Smoking and smoking cessation in relation to mortality in women (original) (raw)
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Smoking and Mortality—Beyond Established Causes
BACKGROUND Mortality among current smokers is 2 to 3 times as high as that among persons who never smoked. Most of this excess mortality is believed to be explained by 21 common diseases that have been formally established as caused by cigarette smoking and are included in official estimates of smoking-attributable mortality in the United States. However, if smoking causes additional diseases, these official estimates may significantly underestimate the number of deaths attributable to smoking. METHODS We pooled data from five contemporary U.S. cohort studies including 421,378 men and 532,651 women 55 years of age or older. Participants were followed from 2000 through 2011, and relative risks and 95% confidence intervals were estimated with the use of Cox proportional-hazards models adjusted for age, race, educational level, daily alcohol consumption, and cohort. RESULTS During the follow-up period, there were 181,377 deaths, including 16,475 among current smokers. Overall, approximately 17% of the excess mortality among current smokers was due to associations with causes that are not currently established as attributable to smoking. These included associations between current smoking and deaths from renal failure (relative risk, 2.0; 95% confidence interval [CI], 1.7 to 2.3), intestinal ischemia (relative risk, 6.0; 95% CI, 4.5 to 8.1), hypertensive heart disease (relative risk, 2.4; 95% CI, 1.9 to 3.0), infections (relative risk, 2.3; 95% CI, 2.0 to 2.7), various respiratory diseases (relative risk, 2.0; 95% CI, 1.6 to 2.4), breast cancer (relative risk, 1.3; 95% CI, 1.2 to 1.5), and prostate cancer (relative risk, 1.4; 95% CI, 1.2 to 1.7). Among former smokers, the relative risk for each of these outcomes declined as the number of years since quitting increased. CONCLUSIONS A substantial portion of the excess mortality among current smokers between 2000 and 2011 was due to associations with diseases that have not been formally established as caused by smoking. These associations should be investigated further and, when appropriate, taken into account when the mortality burden of smoking is investigated. (Funded by the American Cancer Society.
Proportions of Cancer Deaths Attributable to Cigarette Smoking in Women
Women & Health, 1989
Over two-thirds of a million American women mostly over a e 45 were enrolled in a prospective mortality study in k 1982 and fol owed up for four years. In this time per~od 1,527 women died of six smoking-related cancer sites: oral cavity, esophagus, pancreas, larynx, lung, and bladder. Age-adjusted death rates in nonsmokers were used to obtain smoking-attributable risks and numbers of deaths due to these six cancers. Among current smokers, 601 deaths (85.5% of current smokers' deaths) were attributable to cigarette smoking, and among former smokers 284 (69.3% of exsmokers' deaths) were attributable to smoking. Cigarette smoking accounted for 885 excess deaths at these sites, giving a populationattributable risk of 57.9%. Over three-quarters of these excess deaths were due to lung cancer. Cigarette smoking, despite increases in smoking cessation, is still responsible for well over half of the deaths from these six types of cancer in women.
Smoking Cessation and Lung Cancer Mortality in a Cohort of Middle-aged Canadian Women
Annals of Epidemiology, 2005
To determine the impact of smoking cessation on lung cancer mortality among women. METHODS: Survival analysis is used to assess the effect of smoking cessation on lung cancer death in the dietary cohort of 49,165 women aged 40 to 59 years enrolled in the Canadian National Breast Screening Study. RESULTS: During an average of 10.3 years of follow-up, 106 women died of lung cancer. The risk of lung cancer mortality among women who quit before age 50 (HR Z 0.26; 95% CI, 0.13-0.55 among women who quit at ages 40-49) or quit in the previous 10 years (HR Z 0.39; 95% CI, 0.22-0.69) is substantially lower than the risk among current smokers. Women who quit after age 40 or have quit for less than 20 years are at substantially higher risk of lung cancer mortality compared with never smokers. Both duration of smoking cessation and age at quitting have independent effects on lung cancer mortality, after controlling for number of cigarettes smoked per day and number of years smoked, as well as other potential confounding variables. CONCLUSION: These findings suggest that programs and policies to promote early cessation of smoking and prevention of relapse should be a public health priority. Ann Epidemiol 2005;15:302-309. Ó 2005 Elsevier Inc. All rights reserved.
The Lancet Oncology, 2008
Background-Whether women are more susceptible than men to lung cancer caused by cigarette smoking has been controversial. We aimed to determine the susceptibility of men and women to cigarette smoking by comparing lung carcinoma incidence rates by stratum of smoking use in the men and women of the National Institutes of Health-AARP cohort. Methods-The analysis included 279,214 men and 184,623 women from eight U.S. states aged 50 to 71 years at study baseline who were mailed a questionnaire between October 13, 1995 and May 6, 1996 and were followed until December 31, 2003. We present age-standardized incidence rates and multivariate adjusted hazard ratios (HR) adjusted for potential confounders, each with 95% confidence intervals (CI). Findings-During follow-up, lung carcinomas occurred in 4,097 men and 2,237 women. Incidence rates were 20.3 per 100,000 person-years (95% CI: 16.3-24.3) in never smoking men (99 carcinomas) and 25.3, 95% CI: 21.3-29.3 in never smoking women (152 carcinomas); for this group, the HR for lung carcinoma was 1.3 (95%CI: 1.0-1.8) for women relative to men. Smoking was associated with increased lung carcinoma risk in both men and women. The incidence rate of current smokers of >2 packs per day was 1,259.2 (95%CI: 1,035.0-1,483.3) in men and 1,308.9 (95%CI: 924.2-1,693.6) in women. Among current smokers, in a model adjusted for typical smoking dose, the HR was 0.9 (95%CI: 0.8-0.9) for women relative to men. For former smokers, in a model adjusted for years of cessation and typical smoking dose, the HR was 0.9 (95%CI: 0.9-1.0) for women relative to men.
