Lifetime Smoking History and Cause-Specific Mortality in a Cohort Study with 43 Years of Follow-Up

Abstract

BackgroundIn general, smoking increases the risk of mortality. However, it is less clear how the relative risk varies by cause of death. The exact impact of changes in smoking habits throughout life on different mortality risks is less studied.MethodsWe studied the impact of baseline and lifetime smoking habits, and duration of smoking on the risk of all-cause mortality, mortality of cardiovascular diseases (CVD), chronic obstructive pulmonary disease (COPD), any cancer and of the four most common types of cancer (lung, colorectal, prostate, and breast cancer) in a cohort study (Vlagtwedde-Vlaardingen 1965–1990, with a follow-up on mortality status until 2009, n = 8,645). We used Cox regression models adjusted for age, BMI, sex, and place of residence. Since previous studies suggested a potential effect modification of sex, we additionally stratified by sex and tested for interactions. In addition, to determine which cause of death carried the highest risk we performed competing-risk analyses on mortality due to CVD, cancer, COPD and other causes.ResultsCurrent smoking (light, moderate, and heavy cigarette smoking) and lifetime persistent smoking were associated with an increased risk of all-cause, CVD, COPD, any cancer, and lung cancer mortality. Higher numbers of pack years at baseline were associated with an increased risk of all-cause, CVD, COPD, any cancer, lung, colorectal, and prostate cancer mortality. Males who were lifetime persistent pipe/cigar smokers had a higher risk of lung cancer [HR (95% CI) = 7.72 (1.72–34.75)] as well as all-cause and any cancer mortality. A longer duration of smoking was associated with a higher risk of COPD, any and lung cancer [HR (95% CI) = 1.06 (1.00–1.12), 1.03 (1.00–1.06) and 1.10 (1.03–1.17) respectively], but not with other mortality causes. The competing risk analyses showed that ex- and current smokers had a higher risk of cancer, CVD, and COPD mortality compared to all other mortality causes. In addition, heavy smokers had a higher risk for COPD mortality compared to cancer, and CVD mortality.ConclusionOur study indicates that lifetime numbers of cigarettes smoked and the duration of smoking have different impacts for different causes of mortality. Moreover, our findings emphasize the importance of smoking-related competing risks when studying the smoking-related cancer mortality in a general population and that smoking cessation immediately effectively reduces the risk of all-cause and any cancer mortality.

Joint Effect of Alcohol use and Tobacco Smoke on All-Cause Mortality and Premature Death in China: A Cohort Study

“…It has been noted that women smokers and/or drinker are more likely to have greater mortality risk. This phenomena has been reported in previous publications (1,4,9,19,22,23) assessing smoking or drink risk, even among those with existing diseases, such as diabetes (24). The mechanisms underlying the sex difference in mortality may be attribute to their biological or related to differences in smoking behaviour between men and women.…”

Are We Approaching the End of the Linear No-Threshold Era?

“…Smoking prevalence declined considerably between the 1940s and 2000s in these countries (47,48). Since smoking increases all cancer risk (49), and the highest occupational radiation doses were in the earlier years (50), considerable confounding of the cancer mortality dose-response data due to smoking is likely. For French nuclear workers, a study reported that lung cancer rate is substantially confounded by smoking (51).…”

Lesão aguda da parede arterial provocada pelo método de interrupção temporária de fluxo em diferentes vias de cirurgia aórtica: estudo morfológico e biomecânico da aorta de porcos

“…When it undergoes balloon angioplasty, it is subjected to radial tensions that exceed its physiological range and so damage could occur, in particular to collagen fibers. 26 The balloon's complacency causes the area of contact between the balloon and the aorta wall to be greater than its nominal surface, because it accommodates to the smaller diameter of the pig aorta. Experiments have demonstrated that this injury will induce thickening of the wall of the vessel and will be determined by the stress at the surface of the vessel wall that is in contact with the balloon.…”