Overzicht onderzoeken meeroken

Onder- en bovengrenzen die beiden onder de 1 liggen geven een positief effect van meeroken op de gezondheid weer, die waarbij de ondergrens onder de 1 ligt en de bovengrens erboven, zijn statistisch gezien insignificant (geen positief of negatief verband aan te tonen), als ze er beide boven liggen is sprake van een negatief verband (meeroken is slecht voor de gezondheid).

Het National Cancer Institute in de VS geeft de volgende richtlijn bij het interpreteren van OR/RR waarden:

“RR’s van minder dan 2 (d.w.z. een verhoogd risico van 100%) moeten als klein worden beschouwd. Zulke verhogingen kunnen het gevolg zijn van statistische afwijkingen of effecten van intermediërende factoren die soms niet duidelijk zijn”.

Conclusie: RR waarden hoger dan 2 moeten als statistisch relevant worden beschouwd. Beneden die waarde mogen geen conclusies worden getrokken.

Het NCI is niet de enige die dit zegt. Ook anderen kwamen met soortgelijke uitspraken:

Sir Richard Doll

Sir Richard Doll, een van de eerste onderzoekers die een verband tussen roken en longkanker rapporteerde zegt hierover:

” … when the relative risk lies between 1 and 2 … problems of interpretation may become acute, and it may be extremely difficult to disentangle the various contributions of biased information, confounding of two or more factors, and cause and effect.”

(The Causes of Cancer,” by Richard Doll, F.R.S. and Richard Peto. Oxford-New York, Oxford University Press, 1981, p. 1219).

WHO/IARC

Relative risks of less than 2.0 may readily reflect some unperceived bias or confounding factor, those over 5.0 are unlikely to do so.  – Breslow and Day, 1980, Statistical methods in cancer research, Vol. 1, The analysis of case control studies. Published by the World Health Organization, International Agency for Research on Cancer, Sci. Pub. No. 32, Lyon, p. 36

FDA

Relative risks of 2 have a history of unreliability – Robert Temple, M.D. Food and Drug Administration Journal of the American Medical Association (JAMA), Letters, September 8, 1999

“My basic rule is if the relative risk isn’t at least 3 or 4, forget it.” – Robert Temple, director of drug evaluation at the Food and Drug Administration.

IAQC

“An association is generally considered weak if the odds ratio [relative risk] is under 3.0 and particularly when it is under 2.0, as is the case in the relationship of ETS and lung cancer.” – Dr. Kabat, IAQC epidemiologist

Hierna is een overzicht van alle onderzoeken opgenomen

Overzicht

Oordeel Sterkte verband op basis RR>2 6
Negatief effect Sterk (RR>2)
Zwak (RR<=2) 17
Positief effect Zwak (RR<=2) 10
Statistisch insignificant Sterk (RR>2) 2
Zwak (RR<=2) 142
Totaal 177

