The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK

Abstract

SummaryBackgroundWomen born around 1940 in countries such as the UK and USA were the first generation in which many smoked substantial numbers of cigarettes throughout adult life. Hence, only in the 21st century can we observe directly the full effects of prolonged smoking, and of prolonged cessation, on mortality among women in the UK.MethodsFor this prospective study, 1·3 million UK women were recruited in 1996–2001 and resurveyed postally about 3 and 8 years later. All were followed to Jan 1, 2011, through national mortality records (mean 12 woman-years, SD 2). Participants were asked at entry whether they were current or ex-smokers, and how many cigarettes they currently smoked. Those who were ex-smokers at both entry and the 3-year resurvey and had stopped before the age of 55 years were categorised by the age they had stopped smoking. We used Cox regression models to obtain adjusted relative risks that compared categories of smokers or ex-smokers with otherwise similar never-smokers.FindingsAfter excluding 0·1 million women with previous disease, 1·2 million women remained, with median birth year 1943 (IQR 1938–46) and age 55 years (IQR 52–60). Overall, 6% (66 489/1 180 652) died, at mean age 65 years (SD 6). At baseline, 20% (232 461) were current smokers, 28% (328 417) were ex-smokers, and 52% (619 774) were never-smokers. For 12-year mortality, those smoking at baseline had a mortality rate ratio of 2·76 (95% CI 2·71–2·81) compared with never-smokers, even though 44% (37 240/85 256) of the baseline smokers who responded to the 8-year resurvey had by then stopped smoking. Mortality was tripled, largely irrespective of age, in those still smoking at the 3-year resurvey (rate ratio 2·97, 2·88–3·07). Even for women smoking fewer than ten cigarettes per day at baseline, 12-year mortality was doubled (rate ratio 1·98, 1·91–2·04). Of the 30 most common causes of death, 23 were increased significantly in smokers; for lung cancer, the rate ratio was 21·4 (19·7–23·2). The excess mortality among smokers (in comparison with never-smokers) was mainly from diseases that, like lung cancer, can be caused by smoking. Among ex-smokers who had stopped permanently at ages 25–34 years or at ages 35–44 years, the respective relative risks were 1·05 (95% CI 1·00–1·11) and 1·20 (1·14–1·26) for all-cause mortality and 1·84 (1·45–2·34) and 3·34 (2·76–4·03) for lung cancer mortality. Thus, although some excess mortality remains among these long-term ex-smokers, it is only 3% and 10% of the excess mortality among continuing smokers. If combined with 2010 UK national death rates, tripled mortality rates among smokers indicate 53% of smokers and 22% of never-smokers dying before age 80 years, and an 11-year lifespan difference.InterpretationAmong UK women, two-thirds of all deaths of smokers in their 50s, 60s, and 70s are caused by smoking; smokers lose at least 10 years of lifespan. Although the hazards of smoking until age 40 years and then stopping are substantial, the hazards of continuing are ten times greater. Stopping before a...

Smoking‐Related Mortality in Patients With Early Rheumatoid Arthritis: A Retrospective Cohort Study Using the Clinical Practice Research Datalink

“…These results are in agreement with most of the literature from the general population 4, 28. The SHRs for all‐cancer and respiratory deaths were similar to those for circulatory disease but failed to reach statistical significance, while the risk of death due to respiratory infection was found to decrease for each year of cessation in former light smokers only.…”

“…Tobacco smoking is associated with an increased risk of death in the general population, with an estimated 17% of adult deaths in England attributable to smoking in 2013 3. Participants in the Million Women Study who smoked at baseline had approximately 2.7 times increased mortality compared to never smokers 4. Smoking is associated with increased risk of death due to cardiovascular disease (CVD), respiratory infection, and certain forms of cancer, including lung cancer 3, 4.…”

“…Participants in the Million Women Study who smoked at baseline had approximately 2.7 times increased mortality compared to never smokers 4. Smoking is associated with increased risk of death due to cardiovascular disease (CVD), respiratory infection, and certain forms of cancer, including lung cancer 3, 4. There is also evidence that smoking cessation is associated with a gradual normalization of death rates 4.…”

“…Smoking is associated with increased risk of death due to cardiovascular disease (CVD), respiratory infection, and certain forms of cancer, including lung cancer 3, 4. There is also evidence that smoking cessation is associated with a gradual normalization of death rates 4.…”

Cost‐effectiveness of increasing the reach of smoking cessation interventions in Germany: results from the EQUIPTMOD

“…Stopping smoking before the ages of 30 or 40 years has been found to reduce the associated mortality risk by approximately 97 and 90%, respectively 10. In countries with a social health‐care system such as Germany, reducing smoking rates and thus the health consequences also leads to lower health‐care costs, which reduces the burden on society.…”