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Cited by 809Smoking Behavior and CessationChronic Obstructive Pulmonary Disease (COPD) ResearchHealthcare Systems and Public Health

Smoking and Mortality — Beyond Established Causes

Carter, Brian D., Abnet, Christian C., Feskanich, Diane, Freedman, Neal D., Hartge, Patricia, Lewis, Cora E., Ockene, Judith K., Prentice, Ross L. +3 more·2015·New England Journal of Medicine
DOI 10.1056/nejmsa1407211
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Abstract

BACKGROUND: Mortality among current smokers is 2 to 3 times as high as that among persons who never smoked. Most of this excess mortality is believed to be explained by 21 common diseases that have been formally established as caused by cigarette smoking and are included in official estimates of smoking-attributable mortality in the United States. However, if smoking causes additional diseases, these official estimates may significantly underestimate the number of deaths attributable to smoking. METHODS: We pooled data from five contemporary U.S. cohort studies including 421,378 men and 532,651 women 55 years of age or older. Participants were followed from 2000 through 2011, and relative risks and 95% confidence intervals were estimated with the use of Cox proportional-hazards models adjusted for age, race, educational level, daily alcohol consumption, and cohort. RESULTS: During the follow-up period, there were 181,377 deaths, including 16,475 among current smokers. Overall, approximately 17% of the excess mortality among current smokers was due to associations with causes that are not currently established as attributable to smoking. These included associations between current smoking and deaths from renal failure (relative risk, 2.0; 95% confidence interval [CI], 1.7 to 2.3), intestinal ischemia (relative risk, 6.0; 95% CI, 4.5 to 8.1), hypertensive heart disease (relative risk, 2.4; 95% CI, 1.9 to 3.0), infections (relative risk, 2.3; 95% CI, 2.0 to 2.7), various respiratory diseases (relative risk, 2.0; 95% CI, 1.6 to 2.4), breast cancer (relative risk, 1.3; 95% CI, 1.2 to 1.5), and prostate cancer (relative risk, 1.4; 95% CI, 1.2 to 1.7). Among former smokers, the relative risk for each of these outcomes declined as the number of years since quitting increased. CONCLUSIONS: A substantial portion of the excess mortality among current smokers between 2000 and 2011 was due to associations with diseases that have not been formally established as caused by smoking. These associations should be investigated further and, when appropriate, taken into account when the mortality burden of smoking is investigated. (Funded by the American Cancer Society.).

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Authors
Carter, B. D., Abnet, C. C., Feskanich, D., Freedman, N. D., Hartge, P., Lewis, C. E., Ockene, J. K., Prentice, R. L., Speizer, F. E., Thun, M. J., & Jacobs, E. J.
Affiliations
  • Brigham and Women's Hospital (US)
  • National Cancer Institute (US)
  • University of Alabama at Birmingham (US)
  • University of Massachusetts Chan Medical School (US)
  • Fred Hutch Cancer Center (US)
  • American Cancer Society (US)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2015-02-12
Volume
372
Issue
7
Pages
631-640
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmsa1407211
OpenAlex
W2161081593
Cited by
809
References
30
Citations by year
2026: 30 · 2025: 55 · 2024: 54 · 2023: 93 · 2022: 51 · 2021: 79 · 2020: 58 · 2019: 68 · 2018: 68 · 2017: 87 · 2016: 97 · 2015: 68
FWCI
78.53
Type
journal article
Language
en
Open access
closed
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • eScholarship@UMassChan (submittedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
  • Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
Keywords
smoking, excess mortality, smoking-attributable mortality, renal failure, intestinal ischemia, hypertensive heart disease, infection, respiratory diseases, breast cancer, prostate cancer, former smokers, time since quitting, mortality burden, older adults, cohort studies, relative risk, smoking cessation, tobacco control, health effects of smoking
MeSH terms
Alcohol Drinking, Cause of Death, Female, Heart Diseases, Humans, Hypertension, Infections, Male, Middle Aged, Respiratory Tract Diseases, Risk, Smoking, United States, Cohort Studies, Proportional Hazards Models, Renal Insufficiency

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