Resultaten meeroken-onderzoeken
Statistische significantie

Indeling Onderzoek Omschrijving Betrouwbaarheids-
interval (%)		 Onder-
grens		 Relatief
Risico		 Boven-
grens
Negatief effect – Sterk (RR>2) Stockwell et al. (1992) Spouse smoked, 40+ smokeyears, All sexes 95 1.10 2.40 5.30
  Kabat et al. (1995) Spouse smoked, 11+/dag, Males 95 1.35 7.48 41.36
  Janerich et al. (1990) 25+ smokeryears, All sexes 95 1.16 2.07 3.68
  Stockwell et al. (1992) 22+ years, All sexes 95 1.10 2.40 5.40
  Kabat et al. (1995) Adulthood, 1+ smokers, Males 95 1.34 4.15 12.90
  WHO/IARC, 1998 Workplace >=89.0 (level*hours/day*years), All sexes 95 1.33 2.07 3.21
N = 6
Negatief effect – Zwak (RR<=2) Hirayama, 1984 2-29/day, Females 90 1.03 1.12 1.21
  Hirayama, 1984 20+/day, Females 95 1.12 1.23 1.35
  Reynold et al., 1987 All Cancers, All sexes 90 1.12 1.68 1.50
  Reynold et al., 1987 Smoking Related cancers, All sexes 90 1.05 7.01 47.00
  Stjernfeldt et al., 1986 Maternal Smoking >=10, All sexes 95 1.10 1.56 2.30
  Golding et al., 1990 Maternal Smoking, All sexes 90 1.20 2.47 5.10
  Fontham et al. (1994) Spouse smoked, All sexes 95 1.04 1.29 1.60
  Fontham et al. (1994) years of exposure at work, All sexes 95 1.10 1.39 1.70
  Fontham et al. (1994) years of exposure at work, 1-15 years, All sexes 95 1.01 1.30 1.67
  Fontham et al. (1994) years of exposure at work, 16-30, All sexes 95 1.04 1.40 1.88
  Fontham et al. (1994) years of exposure at work, 30+, All sexes 95 1.24 1.86 2.78
  EPA, 1993 95 1.04 1.19 1.35
  WHO/IARC, 1998 Spouse 35-42 years exposed, Females 95 1.06 1.57 2.31
  WHO/IARC, 1998 Spouse >=224 hours/day × years, All sexes 95 1.12 1.80 2.90
  WHO/IARC, 1998 Spouse >=224 hours/day × years, Females 95 1.05 1.70 2.75
  WHO/IARC, 1998 Spouse =23.1 packyears, All sexes 95 1.04 1.64 2.59
  WHO/IARC, 1998 Workplace >=89.0 (level*hours/day*years), Females 95 1.10 1.87 3.20
N = 17
Positief effect Brownson et al. (1992) Spouse smoked, 15-40 smokeyears, All sexes 95 0.50 0.70 1.00
  Brownson et al. (1992) parents, All sexes 95 0.50 0.70 0.90
  WHO/IARC, 1998 childhood childhood, All sexes 95 0.64 0.78 0.96
  WHO/IARC, 1998 childhood childhood, Females 95 0.61 0.77 0.98
  WHO/IARC, 1998 childhood 1 smoker in household, All sexes 95 0.64 0.80 0.99
  WHO/IARC, 1998 childhood 2 smokers in household, All sexes 95 0.44 0.63 0.90
  WHO/IARC, 1998 childhood 1 smoker in household, Females 95 0.59 0.76 0.98
  WHO/IARC, 1998 childhood 14.1–18.0 smoker years, All sexes 95 0.51 0.68 0.92
  WHO/IARC, 1998 Spouse 10-18 cig/day, All sexes 95 0.35 0.58 0.90
  WHO/IARC, 1998 Spouse 10-18 cig/day, Females 95 0.34 0.57 0.93
N = 10
Statistisch insignificant Sandler, et al. 1989 All Cancers, All sexes 95 0.66 1.01 1.53
  Sandler, et al. 1989 All Cancers, Females 95 0.82 1.00 1.21
  Sandler, et al. 1989 Smoking-related cancers, Males 95 0.43 0.96 2.62
  Sandler, et al. 1989 Smoking-related cancers, Females 95 0.88 1.45 2.40
  Sandler, et al. 1989 Other Cancers, Males 95 0.40 1.03 2.62
  Sandler, et al. 1989 Other Cancers, Females 95 0.76 0.93 1.54
  Neutel and Buck, 1970 Maternal Smoking, All sexes 95 0.80 1.30 2.20
  Pershagen et al., 1992 Maternal Smoking <10, All sexes 95 0.80 1.04 1.40
  Pershagen et al., 1992 Maternal Smoking >=10, All sexes 95 0.60 0.92 1.30
  Stjernfeldt et al., 1986 Maternal Smoking <10, All sexes 95 0.60 1.07 1.80
