Background
Evidence of adverse health effects attributable to SHS exposure
Study objective and research question
Methods
Systematic literature review
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study design
-
survey/cross-sectional study (9)
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(systematic) review (28)
-
meta-analysis (5)
-
-
no effect sizes provided (24)
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other outcomes observed (5)
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other exposures considered (4)
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letter to the editor (2)
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conflict of interest (1)
Quality assessment
Calculation of relative risks
Nr. |
Authors
|
Type
|
Location
|
Population/Participants
|
Exposure measurement
|
Exposure
|
Relative Risk
|
Controlled variables
|
Score
|
---|---|---|---|---|---|---|---|---|---|
(95 % CI) | |||||||||
[26] | Bonita et al. (1999) | case–control | New Zealand | 521 patients (279 men, 242 women) 1,851 controls (934 men, 917 women) | self-report | home and workplace |
stroke
| Yes | 9 |
1.65 (1.28–2.16) | |||||||||
men: 1.87 (1.27–2.77) | |||||||||
women: 1.53 (1.06–2.2) | |||||||||
[72] | Chan-Yeung et al. (2007) | case–control | Hong Kong | 289 patients (243 men, 46 women), 289 controls (243 men, 46 women) | self-report | home and workplace |
COPD
| Yes | 9 |
1.64 (0.97–2.03) | |||||||||
[69] | Ciruzzi et al. (1998) | case–control | South America | 336 patients (156 men, 180 women) 446 controls (228 men, 218 women) never-smokers
| self-report | home |
IHD
| Yes | 9 |
2.04 (0.99–12.52) | |||||||||
[16] | Ding et al. (2009) | case–control | Hong Kong | 314 female patients, 319 female controls, never-smokers
| self-report | home: ≥ 4 h/day |
IHD
| Yes | 9 |
women: 1.31 (1.03–6.01) | |||||||||
[87] | Dobson et al. (1991) | case–control | Australia | 759 patients, (519 men, 240 women) 1,308 controls (625 men, 683 women) non-smokers
| self-report (medical records and relatives for deaths) | home and workplace |
IHD
| Yes | 9 |
men: 0.98 (0.63–1.33) | |||||||||
women: 1.92 (1.33–2.69) | |||||||||
[88] | Gallo et al. (2010) | cohort | Europe | 135,233 (19,922 men, 115,311 women) never-smokers
| self-report | home |
stroke
| Yes | 6 |
men: 1.10 (0.36–3.37) | |||||||||
women: 0.93 (0.49–1.74) | |||||||||
[48] | Glymour et al. (2008) | cohort | USA | 16,225 never-smokers
| self-report | home: spousal smoking (current exposure) |
stroke
| Yes | 9 |
1.42 (1.02–1.92) | |||||||||
men: 1.63 (0.83–2.70) | |||||||||
women: 1.46 (1.00–2.18) | |||||||||
[66] | He et al. (1994) | case–control | China | 59 female patients, 126 female controls, never-smokers
| self-report | home |
IHD
| Yes | 10 |
women: 1.16 (0.67–1.95) | |||||||||
[89] | He et al. (2012) | cohort | China | 910 (439 men, 471 women) never-smokers
| self-report | home and workplace |
IHD
| Yes | 7 |
2.15 (1.00–4.61) | |||||||||
men: 2.24 (0.76–6.59) | |||||||||
women: 2.10 (0.69–6.33) | |||||||||
COPD
| |||||||||
2.30 (1.06–5.00) | |||||||||
men: 2.15 (0.86–5.39) | |||||||||
women: 3.31 (0.69–15.82) | |||||||||
stroke
| |||||||||
2.22 (1.21–4.10) | |||||||||
men: 2.25 (1.09–4.66) | |||||||||
women: 2.02 (0.62–6.53) | |||||||||
