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Environmental tobacco smoke and mortality in Chinese women who have never smoked: prospective cohort study

BMJ 2006; 333 doi: (Published 17 August 2006) Cite this as: BMJ 2006;333:376
  1. Wanqing Wen, research assistant professor (wanqing.wen{at},
  2. Xiao Ou Shu, professor1,
  3. Yu-Tang Gao, professor2,
  4. Gong Yang, research assistant professor1,
  5. Qi Li, research associate2,
  6. Honglan Li, research associate2,
  7. Wei Zheng, professor1
  1. 1 Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
  2. 2 Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China 20032
  1. Correspondence to: W Wen
  • Accepted 14 April 2006


Objective To evaluate the association of environmental exposure to tobacco smoke from husbands and from work, as well as from family members in early life, with all cause mortality and mortality due to cancer or cardiovascular disease in Chinese women.

Design Ongoing prospective cohort study in Shanghai, China.

Participants Of 72 829 women who had never smoked, 65 180 women provided information on smoking by their husbands, and 66 520 women provided information on exposure to tobacco smoke at work and in early life from family members.

Main outcome measures All cause mortality and cause specific mortality with the main focus on cancer and cardiovascular disease. Cumulative mortality according to exposure status, and hazard ratios.

Results Exposure to tobacco smoke from husbands (mainly current exposure) was significantly associated with increased all cause mortality (hazard ratio 1.15, 95% confidence interval 1.01 to 1.31) and with increased mortality due to cardiovascular disease (1.37, 1.06 to 1.78). Exposure to tobacco smoke at work was associated with increased mortality due to cancer (1.19, 0.94 to 1.50), especially lung cancer (1.79, 1.09 to 2.93). Exposure in early life was associated with increased mortality due to cardiovascular disease (1.26, 0.94 to 1.69).

Conclusions In Chinese women, exposure to environmental tobacco smoke is related to moderately increased risk of all cause mortality and mortality due to lung cancer and cardiovascular disease.


  • Contributors WW, XOS, Y-TG, and WZ helped design the study and analyse the data. XOS, Y-TG, GY, QL, HL, and WZ helped in data collection and field operations. All authors helped prepare the manuscript.

  • Funding Supported by NIH grant RO1CA70867.

  • Competing interests None declared.

  • Ethical approval Institutional review boards for human research in Shanghai Cancer Institute, China and Vanderbilt University, US.

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