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IntroductionWe conducted a mortality case-control study to assess the risks of all-cause and major causes of death attributable to smoking in Tianjin from 2010 through 2014. The death registry–based study used data from The Tianjin All Causes of Death Surveillance System, which collects information routinely on smoking of the deceased in the death certificate of Tianjin Centers for Disease Control and Prevention.MethodsCases (n = 154,086) and controls (n = 25,476) were deaths at 35 to 79 years from smoking-related and nonsmoking-related causes, respectively. Mortality rate ratios (RRs) for ever smokers versus never smokers, with adjustment for sex, 5-year age group, education, marital status, and year of death, and smoking-attributed fractions were calculated.ResultsThe RRs in men were 1.38 (95% confidence interval [CI], 1.33–1.43) for all causes and 3.07 (95% CI, 2.91–3.24) for lung cancer, and in women were 1.46 (95% CI, 1.39–1.54) and 4.07 (95% CI, 3.81–4.35). The smoking-attributed fractions for all causes and for lung cancer in men were 15.4% and 50.2%, respectively, and in women were 7.3% and 32.7%, respectively. Smoking annually caused an average of 3,756 (9.4%) deaths, mostly from lung cancer in men (47.4%) and women (66.9%). Women who started smoking before 30 had a higher RR (1.79; 95% CI, 1.63–1.97) than men who did so (1.48; 95% CI, 1.41–1.56).ConclusionLung cancer was the main cause of smoking-induced deaths in both sexes. Tobacco use is a major cause of premature deaths in men aged 35 to 79 years. Young women must be urged to not start smoking because they could have greater risk of all-cause and lung cancer deaths than men do.

INTRODUCTION Smoking-attributed mortality is increasing steadily in most developing countries. The aim of the study is to assess the reduction in smoking-associated mortality following cessation. METHODS Death data were collected from 2016 to 2017. Cases were deaths from pre-defined diseases of interest (65298); controls were deaths from pre-defined non-smoking-related diseases (13527). Case versus control odds ratios for ex-smokers versus smokers were calculated by age, sex, marital status and education with standardized logistic regression. These are described as mortality rate ratios (RRs, calculated as odds ratios), with a group-specific confidence interval (CI). The statistical analysis of the data was conducted from June to August 2019. RESULTS For deaths from pre-defined non-smoking-related diseases at age 35–59 years, the RRs for quitting smoking 0–4, 5–9 or ≥10 years ago and never smoking were 0.66 (95% CI: 0.55–0.78), 0.58 (95% CI: 0.38–0.88), 0.61 (95% CI: 0.45–0.82), and 0.43 (95% CI: 0.39–0.46), respectively. The same trend was found at ages 60–69 years and 70–79 years. Younger age of quitting (25–44 or 45–64 years) appeared to be associated with greater protection among the age groups: RR was 0.55 (95% CI: 0.42–0.74) and 0.67 (95% CI: 0.56–0.79), respectively, at age 35–59 years. Among the patients who died of lung cancer, the strong protective effect can only be observed when the duration of quitting is ≥10 years. The effect of smoking cessation on the risk of death from cardiovascular disease can be observed when the duration of quitting is 1–5 years. CONCLUSIONS Longer durations of smoking cessation are associated with progressively lower mortality rates from the diseases of interest, such as lung cancer and other smoking related cancers. For sustainable monitoring of tobacco-attributed mortality, smoking information over decades, such as smoking duration and quit smoking years, should be recorded during registration of death.

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