Zainab Alimoradi, Chung-Ying Lin, Daniel T. Myran, Marco Solmi, Amir H. Pakpour
{"title":"与大麻使用相关的全因死亡率的相对风险：队列研究的系统回顾和荟萃分析","authors":"Zainab Alimoradi, Chung-Ying Lin, Daniel T. Myran, Marco Solmi, Amir H. Pakpour","doi":"10.1002/hsr2.71212","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background and Aims</h3>\n \n <p>Cannabis use has high prevalence and health burden. Although the effects of cannabis use have been studied in the literature, no systematic review and meta-analysis has measured its association with all-cause mortality. The aim of this systematic review and meta-analysis was to systematically synthesize the evidence on association between cannabis use and all-cause mortality.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Following the preregistered protocol (PROSPERO: CRD42023396915), we searched in Scopus, PubMed, Web of Science and ProQuest databases until end of October 2023. We included cohort studies comparing individuals using versus not using cannabis and measuring the association with all-cause mortality. A random-effect meta-analysis was conducted calculating the risk ratio (RR) and 95% confidence interval (CI). Heterogeneity and publication bias were measured. Sensitivity and meta-regression analyses were conducted. The Newcastle Ottawa Scale (NOS) was used to assess study quality.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Fourteen cohort studies were included (prospective 50%), reporting on 17,545,076 participants (3,000,667 people who use cannabis [PWUC]). The overall RR estimation of all-cause mortality among PWUC versus nonusers was 1.53 (95% CI: 1.09; 2.14, <i>I</i><sup>2</sup>: 98%; <i>τ</i><sup>2</sup>: 0.38). Significantly different RR was observed in prospective versus retrospective designs (2.07 vs. 1.11); cohorts of the general population versus patients (2.53 vs. 1.03). Study sample size was a significant moderator of the association between cannabis use and all-cause mortality, with larger sample size being associated with smaller effect size and less heterogeneity. Based on GRADE assessment, observational evidence, with unadjusted estimates, high heterogeneity with inconsistent results, the overall certainty of evidence seems to be low.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Cannabis use was associated with an increased risk of all-cause mortality in the general population but not in patients with severe underlying medical co-morbidities. It should be noted that the evidence may currently be biased and new methodologically strong studies need to be conducted.</p>\n </section>\n </div>","PeriodicalId":36518,"journal":{"name":"Health Science Reports","volume":"8 10","pages":""},"PeriodicalIF":2.1000,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hsr2.71212","citationCount":"0","resultStr":"{\"title\":\"Relative Risk of All-Cause Mortality Associated With Cannabis Use: A Systematic Review and Meta-Analysis of Cohort Studies\",\"authors\":\"Zainab Alimoradi, Chung-Ying Lin, Daniel T. Myran, Marco Solmi, Amir H. Pakpour\",\"doi\":\"10.1002/hsr2.71212\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background and Aims</h3>\\n \\n <p>Cannabis use has high prevalence and health burden. Although the effects of cannabis use have been studied in the literature, no systematic review and meta-analysis has measured its association with all-cause mortality. The aim of this systematic review and meta-analysis was to systematically synthesize the evidence on association between cannabis use and all-cause mortality.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>Following the preregistered protocol (PROSPERO: CRD42023396915), we searched in Scopus, PubMed, Web of Science and ProQuest databases until end of October 2023. We included cohort studies comparing individuals using versus not using cannabis and measuring the association with all-cause mortality. A random-effect meta-analysis was conducted calculating the risk ratio (RR) and 95% confidence interval (CI). Heterogeneity and publication bias were measured. Sensitivity and meta-regression analyses were conducted. The Newcastle Ottawa Scale (NOS) was used to assess study quality.