Onderzoeken Meeroken

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	Aantal
Negatief effect	Sterk (RR>2)	6
	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	!ERROR! C24 -> Formula Error: Unexpected ,	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	!ERROR! C149 -> Formula Error: Unexpected ,	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