  McKinney et al., 1986 Maternal Smoking 1-10, All sexes 95 0.90 1.12 1.50
  McKinney et al., 1986 Maternal Smoking 11+, All sexes 95 0.70 0.84 1.10
  Buckley et al., 1986 Maternal Smoking 1-9, All sexes 95 0.90 1.31 1.90
  Buckley et al., 1986 Maternal Smoking >=10, All sexes 95 0.80 0.97 1.20
  John et al., 1991 Maternal Smoking 1-10, All sexes 95 0.70 1.40 2.70
  John et al., 1991 Maternal Smoking 11+, All sexes 95 0.80 1.50 2.70
  Stockwell et al. (1992) Spouse smoked, All sexes 95 0.80 1.60 3.00
  Stockwell et al. (1992) Spouse smoked, < 22 smokeyears, All sexes 95 0.80 1.60 3.20
  Stockwell et al. (1992) Spouse smoked, 23-39 smokeyears, All sexes 95 0.70 1.40 2.90
  Brownson et al. (1992) Spouse smoked, All sexes 95 0.80 1.00 1.20
  Brownson et al. (1992) Spouse smoked, 0-15 smokeyears, All sexes 95 0.50 0.70 1.10
  Brownson et al. (1992) Spouse smoked, 40+ smokeyears, All sexes 95 1.00 1.30 1.70
  Fontham et al. (1994) Spouse smoked, <15, All sexes 95 0.86 1.08 1.39
  Fontham et al. (1994) Spouse smoked, 15-40, All sexes 95 0.76 1.04 1.42
  Fontham et al. (1994) Spouse smoked, 40-80, All sexes 95 0.97 1.36 1.91
  Fontham et al. (1994) Spouse smoked, 80+, All sexes 95 0.99 1.79 3.25
  Kabat et al. (1995) Spouse smoked, Males 95 0.67 1.60 3.82
  Kabat et al. (1995) Spouse smoked, 1-10/dag, Males 95 0.24 0.74 2.23
  Kabat et al. (1995) Spouse smoked, Females 95 0.60 1.08 1.94
  Kabat et al. (1995) Spouse smoked, 1-10/dag, Females 95 0.42 0.82 1.61
  Kabat et al. (1995) Spouse smoked, 11+/dag, Females 95 0.49 1.06 2.30
  Janerich et al. (1990) 1-24 smokeryears, All sexes 95 0.68 1.09 1.73
  Stockwell et al. (1992) mother, All sexes 95 0.60 1.60 4.30
  Stockwell et al. (1992) father, All sexes 95 0.60 1.20 2.30
  Stockwell et al. (1992) siblings, All sexes 95 0.80 1.70 3.90
  Stockwell et al. (1992) <18 years, All sexes 95 0.70 1.60 3.60
  Stockwell et al. (1992) 18-21 years, All sexes 95 0.50 1.10 2.60
  Brownson et al. (1992) any, All sexes 95 0.60 0.80 1.10
  Fontham et al. (1994) Father smoking, All sexes 95 0.67 0.83 1.02
  Fontham et al. (1994) Mother Smoking, All sexes 95 0.62 0.86 1.18
  Fontham et al. (1994) 1-17 years, All sexes 95 0.73 0.99 1.35
  Fontham et al. (1994) 18+ years, All sexes 95 0.67 0.89 1.16
  Kabat et al. (1995) Childhood, y/n, Males 95 0.43 0.90 1.89
  Kabat et al. (1995) Childhood, 1 smoker, Males 95 0.46 1.12 2.70
  Kabat et al. (1995) Childhood, 1+ smokers, Males 95 0.34 1.13 3.75
  Kabat et al. (1995) Childhood, y/n, Females 95 0.95 1.55 2.79
  Kabat et al. (1995) Childhood, 1 smoker, Females 95 0.91 1.75 3.35
  Kabat et al. (1995) Childhood, 1+ smokers, Females 95 0.43 1.27 3.78
  Kabat et al. (1995) Adulthood, y/n, Males 95 0.53 1.13 2.45
  Kabat et al. (1995) Adulthood, 1 smokers, Males 95 0.19 0.64 2.13
  Kabat et al. (1995) Adulthood, y/n, Females 95 0.53 0.95 1.67
  Kabat et al. (1995) Adulthood, 1 smokers, Females 95 0.50 0.96 1.84
  Kabat et al. (1995) Adulthood, 1+ smokers, Females 95 0.34 0.94 2.63
  Wu et al. (1985) Parents smoked, y/n, All sexes 95 0.20 0.60 1.70
  Kabat and Wynder (1984) Current ETS exposure at home, Males 95 0.33 1.26 4.83
  Kabat and Wynder (1984) Current ETS exposure at home, Females 95 0.40 0.92 2.08
  Kabat et al. (1990) Family member smoked, Males 95 0.34 0.73 1.59
  Kabat et al. (1990) Family member smoked, Females 95 0.86 1.68 3.27
  Sobue (1990) childhood, Father smoked, Females 95 0.52 0.79 1.21