[28] | Helsing et al. (1988) | cohort | USA | 19,035 (4,162 men, 14,873 women) never-smokers
| self-report | home: spousal smoking | IHD | Yes | 7 |
men: 1.38 (1.1–1.8) | |||||||||
women: 1.20 (1.0–1.4) | |||||||||
[90] | Hill et al. (2007) | cohort | New Zealand | 381,462 (152,613 men, 228,849 women) never-smokers
| self-report | home | HD | Yes | 7 |
men: 1.18 (0.96–1.44) | |||||||||
women: 1.27 (0.98–1.66) | |||||||||
stroke
| |||||||||
men: 1.82 (1.20–2.77) | |||||||||
women: 1.17 (0.76–1.82) | |||||||||
[91] | Hole et al. (1989) | cohort | Scotland | 7,997 (3,960 men, 4,037 women) | self-report | home |
IHD
| Yes | 8 |
2.01 (1.21–3.35) | |||||||||
[43] | Iribarren et al. (2004) | cohort | USA | 27,698, (10,482 men, 17,216 women) | self-report | home: ≥ 20 h/week |
stroke
| Yes | 8 |
1.42 (1.08–1.88) | |||||||||
men: 1.29 (0.75–2.20) | |||||||||
women: 1.50 (1.07–2.09) | |||||||||
[92] | Jefferis et al. (2010) | cohort | Great Britain | 2,783 never-smokers
| self-report and cotinine-assessment | home |
IHD
| Yes | 6 |
1.00 (0.86–1.16) | |||||||||
stroke
| |||||||||
0.94 (0.80–1.11) | |||||||||
[64] | Johannessen et al. (2012) | case–control | Norway | 433 patients (258 men, 175 women) 325 controls, (176 men, 149 women) | self-report | home |
COPD
| No | 7 |
men: 0.98 (0.81–1.17) | |||||||||
women: 1.14 (0.93–1.37) | |||||||||
[63] | Kalandidi et al. (1990) | case–control | Greece | 103 female patients 179 female controls, never-smokers
| self-report | home: spousal smoking (1–20 cigarettes/day) |
COPD
| No | 7 |
women: 1.79 (1.17–2.57) | |||||||||
[31] | Kawachi et al. (1997) | cohort | USA | 32,056 female nurses, never-smokers
| self-report | home and workplace: regular exposure |
IHD
| Yes | 8 |
women: 1.91 (1.11–3.28) | |||||||||
[70] | McElduff et al. (1998) | case–control | New Zealand/Australia | 953 patients (686 men, 267 women), 3,189 controls, (1,559 men, 1,630 women) ≥ 10 years non-smokers
| self-report | home and workplace |
IHD
| Yes | 9 |
men: 1.01 (0.86–1.18) | |||||||||
women: 1.78 (1.33–2.36) | |||||||||
[24] | McGhee et al. (2005) | case–control | Hong Kong | 4,838 cases (2,680 men, 2,158 women) 763 controls (418 men, 345 women), never-smokers
| self-report | home |
IHD
| Yes | 9 |
1.18 (1.02–1.36) | |||||||||
men: 1.15 (0.93–1.38) | |||||||||
women: 1.22 (0.97–1.53) | |||||||||
COPD
| |||||||||
1.81 (1.24–2.65) | |||||||||
men: 1.50 (0.96–2.28) | |||||||||
women: 2.59 (1.30–5.27) | |||||||||
stroke
| |||||||||
1.24 (1.08–1.42) | |||||||||
men: 1.16 (0.92–1.44) | |||||||||
women: 1.27 (1.06–1.53) | |||||||||
[93] | Muscat and Wynder (1995) | case–control | USA | 114 cases (68 men, 46 women) 158 controls (108 men, 50 women) never–smokers
| self-report | home and workplace |
IHD
| Yes | 8 |
men: 1.06 (0.55–1.83) | |||||||||
women: 1.33 (0.71–2.87) | |||||||||
[67] | Panagiotakos et al. (2002) | case–control | Greece | 848 cases (700 men, 148 women) 1,078 controls (862 men, 216 women) non-smokers
| self-report | home and workplace: regular exposure |
IHD
| Yes | 10 |
men: 1.43 (1.38–1.47) | |||||||||
women: 1.46 (1.41 – 1.51) | |||||||||
[50] | Pitsavos et al. (2002) | case–control | Greece | 848 cases (700 men, 148 women) 1,078 controls (862 men, 216 women) non-smokers
| self-report | home: regular exposure |
IHD
| Yes | 9 |
1.17 (1.06–1.61) | |||||||||
