Study Looks at 50-Year Trends in Smoking-Related Mortality

Two separate studies published on Jan. 23 in The New England Journal of Medicine look at smoking in the U.S., specifically the trends in smoking-related mortality over 50 years, and the hazards of smoking and benefits of cessation.

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The first examined 50-year trends in smoking-related mortality and found that the risk of death from cigarette smoking continues to increase among women and the higher risk is now nearly identical for men and women.

Looking at temporal trends in mortality from 1959-1965, 1982-1988, and 2000-2010, results showed that in women who were current smokers, compared with women who had never smoked, the relative risks of death from lung cancer were 2.73, 12.65, and 25.66 in the 1960s, 1980s, and contemporary cohorts, respectively; while corresponding relative risks for male current smokers as compared with men who had never smoked, were 12.22, 23.81 and 24.97. In the contemporary cohorts, male and female current smokers also had similar relative risks for death from COPD (25.61 for men and 22.35 for women), ischemic heart disease (2.50 for men and 2.86 for women), any type of stroke (1.92 for men and 2.10 for women), and all causes combined (2.80 for men and 2.76 for women).

In addition, the authors note the risks associated with smoking in men plateaued at the levels seen in the 1980s, but there was a continued increase in mortality from chronic obstructive pulmonary disease (COPD). They add that their findings show "the rate of death from all causes combined is now at least three times as high among current smokers as among those who have never smoked." They conclude that their analysis confirms that quitting smoking at any age dramatically lowers mortality from all major smoking-related diseases.

A separate study looked at the hazards of smoking and benefits of cessation, and found that smokers loose at least one decade of life expectancy, as compared with those who have never smoked. In addition, cessation before the age of 40 years reduces the risk of death associated with continued smoking by about 90 percent.

Looking at smoking and smoking-cessation histories of 113,752 women and 88,496 men ages 25 and older, results showed for participants who were 25 to 79 years of age, the rate of death from any cause among current smokers was about three times that among those who had never smoked (hazard ratio for women, 3.0; 99 percent CI, 2.7 to 3.3; hazard ratio for men, 2.8; 99 percent CI, 2.4 to 3.1). Further, the probability of surviving from 25 to 79 years of age was about twice as great in those who had never smoked when compared with current smokers (70 percent vs. 38 percent among women and 61 percent vs. 26 percent among men). In addition, life expectancy was shortened by more than 10 years among current smokers, as compared to those who had never smoked.

The authors note that "cessation at around 40 years of age results in approximately 90 percent reduction in the excess risk of death associated with continued smoking in later middle age and older age … [however] that is not to say that it is safe to smoke until 40 years of age and stop." They add that their findings highlight the worldwide importance of tobacco control and note that the recent increase of taxes on cigarette packages in addition to recent federal mass-media campaigns and the extension of insurance coverage within the Affordable Care Act are likely to raise cessation rates.

In a related editorial comment, Steven A. Schroeder, MD, from the Department of Medicine, University of California, San Francisco, notes that both articles "confirm that smoking remains a huge threat to the public’s health." He adds that there are two important messages drawn from the articles: "in terms of health benefits, it is never too late to quit," and "the importance of smoking as a health hazard needs to be elevated." He adds, "The need for greater attention to the policies known to reduce the prevalence of smoking remains urgent."

Clinical Topics: Prevention, Smoking

Keywords: Risk, Myocardial Ischemia, Stroke, Life Expectancy, Smoking, New England, Prevalence, Pulmonary Disease, Chronic Obstructive, Tobacco, San Francisco, Tobacco Use Disorder, United States, Lung Neoplasms, Smoking Cessation

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