Excess mortality among cigarette smokers: changes in a 20-year interval
American Journal of Public Health, 1995
OBJECTIVES: This study was undertaken to examine changes in smoking-specific death rates from the 1960s to the 1980s. METHODS: In two prospective studies, one from 1959 to 1965 and the other from 1982 to 1988, death rates from lung cancer, coronary heart disease, and other major smoking-related diseases were measured among more than 200,000 current smokers and 480,000 lifelong non-smokers in each study. RESULTS: From the first to the second study, lung cancer death rates (per 100,000) among current cigarette smokers increased from 26 to 155 in women and from 187 to 341 in men; the increase persisted after current daily cigarette consumption and years of smoking were controlled for. Rates among nonsmokers were stable. In contrast, coronary heart disease and stroke death rates decreased by more than 50% in both smokers and nonsmokers. The all-cause rate difference between smokers and nonsmokers doubled for women but was stable for men. CONCLUSIONS: Premature mortality (the difference ...
The hazards of death by smoking in middle-aged women
European Journal of Epidemiology, 2013
Recent studies have found that the risk of death continues to increase among female smokers, as compared with women who have never smoked. We wanted to examine the effect of smoking on all-cause and causespecific mortality and calculate the corresponding population attributable fraction (PAF) of mortality in the Norwegian women and cancer study; a nationally representative prospective cohort study. We followed 85,320 women, aged 31-70 years, who completed a questionnaire in 1991-1997, through linkages to national registries through December 2008. Questionnaire data included information on lifestyle factors, including lifetime history of smoking. Poisson regression models were fitted to estimate relative risks (RRs) with 95 % confidence intervals (CIs) adjusting for age, birth cohort, education, postmenopausal status, alcohol consumption and body mass index, all at enrollment. During a mean follow-up time of 14 years 2,842 deaths occurred. Compared with that of never smokers, current smokers had a mortality rate that was double (RR = 2.34; 95 % CI 2.13-2.62) from deaths overall, triple (RR = 3.30; 95 % CI 2.21-4.82) from cerebrovascular disease and myocardial infarction (RR = 3.65; 95 % CI 2.18-6.15), 12 times (RR = 12.16; 95 % CI 7.80-19.00) from lung cancer and seventeen times (RR = 17.00; 95 % CI 5.90-48.78) from chronic obstructive pulmonary diseases. The PAF of mortality due to smoking was 34 % (CI 30-39). In summary, one in three deaths among middle aged women in Norway could have been prevented if the women did not smoke. More middleaged women, than ever before, are dying prematurely due to smoking in Norway.
Cigarette Smoking and Colorectal Cancer Mortality in the Cancer Prevention Study II
2000
Background: Recent studies suggest that long-term cigarette smoking is associated with an increased risk of colorectal cancer. Whether the association is causal or due to confounding remains unclear. Methods: We examined cigarette smoking in relation to colorectal cancer mortality, evaluating smoking duration and recency and controlling for potential confounders in the Cancer Prevention Study II. This prospective nationwide mortality study of 1 184 657 adults (age ≥30 years) was begun by the American Cancer Society in 1982. After exclusions, our analytic cohort included 312 332 men and 469 019 women, among whom 4432 colon or rectal cancer deaths occurred between 1982 and 1996 among individuals who were cancer free in 1982. Rate ratios (RRs) and 95% confidence intervals (CIs) were estimated by fitting Cox proportional hazards models. All statistical tests were two-sided. Results: Multivariate-adjusted colorectal cancer mortality rates were highest among current smokers, were intermediate among former smokers, and were lowest in lifelong nonsmokers. The multivariate-adjusted RR (95% CI) for current compared with never smokers was ) among women. Increased risk was evident after 20 or more years of smoking for men and women combined as compared with never smokers. Risk among current and former smokers increased with duration of smoking and average number of cigarettes smoked per day; risk in former smokers decreased significantly with years since quitting. If the multivariate-adjusted RR estimates in this study do, in fact, reflect causality, then approximately 12% of colorectal cancer deaths among both men and women in the general U.S. population in 1997 were attributable to smoking. Conclusions: Long-term cigarette smoking is associated with increased risk of colorectal cancer mortality in both men and women. Clear reduction in risk is observed with early smoking cessation. [J Natl Cancer Inst 2000;92:1888-96]