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Fourteen cohort studies were included (prospective 50%), reporting on 17,545,076 participants (3,000,667 people who use cannabis [PWUC]). The overall RR estimation of all-cause mortality among PWUC versus nonusers was 1.53 (95% CI: 1.09; 2.14, <i>I</i><sup>2</sup>: 98%; <i>τ</i><sup>2</sup>: 0.38). Significantly different RR was observed in prospective versus retrospective designs (2.07 vs. 1.11); cohorts of the general population versus patients (2.53 vs. 1.03). Study sample size was a significant moderator of the association between cannabis use and all-cause mortality, with larger sample size being associated with smaller effect size and less heterogeneity. Based on GRADE assessment, observational evidence, with unadjusted estimates, high heterogeneity with inconsistent results, the overall certainty of evidence seems to be low.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>Cannabis use was associated with an increased risk of all-cause mortality in the general population but not in patients with severe underlying medical co-morbidities. It should be noted that the evidence may currently be biased and new methodologically strong studies need to be conducted.</p>\\n </section>\\n </div>\",\"PeriodicalId\":36518,\"journal\":{\"name\":\"Health Science Reports\",\"volume\":\"8 10\",\"pages\":\"\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2025-09-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hsr2.71212\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Health Science Reports\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/hsr2.71212\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Health Science Reports","FirstCategoryId":"1085","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/hsr2.71212","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
摘要
背景和目的大麻使用具有高流行率和健康负担。虽然大麻使用的影响已经在文献中进行了研究，但没有系统的回顾和荟萃分析衡量其与全因死亡率的关系。本系统综述和荟萃分析的目的是系统地综合大麻使用与全因死亡率之间关系的证据。方法按照预先注册的协议（PROSPERO: CRD42023396915），在Scopus、PubMed、Web of Science和ProQuest数据库中检索至2023年10月底。我们纳入了队列研究，比较使用大麻和不使用大麻的个体，并测量其与全因死亡率的关系。进行随机效应荟萃分析，计算风险比（RR）和95%置信区间（CI）。测量异质性和发表偏倚。进行敏感性和meta回归分析。采用纽卡斯尔渥太华量表（NOS）评价研究质量。结果纳入14项队列研究（预期为50%），报告了17,545,076名参与者（3,000,667名大麻使用者[PWUC]）。全因死亡率在PWUC与非使用者之间的总RR估计为1.53 （95% CI: 1.09; 2.14, I2: 98%; τ2: 0.38）。在前瞻性和回顾性设计中观察到显著不同的RR(2.07比1.11)；普通人群与患者的队列（2.53 vs 1.03）。研究样本量是大麻使用与全因死亡率之间关系的重要调节因素，样本量越大，效应越小，异质性越小。基于GRADE评估，观察性证据，未经调整的估计值，高异质性和不一致的结果，证据的总体确定性似乎很低。结论：在一般人群中，大麻使用与全因死亡风险增加有关，但在有严重潜在医疗合并症的患者中则无相关。应该指出的是，目前的证据可能存在偏见，需要进行新的方法学上强有力的研究。
Relative Risk of All-Cause Mortality Associated With Cannabis Use: A Systematic Review and Meta-Analysis of Cohort Studies
Background and Aims
Cannabis use has high prevalence and health burden. Although the effects of cannabis use have been studied in the literature, no systematic review and meta-analysis has measured its association with all-cause mortality. The aim of this systematic review and meta-analysis was to systematically synthesize the evidence on association between cannabis use and all-cause mortality.
Methods
Following the preregistered protocol (PROSPERO: CRD42023396915), we searched in Scopus, PubMed, Web of Science and ProQuest databases until end of October 2023. We included cohort studies comparing individuals using versus not using cannabis and measuring the association with all-cause mortality. A random-effect meta-analysis was conducted calculating the risk ratio (RR) and 95% confidence interval (CI). Heterogeneity and publication bias were measured. Sensitivity and meta-regression analyses were conducted. The Newcastle Ottawa Scale (NOS) was used to assess study quality.
Results
Fourteen cohort studies were included (prospective 50%), reporting on 17,545,076 participants (3,000,667 people who use cannabis [PWUC]). The overall RR estimation of all-cause mortality among PWUC versus nonusers was 1.53 (95% CI: 1.09; 2.14, I2: 98%; τ2: 0.38). Significantly different RR was observed in prospective versus retrospective designs (2.07 vs. 1.11); cohorts of the general population versus patients (2.53 vs. 1.03). Study sample size was a significant moderator of the association between cannabis use and all-cause mortality, with larger sample size being associated with smaller effect size and less heterogeneity. Based on GRADE assessment, observational evidence, with unadjusted estimates, high heterogeneity with inconsistent results, the overall certainty of evidence seems to be low.
Conclusion
Cannabis use was associated with an increased risk of all-cause mortality in the general population but not in patients with severe underlying medical co-morbidities. It should be noted that the evidence may currently be biased and new methodologically strong studies need to be conducted.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
