Smoking and smoking cessation in relation to mortality in women (original) (raw)
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]
Prospective cohort study of cigarette smoking and colorectal cancer risk in women
International Journal of Cancer, 2002
Epidemiological studies have consistently found a positive association between cigarette smoking and risk of colorectal adenomas, so the absence of a clear association between smoking and colorectal cancer risk may seem paradoxical. However, if colorectal cancer develops only after an induction period of about 35 years, as has been proposed recently, then studies in which all subjects have fewer than about 35 years between smoking commencement and assessment of outcome would be unlikely to detect this association. Few studies have examined smoking of several decades' duration among women. Therefore, in the cohort study reported here, we used proportional hazards models to estimate hazard ratios relating cigarette smoking to colorectal cancer risk among 89,835 women aged 40 -59 years at recruitment into the Canadian National Breast Screening Study, a randomized controlled trial of mammography screening for breast cancer. During an average 10.6 years of follow-up (936,433 person-years), a total of 527 women were diagnosed with incident colorectal cancer (363 colon and 164 rectal). We found that smoking was associated with increased risk of rectal cancer 30 years or more after commencement, and especially with smoking of 40 years' duration or longer (hazard ratio,41.3؍ 95% CI.)24.7-33.1؍ There was little evidence for altered risk of colon cancer. These results, along with those of other recent studies, support the hypothesis that tobacco smoking is an initiator, rather than a promoter, of rectal cancer. However, the results do not support an association with colon cancer risk, even with smoking of very long duration and high intensity.
American Journal of Epidemiology, 2002
The authors investigated the association between changes in smoking habits and mortality by pooling data from three large cohort studies conducted in Copenhagen, Denmark. The study included a total of 19,732 persons who had been examined between 1967 and 1988, with reexaminations at 5- to 10-year intervals and a mean follow-up of 15.5 years. Date of death and cause of death were obtained by record linkage with nationwide registers. By means of Cox proportional hazards models, heavy smokers (>or=15 cigarettes/day) who reduced their daily tobacco intake by at least 50% without quitting between the first two examinations and participants who quit smoking were compared with persons who continued to smoke heavily. After exclusion of deaths occurring in the first 2 years of follow-up, the authors found the following adjusted hazard ratios for subjects who reduced their smoking: for cardiovascular diseases, hazard ratio (HR) = 1.01 (95% confidence interval (CI): 0.76, 1.35); for respiratory diseases, HR = 1.20 (95% CI: 0.70, 2.07); for tobacco-related cancers, HR = 0.91 (95% CI: 0.63, 1.31); and for all-cause mortality, HR = 1.02 (95% CI: 0.89, 1.17). In subjects who stopped smoking, most estimates were significantly lower than the heavy smokers'. These results suggest that smoking reduction is not associated with a decrease in mortality from tobacco-related diseases. The data confirm that smoking cessation reduces mortality risk.
International Journal of Cancer, 2017
An increasing proportion of US smokers smoke ≤10 cigarettes per day (CPD) or do not smoke every day, yet the health effects of low-intensity smoking are poorly understood. We identified lifelong smokers of <1 or 1-10 CPD and evaluated risk of incident cancer among 238,525 cancerfree adults, aged 59-82, in the NIH-AARP Diet and Health Study. A questionnaire administered in 2004-2005 assessed CPD during nine age-periods (<15 to ≥70). We estimated hazard ratios (HR) and 95% confidence intervals (CI) using multivariable-adjusted Cox proportional hazards regression with age as the underlying time metric. Of the 18,233 current smokers (7.6%), 137 and 1,243 reported consistently smoking <1 CPD and 1-10 CPD, respectively. Relative to never smokers, current smokers who reported consistently smoking 1-10 CPD over their lifetime were 2.34 (95% CI=1.86-2.93) times more likely to develop smoking-related cancer. Current lifetime smokers of <1 CPD were 1.89 (95% CI=0.90-3.96) times more likely to develop tobacco-related cancer, although the association did not reach statistical significance. Associations were observed for lifelong smoking of ≤10 CPD with lung cancer (HR=9.65, 95% CI=6.93-13.43); bladder cancer (HR=2.22, 95% CI=1.22-4.05); and pancreatic cancer (HR=2.03, 95%CI: 1.05-3.95). Among lifelong ≤10 CPD smokers, former smokers had lower risks of smoking-related cancer with longer time since cessation and longer smoking duration. Lifelong <1 and 1-10 CPD smokers are at increased risk of incident cancer relative to never smokers and would benefit from cessation, providing further evidence that even even low-levels of cigarette smoking cause cancer.
Underlying and multiple causes of death related to smoking
Population Research and Policy …, 1994
Although smoking has been linked to various causes of death, there is no systematic account of the underlying and multiple cause-of-death distributions associated with various smoking statuses. We analyze such patterns by age and gender for the USA in 1986. Our study is based on a one-percent random sample of decedents 25 and over in the USA for whom survey data from informants were linked to death certificate data. Smoking is related to several underlying causes of death, the most common being circulatory diseases. Lung cancer is less prevalent than circulatory diseases or other cancers among ever smokers. Multiple medical conditions are common for both smokers and nonsmokers, but particular combinations vary among persons with different smoking statuses. Former smokers who quit soon before death and were under frequent medical care are most likely to have had lung cancer. Amount of smoking is tied to variations in cause-of-death patterns. Differences by age and gender are not substantial, although other cancers appear frequently for both smokers and non-smokers among women. The distribution of medical causes of death for ever smokers is not radically different from that of never smokers. However, differences in cause patterns are seen when smoking statuses are detailed by amount of smoking and timing of quitting. These similarities and differences in cause patterns must be related to the fundamental fact that the average smoker will die earlier than the average nonsmoker. Such findings should especially influence programs for diseases whose links to smoking have been underestimated.
Cigarette Smoking and Colorectal Cancer Risk: A Burning Issue
Gastroenterology, 2008
Cigarette smoking is an established risk factor for colorectal cancer. Because colorectal carcinogenesis is a heterogeneous process, we investigated whether cigarette smoking is differentially associated with molecularly defined subtypes of colorectal cancer.