Secondhand smoke exposure predicted COPD and other tobacco-related mortality in a 17-year cohort study in China

Chest. 2012 Oct;142(4):909-918. doi: 10.1378/chest.11-2884.


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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cause of Death / trends
  • China / epidemiology
  • Cross-Sectional Studies
  • Female
  • Follow-Up Studies
  • Forecasting*
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Pulmonary Disease, Chronic Obstructive / mortality*
  • Risk Factors
  • Smoking / adverse effects
  • Smoking / mortality*
  • Survival Rate / trends
  • Time Factors
  • Tobacco Products / adverse effects*
  • Tobacco Smoke Pollution / adverse effects*


  • Tobacco Smoke Pollution