lan Sun
authors.initials: LS
authors.lastname: Li
authors.affiliation: Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, China.
authors.forename: Lisanne
authors.initials: L
authors.lastname: Ko
authors.affiliation: Institute of Geriatrics, Chinese PLA General Hospital, Beijing, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Wu
authors.affiliation: Institute of Geriatrics, Chinese PLA General Hospital, Beijing, China.
authors.forename: Dong Ling
authors.initials: DL
authors.lastname: Sun
authors.affiliation: Department of Medicine, Kun Lun Machinery Factory Hospital, Xi'an, China.
authors.forename: Shu Fang
authors.initials: SF
authors.lastname: He
authors.affiliation: Department of Epidemiology, 4th Military Medical University, Xi'an, China.
authors.forename: Bao Qing
authors.initials: BQ
authors.lastname: Liang
authors.affiliation: Department of Nutrition, Harvard School of Public Health, Boston MA.
authors.forename: Frank B
authors.initials: FB
authors.lastname: Hu
authors.affiliation: School of Public Health and Department of Community Medicine, The University of Hong Kong, Hong Kong, China.
authors.forename: Tai Hing
authors.initials: TH
authors.lastname: Lam
mesh_terms: D002423:Cause of Death / Q000639:trends; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000401:mortality*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D062789:Tobacco Products / Q000009:adverse effects*; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*
chemical_list: D014028:Tobacco Smoke Pollution