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

OordeelSterkte verband op basis RR>2Aantal
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
Totaal177

Resultaten meeroken-onderzoeken

Statistische significantie

IndelingOnderzoekOmschrijvingBetrouwbaarheids-
interval (%)
Onder-
grens
Relatief
Risico
Boven-
grens
Negatief effect - Sterk (RR>2)Stockwell et al. (1992)Spouse smoked, 40+ smokeyears, All sexes951.102.405.30
 Kabat et al. (1995)Spouse smoked, 11+/dag, Males951.357.4841.36
 Janerich et al. (1990)25+ smokeryears, All sexes951.162.073.68
 Stockwell et al. (1992)22+ years, All sexes951.102.405.40
 Kabat et al. (1995)Adulthood, 1+ smokers, Males951.344.1512.90
 WHO/IARC, 1998 Workplace>=89.0 (level*hours/day*years), All sexes951.332.073.21
N = 6
Negatief effect - Zwak (RR<=2)Hirayama, 19842-29/day, Females901.031.121.21
 Hirayama, 198420+/day, Females951.121.231.35
 Reynold et al., 1987All Cancers, All sexes901.121.681.50
 Reynold et al., 1987Smoking Related cancers, All sexes901.057.0147.00
 Stjernfeldt et al., 1986Maternal Smoking >=10, All sexes951.101.562.30
 Golding et al., 1990Maternal Smoking, All sexes901.202.475.10
 Fontham et al. (1994)Spouse smoked, All sexes951.041.291.60
 Fontham et al. (1994)years of exposure at work, All sexes951.101.391.70
 Fontham et al. (1994)years of exposure at work, 1-15 years, All sexes951.011.301.67
 Fontham et al. (1994)years of exposure at work, 16-30, All sexes951.041.401.88
 Fontham et al. (1994)years of exposure at work, 30+, All sexes951.241.862.78
 EPA, 1993 951.041.191.35
 WHO/IARC, 1998 Spouse35-42 years exposed, Females951.061.572.31
 WHO/IARC, 1998 Spouse>=224 hours/day × years, All sexes951.121.802.90
 WHO/IARC, 1998 Spouse>=224 hours/day × years, Females951.051.702.75
 WHO/IARC, 1998 Spouse!ERROR! unexpected comma951.041.642.59
 WHO/IARC, 1998 Workplace>=89.0 (level*hours/day*years), Females951.101.873.20
N = 17
Positief effectBrownson et al. (1992)Spouse smoked, 15-40 smokeyears, All sexes950.500.701.00
 Brownson et al. (1992)parents, All sexes950.500.700.90
 WHO/IARC, 1998 childhoodchildhood, All sexes950.640.780.96
 WHO/IARC, 1998 childhoodchildhood, Females950.610.770.98
 WHO/IARC, 1998 childhood1 smoker in household, All sexes950.640.800.99
 WHO/IARC, 1998 childhood2 smokers in household, All sexes950.440.630.90
 WHO/IARC, 1998 childhood1 smoker in household, Females950.590.760.98
 WHO/IARC, 1998 childhood14.1–18.0 smoker years, All sexes950.510.680.92
 WHO/IARC, 1998 Spouse10-18 cig/day, All sexes950.350.580.90
 WHO/IARC, 1998 Spouse10-18 cig/day, Females950.340.570.93
N = 10
Statistisch insignificantSandler, et al. 1989All Cancers, All sexes950.661.011.53
 Sandler, et al. 1989All Cancers, Females950.821.001.21
 Sandler, et al. 1989Smoking-related cancers, Males950.430.962.62
 Sandler, et al. 1989Smoking-related cancers, Females950.881.452.40
 Sandler, et al. 1989Other Cancers, Males950.401.032.62
 Sandler, et al. 1989Other Cancers, Females950.760.931.54
 Neutel and Buck, 1970Maternal Smoking, All sexes950.801.302.20
 Pershagen et al., 1992Maternal Smoking <10, All sexes950.801.041.40
