Background Despite an increasing proportion of smokers who use non-cigarette products, the harmfulness of these is inconsistent. This study aimed to evaluate the impact of waterpipe tobacco (WTP) smoking on all-cause mortality. Methods A prospective cohort study followed up on 35 646 participants from 2007 to 2019 in Northern Viet Nam. Data for each type of cigarette and WTP smoking were collected based on demographic lifestyle and semi-quantitative food frequency questionnaires. Smokers were categorized as current smokers and former smokers who were lifetime ever smokers but stopped smoking >6 months before the interview. Data on all-cause mortality (2449 deaths) were obtained from medical records at the state health facilities. The hazard ratios (HRs) and 95% CIs for mortality were estimated using a Cox proportional-hazards model. Results Compared with non-smokers, ever smokers had a higher all-cause mortality risk (HR = 1.29, 95% CI = 1.16–1.43). Current WTP (HR = 1.37, 95% CI = 1.19–1.57), current cigarette (HR = 1.40, 95% CI = 1.22–1.60) and former WTP smokers (HR = 1.39, 95% CI = 1.10–1.76) showed an elevated risk of dying. The mortality risk was significantly elevated in dual smokers using WTP and cigarettes (HR = 1.55, 95% CI = 1.35–1.79) and exclusive WTP smokers (HR = 1.38, 95% CI = 1.21–1.57). Elevated risk was observed for the main targeted attractions of cancer, diabetes and heart diseases. Smoking cessation of >10 years decreased the risk of all-cause mortality (HR = 0.61, 95% CI = 0.44–0.85) and cancer (HR = 0.24, 95% CI = 0.11–0.52). Conclusions WTP smoking increases the risk of all-cause mortality. A unique programme to control exposure to WTP should be a high priority in Viet Nam and other countries.

中文翻译：

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吸水烟与全因死亡风险：一项前瞻性队列研究

背景 尽管使用非香烟产品的吸烟者比例不断增加，但这些产品的危害性并不一致。本研究旨在评估吸水烟 (WTP) 对全因死亡率的影响。方法 一项前瞻性队列研究对 2007 年至 2019 年越南北部的 35 646 名参与者进行了随访。根据人口生活方式和半定量食物频率调查问卷收集每种类型香烟和吸烟意愿的数据。吸烟者被分为当前吸烟者和曾经吸烟者，后者是终生吸烟但在访谈前超过6个月停止吸烟的人。全因死亡率（2449 例死亡）的数据来自州卫生机构的医疗记录。使用 Cox 比例风险模型估算死亡率的风险比 (HR) 和 95% CI。结果与不吸烟者相比，曾经吸烟者的全因死亡风险更高（HR = 1.29，95% CI = 1.16–1.43）。目前的 WTP（HR = 1.37，95% CI = 1.19–1.57）、当前吸烟者（HR = 1.40，95% CI = 1.22–1.60）和以前的 WTP 吸烟者（HR = 1.39，95% CI = 1.10–1.76）显示出死亡风险增加。使用 WTP 和香烟的双重吸烟者（HR = 1.55，95% CI = 1.35–1.79）和仅 WTP 吸烟者（HR = 1.38，95% CI = 1.21–1.57）的死亡风险显着升高。癌症、糖尿病和心脏病等主要目标风险较高。戒烟超过 10 年可降低全因死亡（HR = 0.61，95% CI = 0.44–0.85）和癌症（HR = 0.24，95% CI = 0.11–0.52）的风险。结论 WTP 吸烟会增加全因死亡的风险。越南和其他国家应高度优先考虑制定控制 WTP 暴露的独特计划。