  Sobue (1990) childhood, Mother smoked, Females 95 0.74 1.33 2.37
  Sobue (1990) childhood, Other smoked, Females 95 0.76 1.18 1.84
  Gao et al. (1987) Lived with a smoker, Females 95 0.70 1.10 1.70
  Koo et al. (1987) cohabitants who smoked, 1, Females 95 0.60 1.73 6.40
  Koo et al. (1987) cohabitants who smoked, 1+, Females 95 0.60 1.35 5.00
  Wu-Williams et al. (1990) father smoked, Females 95 0.80 1.10 1.40
  Wu-Williams et al. (1990) mother smoked, Females 95 0.60 0.90 1.10
  Pershagen et al. (1986) parents smoked, Females 95 0.40 1.00 2.30
  Svensson et al. (1989) father smoked, Females 95 0.40 0.90 2.30
  Svensson et al. (1989) mother smoked, Females 95 0.50 3.30 18.80
  Kabat & Wynder et al. (1984) workplace, Males 95 1.00 3.30 10.40
  Kabat & Wynder et al. (1984) workplace, Females 95 0.30 0.70 1.50
  Garfinkel et al. (1985) work, past 5 years, All sexes 95 0.70 0.88 1.20
  Garfinkel et al. (1985) work, past 25 years, All sexes 95 0.70 0.93 1.20
  Wu et al. (1985) years exposed at each job, All sexes 95 0.50 1.30 3.30
  Janerich et al. (1990) # smokers at work, All sexes 95 . . .
  Brownson et al. (1992) exposed to other’s smoke, All sexes 95 0.90 1.20 1.70
  Kabat et al. (1995) 4 jobs that lasted 1 year or more, Males 95 0.50 1.02 2.09
  Kabat et al. (1995) 4 jobs that lasted 1 year or more, Females 95 0.62 1.15 2.13
  Lee et al. (1986) exposure as no, little, a lot, Males 95 0.40 1.61 6.60
  Lee et al. (1986) exposure as no, little, a lot, Females 95 0.20 0.63 2.30
  Kalandidi et al. (1990) #smokers at work, All sexes 95 0.80 1.39 2.50
  Koo et al. (1987) any ETS exposure at work, All sexes 95 . 0.91 .
  Shimizu et al. (1988) any smokers at work, All sexes 95 . 1.20 .
  Wu-Williams et al. (1990) exposure at each job, All sexes 95 0.90 1.20 1.60
  WHO/IARC, 1998 childhood 3+ smokers in household, All sexes 95 0.65 1.05 1.70
  WHO/IARC, 1998 childhood 2 smokers in household, Females 95 0.46 0.69 1.04
  WHO/IARC, 1998 childhood 3+ smokers in household, Females 95 0.67 1.13 1.91
  WHO/IARC, 1998 childhood 0.1-14 smoker years, All sexes 95 0.66 0.83 1.04
  WHO/IARC, 1998 childhood >18 smoker years, All sexes 95 0.51 0.80 1.24
  WHO/IARC, 1998 childhood 0.1-14 smoker years, Females 95 0.60 0.78 1.02
  WHO/IARC, 1998 childhood 14.1–18.0 smoker years, Females 95 0.53 0.73 1.02
  WHO/IARC, 1998 childhood >18 smoker years, Females 95 0.54 0.90 1.50
  WHO/IARC, 1998 Spouse Spouse, All sexes 95 0.93 1.16 1.44
  WHO/IARC, 1998 Spouse Spouse, Females 95 0.88 1.11 1.39
  WHO/IARC, 1998 Spouse 1-34 years exposed, All sexes 95 0.83 1.05 1.33
  WHO/IARC, 1998 Spouse 35-42 years exposed, All sexes 95 0.12 0.63 2.37
  WHO/IARC, 1998 Spouse >=43 years exposed, All sexes 95 0.68 1.07 1.68
  WHO/IARC, 1998 Spouse 1-34 years exposed, Females 95 0.77 0.99 1.27
  WHO/IARC, 1998 Spouse >=43 years exposed, Females 95 0.66 1.05 1.68
  WHO/IARC, 1998 Spouse 1–135 hours/day × years, All sexes 95 0.70 0.90 1.16
  WHO/IARC, 1998 Spouse 136–223 hours/day × years, All sexes 95 0.78 1.20 1.85
  WHO/IARC, 1998 Spouse 1–135 hours/day × years, Females 95 0.61 0.80 1.06
  WHO/IARC, 1998 Spouse 136–223 hours/day × years, Females 95 0.72 1.12 1.74
  WHO/IARC, 1998 Spouse 1-10 cig/day, All sexes 95 0.86 1.10 1.40
  WHO/IARC, 1998 Spouse >=18 cig/day, All sexes 95 0.85 1.37 2.20
  WHO/IARC, 1998 Spouse 1-10 cig/day, Females 95 0.77 1.00 1.31
