Cigarette Smoking and Mortality in Adults Aged 70 Years and Older: Results From the NIH-AARP Cohort

Abstract

Introduction Tobacco use remains a leading modifiable cause of cancer incidence and premature mortality in the U.S. and globally. Despite increasing life expectancy worldwide, less is known about the effects of cigarette smoking on older populations. This study sought to determine the effects of smoking on mortality in older age. Methods Associations of mortality with self-reported age at smoking cessation, age at smoking initiation, and amount smoked after age 70 years were examined in 160,113 participants of the NIH-AARP Diet and Health Study aged >70 years. Participants completed a questionnaire detailing their smoking use in 2004–2005, and were followed for mortality through December 31, 2011. Analyses were conducted between 2014 and 2016. Results Relative to never smokers, current smokers were more likely to die during follow-up (hazard ratio, 3.18; 95% CI=3.04, 3.31). Furthermore, former smokers had lower risks than current smokers (hazard ratios for quitting between ages 30–39, 40–49, 50–59, and 60–69 years were 0.41 [95% CI=0.39, 0.43], 0.51 [95% CI=0.49, 0.54], 0.64 [95% CI=0.61, 0.67], and 0.77 [95% CI=0.73, 0.81], respectively). Among current smokers, mortality was inversely associated with age at initiation, but directly associated with the number of cigarettes smoked per day >70 years. Conclusions As among younger people, lifetime cigarette smoking history is a key determinant of mortality after age 70 years.

Modifiable risk factors for 9-year mortality in older English and Brazilian adults: The ELSA and SIGa-Bagé ageing cohorts

“…A recent literature review of longitudinal studies on the smoking-mortality association in community-dwelling older adults concluded that there was a scarcity of studies from LICs; smoking was associated with mortality in all studies, reinforcing smoking as an established risk factor for premature mortality. The HRs comparing currentand non-smokers have ranged from 1.3 to 5.0; with the highest HRs observed in HICs 12,13,16,19,[44][45][46] . In addition to cardiovascular disease (CVD)-specific mortality, smoking is a major risk factor for several types of cancer 46 , reflecting its broad impact on all-cause mortality, and its strong association with premature death 12 .…”

“…In conclusion, smoking and physical inactivity were found to be the main risk factors of all-cause mortality among older English and Brazilian adults, suggesting that both factors should remain a key focus of health policy debates, to prevent NCDs and subsequent mortality risk. Older adults should be encouraged to increase their levels of physical activity and to quit smoking, considering previous evidence about the benefits of smoking cessation and physical activity on mortality even later in life 13,36 . Furthermore, diabetes was found to be a risk factor of all-cause mortality over the 9-year follow-up period, mainly among older English adults.…”

Prediction of Long-Term Survival After Lung Cancer Surgery for Elderly Patients in The Society of Thoracic Surgeons General Thoracic Surgery Database

“…One modifiable risk factor that significantly impacts long-term survival in this data set is smoking. A recent NIH-AARP cohort study in more than 160,000 patients over age 70 years demonstrated decreased hazard ratios for allcause mortality for former smokers as compared with current smokers [13]. A recent meta-analysis demonstrated worse survival in early-stage NSCLC continuing smokers [14].…”

Cigarette Smoking and All-cause Mortality in Rural Chinese Male Adults:15-year Follow-up of the Anqing Cohort Study

“…The hazards of smoking have been documented over the past 55 years, providing su cient evidence of a causal relationship between smoking and many types of death 7 . A total of 160,113 participants of the NIH-AARP Diet and Health Study aged >70 years showed that relative to never smokers, current smokers were more likely to die during follow-up (hazard ratio, 3.18; 95% CI,3.04-3.31) 8 . For participants who were 25 to 79 years of age in the U.S. National Health Interview Survey, the rate of death from any cause among current smokers was about three times that of those who had never smoked (hazard ratio for men, 2.8; 99% CI, 2.4-3.1) 9 .…”