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Mortality in relation to smoking: 40 years' observations on male British doctors

Doll, R, Peto, R, Wheatley, K, Gray, R, Sutherland, I·1994·BMJ
DOI 10.1136/bmj.309.6959.901
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Abstract

Objective: To assess the hazards associated with long term use of tobacco. Design: Prospective study of mortality in relation to smoking habits assessed in 1951 and again from20time to time thereafter, with causes sought of deaths20over 40 years (to 1991). Continuation of a study that was last reported after 20 years' follow up (1951-71). Subjects: 34 439 British male doctors who replied20to a postal questionnaire in 1951, of whom 10 000 had died during the first 20 years and another 10 000 have died during the second 20 years. Results - Excess mortality associated with20smoking was about twice as extreme during the second half of the study as it had been during the first half. The death rate ratios during 1971-91 (comparing continuing cigarette smokers with lifelong20non-smokers) were approximately threefold at ages 45-64 and twofold at ages 65-84. The excess mortality was chiefly from diseases that can be caused by smoking. Positive associations with smoking were confirmed for death from cancers of the mouth, oesophagus, pharynx, larynx, lung, pancreas, and bladder; from chronic obstructive pulmonary disease and other respiratory diseases; from vascular diseases; from peptic ulcer; and (perhaps because of confounding by personality and alcohol use) from cirrhosis, suicide, and poisoning. A negative association was confirmed with death20from Parkinson's disease. Those who stopped20smoking before middle age subsequently avoided almost all of the excess risk that they would otherwise have suffered, but even those who stopped smoking in middle age were subsequently at substantially less risk than those who continued to smoke. Conclusion: Results from the first 20 years of this study, and of other studies at that time, substantially20underestimated the hazards of long term use of tobacco. It now seems that about half of all regular cigarette smokers will eventually be killed by their habit.

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  8. 36 Marmot M, Brunner E. Alcohol and cardiovascular disease: the status of the U shaped curve. BMf 1991;303:565-8. comsumption of alcohol: 13 years' observations on male British doctors. BMf1994;309:911-8.
  9. 38 Peto R, Lopez A, Boreham J, Thun M, Heath C. Mortality from tobacco in developed countries: indirect estimation from national vital statistics. Lancet 1992;339:1268-78.
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  13. 44 Peto R, Lopez A, Boreham J, Heath C, Thun M. Mortality from tobacco in developed countries, 1950-2000. Oxford: Oxford University Press, 1994.
  14. 45 World Bank. World development report 1993. Investing in health. New York: Oxford University Press, 1993.

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Authors
Doll, R., Peto, R., Wheatley, K., Gray, R., & Sutherland, I.
Venue
BMJ
Publisher
BMJ
Published
1994-10-08
Volume
309
Issue
6959
Pages
901-911
ISSN
  • 0959-8138
  • 1468-5833
DOI
10.1136/bmj.309.6959.901
Cited by
1,321
References
2
Language
en
Licence
www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)

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