  WHO/IARC, 1998 Spouse >=18 cig/day, Females 95 0.83 1.34 2.17
  WHO/IARC, 1998 Spouse 0.1-13 packyears, All sexes 95 0.78 1.00 1.28
  WHO/IARC, 1998 Spouse 13.1-23 packyears, All sexes 95 0.57 0.89 1.39
  WHO/IARC, 1998 Spouse 0.1-13 packyears, Females 95 0.70 0.91 1.19
  WHO/IARC, 1998 Spouse 13.1-23 packyears, Females 95 0.52 0.83 1.30
  WHO/IARC, 1998 Spouse =23.1 packyears, Females 95 0.97 1.54 2.44
  WHO/IARC, 1998 Workplace Workplace, All sexes 95 0.90 1.17 1.45
  WHO/IARC, 1998 Workplace Workplace, Females 95 0.94 1.19 1.51
  WHO/IARC, 1998 Workplace 1-29 years, All sexes 95 0.91 1.15 1.44
  WHO/IARC, 1998 Workplace 30-38 years, All sexes 95 0.85 1.26 1.85
  WHO/IARC, 1998 Workplace >=39 years, All sexes 95 0.76 1.19 1.86
  WHO/IARC, 1998 Workplace 1-29 years, Females 95 0.89 1.14 1.47
  WHO/IARC, 1998 Workplace 30-38 years, Females 95 0.93 1.50 2.43
  WHO/IARC, 1998 Workplace >=39 years, Females 95 0.67 1.24 2.28
  WHO/IARC, 1998 Workplace 0.1–46.1 (level*hours/day*years), All sexes 95 0.76 0.97 1.25
  WHO/IARC, 1998 Workplace 46.2–88.9 (level*hours/day*years), All sexes 95 0.93 1.41 2.12
  WHO/IARC, 1998 Workplace 0.1–46.1 (level*hours/day*years), Females 95 0.78 1.03 1.36
  WHO/IARC, 1998 Workplace 46.2–88.9 (level*hours/day*years), Females 95 0.65 1.08 1.81
  WHO/IARC, 1998 Work+spouse Workplace+spouse, All sexes 95 0.88 1.14 1.47
  WHO/IARC, 1998 Work+spouse Workplace+spouse, Females 95 0.86 1.15 1.55
  WHO/IARC, 1998 Work+spouse 1–36 years, All sexes 95 0.85 1.11 1.46
  WHO/IARC, 1998 Work+spouse 37–43 years, All sexes 95 0.87 1.26 1.81
  WHO/IARC, 1998 Work+spouse >=44 years, All sexes 95 0.87 1.29 1.92
  WHO/IARC, 1998 Work+spouse 1–36 years, Females 95 0.80 1.09 1.50
  WHO/IARC, 1998 Work+spouse 37–43 years, Females 95 0.85 1.28 1.94
  WHO/IARC, 1998 Work+spouse >=44 years, Females 95 0.80 1.25 1.95
  WHO/IARC, 1998 Work+spouse 0-165 (hours/day*years), All sexes 95 0.69 0.91 1.20
  WHO/IARC, 1998 Work+spouse 166–253 (hours/day*years), All sexes 95 0.88 1.31 1.94
  WHO/IARC, 1998 Work+spouse >=254 (hours/day*years), All sexes 95 0.96 1.46 2.22
  WHO/IARC, 1998 Work+spouse 0-165 (hours/day*years), Females 95 0.63 0.87 1.21
  WHO/IARC, 1998 Work+spouse 166–253 (hours/day*years), Females 95 0.72 1.15 1.82
  WHO/IARC, 1998 Work+spouse >=254 (hours/day*years), Females 95 0.93 1.49 2.38
  Enstrom & Kabat (2003) Coronary Heart Disease, Males 95 0.85 0.94 1.05
  Enstrom & Kabat (2003) Lung Cancer, Males 95 0.42 0.75 1.35
  Enstrom & Kabat (2003) COPD, Males 95 0.78 1.27 2.08
  Enstrom & Kabat (2003) Coronary Heart Disease, Females 95 0.94 1.01 1.08
  Enstrom & Kabat (2003) Lung Cancer, Females 95 0.72 0.99 1.37
  Enstrom & Kabat (2003) COPD, Females 95 0.80 1.13 1.58
N = 144

Bron: Drug Library

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  • "Es ist schwieriger, eine vorgefaßte Meinung zu zertrümmern als ein Atom."
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  • I've alllllllways said that asking smokers "do you want to quit?" and reporting the results of that question, as is, is horribly misleading. It's a TWO part question. After asking if one wants to quit it must be followed up with "Why?" Ask why and the majority of the answers will be "because I'm supposed to" (victims of guilt and propaganda), not "because I want to."
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