 Pershagen et al., 1992Maternal Smoking >=10, All sexes950.600.921.30
 Stjernfeldt et al., 1986Maternal Smoking <10, All sexes950.601.071.80
 McKinney et al., 1986Maternal Smoking 1-10, All sexes950.901.121.50
 McKinney et al., 1986Maternal Smoking 11+, All sexes950.700.841.10
 Buckley et al., 1986Maternal Smoking 1-9, All sexes950.901.311.90
 Buckley et al., 1986Maternal Smoking >=10, All sexes950.800.971.20
 John et al., 1991Maternal Smoking 1-10, All sexes950.701.402.70
 John et al., 1991Maternal Smoking 11+, All sexes950.801.502.70
 Stockwell et al. (1992)Spouse smoked, All sexes950.801.603.00
 Stockwell et al. (1992)Spouse smoked, < 22 smokeyears, All sexes950.801.603.20
 Stockwell et al. (1992)Spouse smoked, 23-39 smokeyears, All sexes950.701.402.90
 Brownson et al. (1992)Spouse smoked, All sexes950.801.001.20
 Brownson et al. (1992)Spouse smoked, 0-15 smokeyears, All sexes950.500.701.10
 Brownson et al. (1992)Spouse smoked, 40+ smokeyears, All sexes951.001.301.70
 Fontham et al. (1994)Spouse smoked, <15, All sexes950.861.081.39
 Fontham et al. (1994)Spouse smoked, 15-40, All sexes950.761.041.42
 Fontham et al. (1994)Spouse smoked, 40-80, All sexes950.971.361.91
 Fontham et al. (1994)Spouse smoked, 80+, All sexes950.991.793.25
 Kabat et al. (1995)Spouse smoked, Males950.671.603.82
 Kabat et al. (1995)Spouse smoked, 1-10/dag, Males950.240.742.23
 Kabat et al. (1995)Spouse smoked, Females950.601.081.94
 Kabat et al. (1995)Spouse smoked, 1-10/dag, Females950.420.821.61
 Kabat et al. (1995)Spouse smoked, 11+/dag, Females950.491.062.30
 Janerich et al. (1990)1-24 smokeryears, All sexes950.681.091.73
 Stockwell et al. (1992)mother, All sexes950.601.604.30
 Stockwell et al. (1992)father, All sexes950.601.202.30
 Stockwell et al. (1992)siblings, All sexes950.801.703.90
 Stockwell et al. (1992)<18 years, All sexes950.701.603.60
 Stockwell et al. (1992)18-21 years, All sexes950.501.102.60
 Brownson et al. (1992)any, All sexes950.600.801.10
 Fontham et al. (1994)Father smoking, All sexes950.670.831.02
 Fontham et al. (1994)Mother Smoking, All sexes950.620.861.18
 Fontham et al. (1994)1-17 years, All sexes950.730.991.35
 Fontham et al. (1994)18+ years, All sexes950.670.891.16
 Kabat et al. (1995)Childhood, y/n, Males950.430.901.89
 Kabat et al. (1995)Childhood, 1 smoker, Males950.461.122.70
 Kabat et al. (1995)Childhood, 1+ smokers, Males950.341.133.75
 Kabat et al. (1995)Childhood, y/n, Females950.951.552.79
 Kabat et al. (1995)Childhood, 1 smoker, Females950.911.753.35
 Kabat et al. (1995)Childhood, 1+ smokers, Females950.431.273.78
 Kabat et al. (1995)Adulthood, y/n, Males950.531.132.45
 Kabat et al. (1995)Adulthood, 1 smokers, Males950.190.642.13
 Kabat et al. (1995)Adulthood, y/n, Females950.530.951.67
 Kabat et al. (1995)Adulthood, 1 smokers, Females950.500.961.84
 Kabat et al. (1995)Adulthood, 1+ smokers, Females950.340.942.63
 Wu et al. (1985)Parents smoked, y/n, All sexes950.200.601.70
 Kabat and Wynder (1984)Current ETS exposure at home, Males950.331.264.83
 Kabat and Wynder (1984)Current ETS exposure at home, Females950.400.922.08
