Case-Spouse Control Design in Practice: An Experience in Estimating Smoking and Chronic Obstructive Pulmonary Disease Deaths in

Background/Purpose: We assessed the effect of smoking on death from chronic obstructive pulmonary disease (COPD) in China by employing a large population-based, case–spouse control study design using data from a nationwide survey of mortality. Methods: During 1989–1991, a nationwide retrospective survey of mortality was conducted in China. For approximately 1,000,000 adults dying from all causes during 1986–1988, their surviving spouses or other informants provided detailed information about their own as well as the deceased person’s smoking history. For this study, 183,393 individuals who died of COPD at age ≥ 40 years were taken as cases, while 272,984 sex-matched surviving spouses of subjects who died from any cause were taken as controls. Results: COPD death rates for smokers were more than twice as high as those of non-smokers, with a dose–response risk pattern, despite the fact that COPD death rates varied widely by region and age. Tobacco accounted for 41.4% of COPD deaths in men, but only 13.5% of those in women, who had a lower rate of smoking. Conclusion: A case–spouse control study, as an alternative design, is valid and feasible in utilizing information from population-based, retrospective mortality survey data for an analytical epidemiological study of disease etiology.