Cited by 5,932Smoking Behavior and CessationGlobal Cancer Incidence and ScreeningChronic Obstructive Pulmonary Disease (COPD) Research

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

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Doll, R, Peto, R, Wheatley, K, Gray, R, Sutherland, I·1994·BMJ

DOI 10.1136/bmj.309.6959.901PMC PMC1732608

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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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Authors: Doll, R., Peto, R., Wheatley, K., Gray, R., & Sutherland, I.
Affiliations: University of Oxford (GB)
Corresponding author: Doll, R
ORCID: Peto, R
Wheatley, K
Gray, R
Venue: BMJ
Publisher: BMJ
Published: 1994-10-08
Volume: 309
Issue: 6959
Pages: 901-911
ISSN: 0007-1447 (ISSN-L)
0959-8138
1468-5833
DOI: 10.1136/bmj.309.6959.901
PMC: PMC1732608
OpenAlex: W2100346673
Cited by: 5,932
References: 3
Citations by year: 2026: 9 · 2025: 33 · 2024: 73 · 2023: 128 · 2022: 90 · 2021: 144 · 2020: 174 · 2019: 164 · 2018: 181 · 2017: 181 · 2016: 197 · 2015: 253 · 2014: 245 · 2013: 317 · 2012: 299
FWCI: 191.96
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
Locations: BMJ (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
HighWire Press Open Archive (submittedVersion)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › 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: smoking, mortality, tobacco use, long-term smoking, excess mortality, cancer mortality, chronic obstructive pulmonary disease, cardiovascular disease, peptic ulcer, liver cirrhosis, Parkinson's disease, smoking cessation, British doctors
MeSH terms: Adult, Age Factors, Aged, Aged, 80 and over, Cause of Death, Follow-Up Studies, United Kingdom, Humans, Male, Middle Aged, Mortality, Prospective Studies, Smoking, Survival Rate, Survival Analysis

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

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