 Kabat et al. (1990)Family member smoked, Males950.340.731.59
 Kabat et al. (1990)Family member smoked, Females950.861.683.27
 Sobue (1990)childhood, Father smoked, Females950.520.791.21
 Sobue (1990)childhood, Mother smoked, Females950.741.332.37
 Sobue (1990)childhood, Other smoked, Females950.761.181.84
 Gao et al. (1987)Lived with a smoker, Females950.701.101.70
 Koo et al. (1987)cohabitants who smoked, 1, Females950.601.736.40
 Koo et al. (1987)cohabitants who smoked, 1+, Females950.601.355.00
 Wu-Williams et al. (1990)father smoked, Females950.801.101.40
 Wu-Williams et al. (1990)mother smoked, Females950.600.901.10
 Pershagen et al. (1986)parents smoked, Females950.401.002.30
 Svensson et al. (1989)father smoked, Females950.400.902.30
 Svensson et al. (1989)mother smoked, Females950.503.3018.80
 Kabat & Wynder et al. (1984)workplace, Males951.003.3010.40
 Kabat & Wynder et al. (1984)workplace, Females950.300.701.50
 Garfinkel et al. (1985)work, past 5 years, All sexes950.700.881.20
 Garfinkel et al. (1985)work, past 25 years, All sexes950.700.931.20
 Wu et al. (1985)years exposed at each job, All sexes950.501.303.30
 Janerich et al. (1990)# smokers at work, All sexes95. . .
 Brownson et al. (1992)exposed to other’s smoke, All sexes950.901.201.70
 Kabat et al. (1995)4 jobs that lasted 1 year or more, Males950.501.022.09
 Kabat et al. (1995)4 jobs that lasted 1 year or more, Females950.621.152.13
 Lee et al. (1986)exposure as no, little, a lot, Males950.401.616.60
 Lee et al. (1986)exposure as no, little, a lot, Females950.200.632.30
 Kalandidi et al. (1990)#smokers at work, All sexes950.801.392.50
 Koo et al. (1987)any ETS exposure at work, All sexes95. 0.91.
 Shimizu et al. (1988)any smokers at work, All sexes95. 1.20.
 Wu-Williams et al. (1990)exposure at each job, All sexes950.901.201.60
 WHO/IARC, 1998 childhood3+ smokers in household, All sexes950.651.051.70
 WHO/IARC, 1998 childhood2 smokers in household, Females950.460.691.04
 WHO/IARC, 1998 childhood3+ smokers in household, Females950.671.131.91
 WHO/IARC, 1998 childhood0.1-14 smoker years, All sexes950.660.831.04
 WHO/IARC, 1998 childhood>18 smoker years, All sexes950.510.801.24
 WHO/IARC, 1998 childhood0.1-14 smoker years, Females950.600.781.02
 WHO/IARC, 1998 childhood14.1–18.0 smoker years, Females950.530.731.02
 WHO/IARC, 1998 childhood>18 smoker years, Females950.540.901.50
 WHO/IARC, 1998 SpouseSpouse, All sexes950.931.161.44
 WHO/IARC, 1998 SpouseSpouse, Females950.881.111.39
 WHO/IARC, 1998 Spouse1-34 years exposed, All sexes950.831.051.33
 WHO/IARC, 1998 Spouse35-42 years exposed, All sexes950.120.632.37
 WHO/IARC, 1998 Spouse>=43 years exposed, All sexes950.681.071.68
 WHO/IARC, 1998 Spouse1-34 years exposed, Females950.770.991.27
 WHO/IARC, 1998 Spouse>=43 years exposed, Females950.661.051.68
 WHO/IARC, 1998 Spouse1–135 hours/day × years, All sexes950.700.901.16
 WHO/IARC, 1998 Spouse136–223 hours/day × years, All sexes950.781.201.85
 WHO/IARC, 1998 Spouse1–135 hours/day × years, Females950.610.801.06
