21st-Century Hazards of Smoking and Benefits of Cessation in the United States

Center for Global Health Research, Toronto, ON M5C 1N8, Canada.
New England Journal of Medicine (Impact Factor: 55.87). 01/2013; 368(4):341-50. DOI: 10.1056/NEJMsa1211128
Source: PubMed


Extrapolation from studies in the 1980s suggests that smoking causes 25% of deaths among women and men 35 to 69 years of age in the United States. Nationally representative measurements of the current risks of smoking and the benefits of cessation at various ages are unavailable.
We obtained smoking and smoking-cessation histories from 113,752 women and 88,496 men 25 years of age or older who were interviewed between 1997 and 2004 in the U.S. National Health Interview Survey and related these data to the causes of deaths that occurred by December 31, 2006 (8236 deaths in women and 7479 in men). Hazard ratios for death among current smokers, as compared with those who had never smoked, were adjusted for age, educational level, adiposity, and alcohol consumption.
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% confidence interval [CI], 2.7 to 3.3; hazard ratio for men, 2.8; 99% CI, 2.4 to 3.1). Most of the excess mortality among smokers was due to neoplastic, vascular, respiratory, and other diseases that can be caused by smoking. The probability of surviving from 25 to 79 years of age was about twice as great in those who had never smoked as in current smokers (70% vs. 38% among women and 61% vs. 26% among men). Life expectancy was shortened by more than 10 years among the current smokers, as compared with those who had never smoked. Adults who had quit smoking at 25 to 34, 35 to 44, or 45 to 54 years of age gained about 10, 9, and 6 years of life, respectively, as compared with those who continued to smoke.
Smokers lose at least one decade of life expectancy, as compared with those who have never smoked. Cessation before the age of 40 years reduces the risk of death associated with continued smoking by about 90%.

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Available from: Robert N Anderson, Dec 26, 2013
    • "Indeed, smoking alone may explain as much as 25% of the risk of mortality at midlife (Jha et al. 2013). It therefore follows that modifying health behaviors drastically reduces morbidity and mortality (Hyland, Barnoya and Corral 2012; Jha et al. 2013). Health behaviors are routinely modified in both individuals and throughout whole populations as a result of trends in political, economic, and technological change. "
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    ABSTRACT: Education is a fundamental cause of social inequalities in health because it influences the distribution of resources, including money, knowledge, power, prestige, and beneficial social connections, that can be used in situ to influence health. Recent studies have highlighted early-life cognition as commonly indicating the propensity for educational attainment and determining health and age of mortality. Health behaviors provide a plausible mechanism linking both education and cognition to later-life health and mortality. We examine the role of education and cognition in predicting smoking, heavy drinking, and physical inactivity at midlife using data from the Wisconsin Longitudinal Study (N = 10,317), National Survey of Health and Development (N = 5,362), and National Childhood Development Study (N = 16,782). Adolescent cognition was associated with education but was inconsistently associated with health behaviors. Education, however, was robustly associated with improved health behaviors after adjusting for cognition. Analyses highlight structural inequalities over individual capabilities when studying health behaviors. © American Sociological Association 2015.
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    • "Smoking is a leading cause of preventable death and disability worldwide (Knopik et al., 2012; Schroeder, 2013; Thun et al., 2013; Whiteford and Baxter, 2013), and smoking cessation greatly diminishes the increased risk of mortality (Jha et al., 2013). Two pharmacotherapies have been shown to be more effective than others for smoking cessation: combination Nicotine Replacement Therapy (cNRT) and varenicline (Fiore and Baker, 2011; Fiore et al., 2008; Piper et al., 2009). "
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    • "The benefits of smoking cessation are dramatic for all age groups ( Jha et al., 2013; Pirie, Peto, Reeves, Green, & Beral, 2013). Those who quit smoking between ages 25 and 34 live 10 years longer than those who do not quit; those who quit between ages 35 and 44 gain 9 years of life, those who quit between ages 45 and 54 gain 6 years, and those who quit between ages 55 and 64 gain 4 years compared to those who do not quit smoking ( Jha et al., 2013). Smoking cessation in those with schizophrenia with multiple cardiovascular risk factors has been reported to drive reduction in Framingham cardiovascular risk despite abstinence associated weight gain (Thorndike, Achytes, Cather, Pachas, & Achtyes, In press). "
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