[45] | Qureshi et al. (2005) | cohort | USA | 3,032 women non-smokers
| self-report | home: spousal smoking |
stroke
| Yes | 7 |
0.8 (0.6–1.3) | |||||||||
[68] | Rosenlund et al. (2001) | case–control | Sweden | 334 cases (199 men, 135 women) 677 controls (401 men, 276 women) never-smokers
| self-report | home: spousal smoking (current exposure) |
IHD
| Yes | 8 |
1.23 (0.93–1.57) | |||||||||
men: 0.99 (0.67–1.39) | |||||||||
women: 1.79 (1.17–2.54) | |||||||||
[94] | Rostron (2013) | cohort | USA | 7,586 never-smokers
| cotinine-assessed | home: high exposure |
IHD
| Yes | 8 |
2.47 (1.04–5.86) | |||||||||
[95] | Schwartz et al. (2009) | case–control | USA | 562 female cases, 564 female controls | self-report | home |
COPD
| Yes | 9 |
women: 1.68 (1.12–2.61) | |||||||||
[65] | Steenland et al. (1996) | cohort | USA | 309,599 (101,227 men, 208,372 women) never-smokers
| self-report | home: spousal smoking |
IHD
| Yes | 7 |
men: 1.22 (1.07–1.40) | |||||||||
women: 1.10 (0.96–1.27) | |||||||||
[73] | Wen et al. (2006) | cohort | China | 72,829 women never-smokers
| self-report | home: spousal smoking (current exposure) |
IHD
| Yes | 8 |
women: 1.37 (1.06–1.78) | |||||||||
stroke
| |||||||||
women: 1.52 (1.08–2.15) | |||||||||
[96] | Whincup et al. (2004) | cohort | Great Britain | 945 men never-smokers
| cotinine-assessment | not specified |
IHD
| Yes | 9 |
men: 1.67 (0.91–3.07) | |||||||||
[75] | Wu et al. (2010) | case–control | Taiwan | 205 female cases 205 female controls | self-report (validation by cotinine-assessment for 71 subjects) | home and workplace |
COPD
| Yes | 9 |
women: 3.12 (1.56–6.50) | |||||||||
[71] | Yin et al. (2007) | Cohort | China | 15,379 (1,777 men, 13,602 women) never-smokers
| self-report | home: ≥ 5 years of 40 h/week |
COPD
| Yes | 8 |
1.60 (1.23–2.10) | |||||||||
[25] | You et al. (1999) | case–control | Australia | 154 cases, 213 controls, never-smokers
| self-report | home: spousal smoking (>20 cigarettes/day) |
stroke
| Yes | 9 |
1.44 (0.96–2.01) | |||||||||
[74] | Zhang et al. (2005) | Cohort | China | 60,377 women, never-smokers
| self-report | home: spousal smoking (≥20 cigarettes/day) |
stroke
| Yes | 8 |
women: 1.62 (1.28–2.05) |
Meta-analysis
Statistical analysis
Results
Studies of SHS exposure and selected outcomes
Effect sizes for SHS exposure and selected outcomes
SHS and ischaemic heart disease
Nr. |
Authors
|
Sex
|
RR (95 % CI) |
log (rr) |
se
|
n
|
w (%) |
---|---|---|---|---|---|---|---|
[69] | Ciruzzi et al. (1998) | both sexes | 2.04 (0.99–12.52) | 0.71 | 0.65 | 782 | 1.39 |
[16] | Ding et al. (2009) | women | 1.31 (1.03–6.01) | 0.27 | 0.45 | 633 | 2.27 |
[87] | Dobson et al. (1991) | men | 0.98 (0.63–1.33) | −0.02 | 0.19 | 1,144 | 8.35 |
women | 1.92 (1.33–2.69) | 0.65 | 0.18 | 923 | 12.19 | ||
[66] | He et al. (1994) | women | 1.16 (0.67–1.95) | 0.15 | 0.27 | 185 | 5.87 |
[91] | Hole et al. (1989) | both sexes | 2.01 (1.21–3.35) | 0.70 | 0.26 | 7,997 | 7.69 |
[31] | Kawachi et al. (1997) | women | 1.91 (1.11–3.28) | 0.65 | 0.28 | 32,056 | 5.72 |
[70] | McElduff et al. (1998) | men | 1.01 (0.86–1.18) | 0.01 | 0.08 | 2,245 | 46.59 |
women | 1.78 (1.33–2.36) | 0.58 | 0.15 | 1,897 | 16.90 | ||
[24] | McGhee et al. (2005) | both sexes | 1.18 (1.02–1.36) | 0.17 | 0.07 | 5,601 | 38.73 |
men | 1.15 (0.93–1.38) | 0.14 | 0.10 | 3,098 | 29.93 | ||