 WHO/IARC, 1998 Spouse136–223 hours/day × years, Females950.721.121.74
 WHO/IARC, 1998 Spouse1-10 cig/day, All sexes950.861.101.40
 WHO/IARC, 1998 Spouse>=18 cig/day, All sexes950.851.372.20
 WHO/IARC, 1998 Spouse1-10 cig/day, Females950.771.001.31
 WHO/IARC, 1998 Spouse>=18 cig/day, Females950.831.342.17
 WHO/IARC, 1998 Spouse0.1-13 packyears, All sexes950.781.001.28
 WHO/IARC, 1998 Spouse13.1-23 packyears, All sexes950.570.891.39
 WHO/IARC, 1998 Spouse0.1-13 packyears, Females950.700.911.19
 WHO/IARC, 1998 Spouse13.1-23 packyears, Females950.520.831.30
 WHO/IARC, 1998 Spouse!ERROR! unexpected comma950.971.542.44
 WHO/IARC, 1998 WorkplaceWorkplace, All sexes950.901.171.45
 WHO/IARC, 1998 WorkplaceWorkplace, Females950.941.191.51
 WHO/IARC, 1998 Workplace1-29 years, All sexes950.911.151.44
 WHO/IARC, 1998 Workplace30-38 years, All sexes950.851.261.85
 WHO/IARC, 1998 Workplace>=39 years, All sexes950.761.191.86
 WHO/IARC, 1998 Workplace1-29 years, Females950.891.141.47
 WHO/IARC, 1998 Workplace30-38 years, Females950.931.502.43
 WHO/IARC, 1998 Workplace>=39 years, Females950.671.242.28
 WHO/IARC, 1998 Workplace0.1–46.1 (level*hours/day*years), All sexes950.760.971.25
 WHO/IARC, 1998 Workplace46.2–88.9 (level*hours/day*years), All sexes950.931.412.12
 WHO/IARC, 1998 Workplace0.1–46.1 (level*hours/day*years), Females950.781.031.36
 WHO/IARC, 1998 Workplace46.2–88.9 (level*hours/day*years), Females950.651.081.81
 WHO/IARC, 1998 Work+spouseWorkplace+spouse, All sexes950.881.141.47
 WHO/IARC, 1998 Work+spouseWorkplace+spouse, Females950.861.151.55
 WHO/IARC, 1998 Work+spouse1–36 years, All sexes950.851.111.46
 WHO/IARC, 1998 Work+spouse37–43 years, All sexes950.871.261.81
 WHO/IARC, 1998 Work+spouse>=44 years, All sexes950.871.291.92
 WHO/IARC, 1998 Work+spouse1–36 years, Females950.801.091.50
 WHO/IARC, 1998 Work+spouse37–43 years, Females950.851.281.94
 WHO/IARC, 1998 Work+spouse>=44 years, Females950.801.251.95
 WHO/IARC, 1998 Work+spouse0-165 (hours/day*years), All sexes950.690.911.20
 WHO/IARC, 1998 Work+spouse166–253 (hours/day*years), All sexes950.881.311.94
 WHO/IARC, 1998 Work+spouse>=254 (hours/day*years), All sexes950.961.462.22
 WHO/IARC, 1998 Work+spouse0-165 (hours/day*years), Females950.630.871.21
 WHO/IARC, 1998 Work+spouse166–253 (hours/day*years), Females950.721.151.82
 WHO/IARC, 1998 Work+spouse>=254 (hours/day*years), Females950.931.492.38
 Enstrom & Kabat (2003)Coronary Heart Disease, Males950.850.941.05
 Enstrom & Kabat (2003)Lung Cancer, Males950.420.751.35
 Enstrom & Kabat (2003)COPD, Males950.781.272.08
 Enstrom & Kabat (2003)Coronary Heart Disease, Females950.941.011.08
 Enstrom & Kabat (2003)Lung Cancer, Females950.720.991.37
 Enstrom & Kabat (2003)COPD, Females950.801.131.58
N = 144

Bron: Drug Library

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  • "Als je alles zou laten dat slecht is voor je gezondheid, dan ging je kapot"
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  • "The effects of other people smoking in my presence is so small it doesn't worry me."
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