50-Year Trends in Smoking-Related Mortality in the United States
Open accessAbstract
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.
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Differences in age at initiation by country may reflect variation in stages of tobacco use epidemic between countries or the complexity of tobacco control measures implemented.
“differences in age at initiation by country may reflect variation in stages of tobacco use epidemic between countries or the complexity of tobacco control measures implemented (36).”
From Community-Based Screening, Brief Intervention, and Referral for Treatment for Unhealthy Tobacco Use: Single Arm Study Experience and Implementation Success in Rural and Semi-Rural Settings, South-West Nigeria (2016) · cites this paper as [36]
The Conclusions describe how the average age at smoking initiation fell across successive generations of U.S. smokers, first among men and then among women. This supports a link between initiation age and the historical progression of smoking in the United States, but the paper does not address differences between countries or attribute them to tobacco-control measures. (LLM, conf=0.78)
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BackgroundInsights into US life expectancy stagnation from birth cohort mortality dynamics
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“In addition, disparate causes of death may relate to common upstream factors such as cigarette smoking impacting cancer and heart disease, among other causes (23, 24), and stress impacting cancer, heart disease, and drug use (25–27).”
- Authors
- Thun, M. J., Carter, B. D., Feskanich, D., Freedman, N. D., Prentice, R., Lopez, A. D., Hartge, P., & Gapstur, S. M.
- Affiliations
- American Cancer Society (US)
- Brigham and Women's Hospital (US)
- National Cancer Institute (US)
- Fred Hutch Cancer Center (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2013-01-24
- Volume
- 368
- Issue
- 4
- Pages
- 351-364
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC3632080
- OpenAlex
- W2127817571
- Cited by
- 1,177
- References
- 27
- Citations by year
- 2026: 57 · 2025: 61 · 2024: 89 · 2023: 64 · 2022: 74 · 2021: 93 · 2020: 98 · 2019: 100 · 2018: 96 · 2017: 89 · 2016: 89 · 2015: 102 · 2014: 106 · 2013: 56 · 2012: 1
- FWCI
- 81.06
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (n01wh42124-20-0-0, n01wh32105-27-0-1, n01wh42120-22-0-1, n01wh32106-28-0-1, n01wh42125-19-0-1, n01wh32108-30-0-1, n01wh042116-008, n01wh32112-26-0-1, N01-WH-4-2122, n01wh32100-28-0-1, n01wh42130-23-0-1, n01wh42123-22-0-1, n01wh42108-21-0-1, n01wh042114-008, n01wh32118-27-0-1, N01 WH044221, n01wh42110-25-0-0, n01wh42122-22-0-1, N01-WH-4-2126, N01-WH-4-2111, n01wh42131-22-0-1, N01-WH-4-2130, n01wh44221-7-0-1, n01wh42129-23-0-1, N01-WH-4-2116, N01-WH-4-2110, n01wh42115-19-0-1, N01-WH-3-2101, n01wh32111-28-0-1, n01wh32115-26-0-1, n01wh22110-38-0-0, N01-WH-4-2117, n01wh42132-22-0-1, n01wh42121-21-0-1, n01wh32101-25-0-1, n01wh42111-19-0-1, N01 WH024152, N01-WH-4-2124, n01wh24152-12-0-0, n01wh42113-23-0-1, N01-WH-4-2131, n01wh32113-30-0-1, N01-WH-4-2113, n01wh42119-25-0-1, N01-WH-4-2109, N01-WH-4-2115, N01-WH-4-2121, n01wh42126-26-0-1, n01wh32122-31-0-1, n01wh42118-20-0-1, N01-WH-4-2119, n01wh32119-24-0-1, n01wh42107-22-0-1, N01-WH-4-2125, n01wh42109-28-0-1, n01wh042112-013, N01-WH-4-2120, N01-WH-4-2114, n01wh42117-21-0-1, n01wh32102-33-0-0, N01-WH-4-2123, N01-WH-4-2118, N01-WH-3-2102, N01-WH-4-2112, N01-WH-4-2108, N01 WH032100, N01 WH032108, N01 WH022110, N01 WH032113, N01 WH042129, N01 WH032115, N01 WH032106, N01 WH032119, N01 WH032111, N01 WH042132, N01 WH032112, N01 WH032109, N01 WH032122, n01wh32109-27-0-1)
- National Heart, Lung, and Blood Institute (N01 WH032118, N01 WH042107, N01 WH042126, N01 WH032105)
- National Cancer Institute (U01CA098710, P01CA087969, P01CA055075)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Keywords
- cigarette smoking, smoking-related mortality, temporal trends, sex differences, lung cancer mortality, chronic obstructive pulmonary disease, ischemic heart disease, stroke, all-cause mortality, smoking cessation, older adults, historical cohort study
- MeSH terms
- Aged, Aged, 80 and over, Cause of Death, Female, Humans, Lung Neoplasms, Male, Middle Aged, Mortality, Risk, Smoking, United States, Cohort Studies, Sex Distribution, Pulmonary Disease, Chronic Obstructive
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