women | 1.22 (0.97–1.53) | 0.20 | 0.12 | 2,503 | 23.48 | ||
[93] | Muscat and Wynder (1995) | men | 1.06 (0.55–1.83) | 0.06 | 0.31 | 176 | 3.23 |
women | 1.33 (0.71–2.87) | 0.29 | 0.36 | 96 | 3.56 | ||
[50] | Pitsavos et al. (2002) | both sexes | 1.17 (1.06–1.61) | 0.16 | 0.11 | 1,926 | 27.88 |
[68] | Rosenlund et al. (2001) | both sexes | 1.23 (0.93–1.57) | 0.21 | 0.13 | 1,011 | 21.40 |
men | 0.99 (0.67–1.39) | −0.01 | 0.19 | 600 | 8.75 | ||
women | 1.79 (1.17–2.54) | 0.59 | 0.20 | 411 | 10.37 | ||
[94] | Rostron (2013) | both sexes | 2.47 (1.04–5.86) | 0.90 | 0.44 | 7,586 | 2.91 |
[73] | Wen et al. (2006) | women | 1.37 (1.06–1.78) | 0.31 | 0.13 | 72,829 | 19.64 |
[96] | Whincup et al. (2004) | men | 1.67 (0.91–3.07) | 0.51 | 0.31 | 945 | 3.15 |
Sex
|
RR (95 % CI) |
Q
|
p
|
I
2
| |||
Synthesis | both sexes | 1.27 (1.10–1.48) | 7.22 | 0.205 | 30.78 | ||
men | 1.06 (0.96–1.19) | 3.46 | 0.629 | 0.00 | |||
women | 1.50 (1.31–1.72) | 9.52 | 0.300 | 16.00 |
SHS and chronic obstructive pulmonary disease
Nr. |
Authors
|
Sex
|
RR (95 % CI) |
log (rr) |
se
|
n
|
w (%) |
---|---|---|---|---|---|---|---|
[72] | Chan-Yeung et al. (2007) | both sexes | 1.64 (0.97–2.03) | 0.49 | 0.19 | 578 | 25.96 |
[24] | McGhee et al. (2005) | both sexes | 1.81 (1.24–2.65) | 0.59 | 0.19 | 5,601 | 24.55 |
men | 1.50 (0.96–2.28) | 0.41 | 0.22 | 3,098 | 100.00a
| ||
women | 2.59 (1.30–5.27) | 0.95 | 0.36 | 2,503 | 24.69 | ||
[95] | Schwartz et al. (2009) | women | 1.68 (1.12–2.61) | 0.52 | 0.22 | 1,126 | 51.40 |
[75] | Wu et al. (2010) | women | 3.12 (1.56–6.50) | 1.14 | 0.36 | 410 | 23.91 |
[71] | Yin et al. (2007) | both sexes | 1.60 (1.23–2.10) | 0.47 | 0.14 | 15,379 | 49.49 |
Sex
|
RR (95 % CI) |
Q
|
p
|
I
2
| |||
Synthesis | both sexes | 1.66 (1.38–2.00) | 0.28 | 0.871 | 0.00 | ||
men | 1.50 (0.96–2.28)a
| ||||||
women | 2.17 (1.48–3.18) | 2.60 | 0.273 | 22.95 |
SHS and stroke
Nr. |
Authors
|
Sex
|
RR (95 % CI) |
log (rr) |
se
|
n
|
w (%) |
---|---|---|---|---|---|---|---|
[26] | Bonita et al. (1999) | both sexes | 1.65 (1.28–2.16) | 0.50 | 0.13 | 2,372 | 15.23 |
men | 1.87 (1.27–2.77) | 0.63 | 0.20 | 1,213 | 25.68 | ||
women | 1.53 (1.06–2.22) | 0.43 | 0.19 | 1,159 | 9.27 | ||
[48] | Glymour et al. (2008) | both sexes | 1.42 (1.02–1.92) | 0.35 | 0.16 | 16,225 | 10.48 |
men | 1.63 (0.83–2.70) | 0.49 | 0.30 | 8,112 | 14.39 | ||
women | 1.46 (1.00–2.18) | 0.38 | 0.20 | 8,113 | 8.34 | ||
[43] | Iribarren et al. (2004) | both sexes | 1.42 (1.08–1.88) | 0.35 | 0.14 | 27,698 | 13.60 |
men | 1.29 (0.75–2.20) | 0.25 | 0.27 | 10,482 | 16.56 | ||
women | 1.50 (1.07–2.09) | 0.41 | 0.17 | 17,216 | 11.30 | ||
[24] | McGhee et al. (2005) | both sexes | 1.24 (1.08–1.42) | 0.22 | 0.07 | 5,601 | 52.98 |
men | 1.16 (0.92–1.44) | 0.15 | 0.11 | 3,098 | 43.38 | ||
women | 1.27 (1.06–1.53) | 0.24 | 0.09 | 2,503 | 37.59 | ||
[73] | Wen et al. (2006) | women | 1.52 (1.08–2.15) | 0.42 | 0.18 | 72,829 | 10.68 |
[25] | You et al. (1999) | both sexes | 1.44 (0.96–2.01) | 0.36 | 0.19 | 367 | 7.71 |
[74] | Zhang et al. (2005) | women | 1.62 (1.28–2.05) | 0.48 | 0.12 | 60,377 | 22.83 |
Sex
|
RR (95 % CI) |
Q
|
p
|
I
2
| |||
Synthesis | both sexes | 1.35 (1.22–1.50) | 4.08 | 0.395 | 2.08 | ||
men | 1.40 (1.09–1.81) | 4.84 | 0.184 | 37.95 | |||
women | 1.43 (1.28–.61) | 3.02 | 0.697 | 0.00 |