烟草吸烟对人类具有致癌作用。除了香烟这种最常见的烟草吸烟形式外，鲜有证据证明水烟斗对鼻咽癌的致癌性作用。本研究调查了水烟斗吸烟与鼻咽癌死亡的关联。我们对越南北部九个社区的20,144名合格男性参与者进行了2007年至2019年的追踪调查。通过面对面访谈采集了独立水烟斗和香烟吸烟以及膳食摄入数据，使用结构化半定量食物频率和生活方式问卷。通过访问国家卫生设施的医疗记录确定鼻咽癌的发生情况。我们估计了Cox比例风险比和95%置信区间，HR（95% CI）。从未吸烟者、独立水烟斗吸烟者、独立香烟吸烟者和水烟斗和香烟双重吸烟者的比例分别为55.8%、14.5%、16.6%和13.1%。与独立吸烟者相比，仅水烟斗吸烟者导致鼻咽癌死亡的风险增加，HR（95% CI）为4.51（1.25, 16.31），p = 0.022。高强度水烟斗吸烟、年龄较早开始吸烟、吸烟时间较长和累计吸烟年数与鼻咽癌之间存在剂量依赖的正相关关系，HR（95% CI）分别为1.35（1.07, 1.71）、1.26（1.06, 1.50）、1.31（1.04, 1.66）和1.37（1.08, 1.74）。我们观察到男性独立水烟斗吸烟与鼻咽癌之间存在显著的正相关关系。研究结果表明，水烟斗吸烟可能比香烟更有害于发展这种癌症。强烈建议采取有力的烟草控制措施禁止水烟斗吸烟。© 2023. Springer Nature Limited.

Tobacco smoking is carcinogenic to humans. Besides cigarettes, the most common form of tobacco smoking, there was sparse evidence of waterpipe's carcinogenicity-induced nasopharyngeal cancer (NPC). This study investigated the association between waterpipe smoking and NPC mortality. Our study followed up with 20,144 eligible man participants from nine northern Vietnam communes between 2007 and 2019. Face-to-face interviews were conducted to gather data on exclusive waterpipe and cigarette smoking and dietary intake using structured semi-quantitative food frequency and lifestyle questionnaires. Nasopharyngeal cancer was determined by accessing the medical records at the state health facilities. We estimated the Cox proportional hazard ratio and 95% confidence intervals, HR (95% CI). The proportion of never smokers, exclusive waterpipe, exclusive cigarette, and dual waterpipe and cigarette smokers was 55.8%, 14.5%, 16.6%, and 13.1%, respectively. Exclusively waterpipe smokers increased the risk of NPC death compared to exclusively cigarette smokers, HR (95% CI): 4.51 (1.25, 16.31), p = 0.022. A dose-dependent positive relationship between NPC and exclusive waterpipe smoking was significantly seen for higher intensity HR (95% CI): 1.35 (1.07, 1.71), earlier age of smoking initiation HR (95% CI): 1.26 (1.06, 1.50), longer duration HR (95% CI): 1.31 (1.04, 1.66), and the cumulative number of a smoke lifetime HR (95% CI): 1.37 (1.08, 1.74). We observed a significant positive association between exclusive waterpipe smoking and NPC in men. The findings suggested that waterpipe smoking is likely more harmful than cigarettes in developing this cancer. A firm tobacco control against waterpipe smoking is highly recommended.© 2023. Springer Nature Limited.