50-Year trends in smoking-related mortality in the United States

Thun, Michael J., Carter, Brian D., Feskanich, Diane, Freedman, Neal D., Prentice, Ross, Lopez, Alan D., Hartge, Patricia and Gapstur, Susan M. (2013) 50-Year trends in smoking-related mortality in the United States. New England Journal of Medicine, 368 4: 351-364. doi:10.1056/NEJMsa1211127

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Author Thun, Michael J.
Carter, Brian D.
Feskanich, Diane
Freedman, Neal D.
Prentice, Ross
Lopez, Alan D.
Hartge, Patricia
Gapstur, Susan M.
Title 50-Year trends in smoking-related mortality in the United States
Journal name New England Journal of Medicine   Check publisher's open access policy
ISSN 0028-4793
Publication date 2013-01-01
Year available 2013
Sub-type Article (original research)
DOI 10.1056/NEJMsa1211127
Open Access Status File (Publisher version)
Volume 368
Issue 4
Start page 351
End page 364
Total pages 14
Place of publication Boston, MA, United States
Publisher Massachusetts Medical Society
Language eng
Formatted abstract
Background: The disease risks from cigarette smoking increased in the United States over most of the 20th century, first among male smokers and later among female smokers. Whether these risks have continued to increase during the past 20 years is unclear.

Methods: We measured temporal trends in mortality across three time periods (1959-1965, 1982-1988, and 2000-2010), comparing absolute and relative risks according to sex and self-reported smoking status in two historical cohort studies and in five pooled contemporary cohort studies, among participants who became 55 years of age or older during follow-up.

Results: For women who were current smokers, as 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; 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 chronic obstructive pulmonary disease (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). Mortality from COPD among male smokers continued to increase in the contemporary cohorts in nearly all the age groups represented in the study and within each stratum of duration and intensity of smoking. Among men 55 to 74 years of age and women 60 to 74 years of age, all-cause mortality was at least three times as high among current smokers as among those who had never smoked. Smoking cessation at any age dramatically reduced death rates.

Conclusions: The risk of death from cigarette smoking continues to increase among women and the increased risks are now nearly identical for men and women, as compared with persons who have never smoked. Among men, the risks associated with smoking have plateaued at the high levels seen in the 1980s, except for a continuing, unexplained increase in mortality from COPD
Keyword Mortality
Chronic obstructive pulmonary disease (COPD)
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
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