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Mortality in relation to smoking: 50 years' observations on male British doctors
Open accessAbstract
OBJECTIVE: To compare the hazards of cigarette smoking in men who formed their habits at different periods, and the extent of the reduction in risk when cigarette smoking is stopped at different ages. DESIGN: Prospective study that has continued from 1951 to 2001. SETTING: United Kingdom. PARTICIPANTS: 34 439 male British doctors. Information about their smoking habits was obtained in 1951, and periodically thereafter; cause specific mortality was monitored for 50 years. MAIN OUTCOME MEASURES: Overall mortality by smoking habit, considering separately men born in different periods. RESULTS: The excess mortality associated with smoking chiefly involved vascular, neoplastic, and respiratory diseases that can be caused by smoking. Men born in 1900-1930 who smoked only cigarettes and continued smoking died on average about 10 years younger than lifelong non-smokers. Cessation at age 60, 50, 40, or 30 years gained, respectively, about 3, 6, 9, or 10 years of life expectancy. The excess mortality associated with cigarette smoking was less for men born in the 19th century and was greatest for men born in the 1920s. The cigarette smoker versus non-smoker probabilities of dying in middle age (35-69) were 42% nu 24% (a twofold death rate ratio) for those born in 1900-1909, but were 43% nu 15% (a threefold death rate ratio) for those born in the 1920s. At older ages, the cigarette smoker versus non-smoker probabilities of surviving from age 70 to 90 were 10% nu 12% at the death rates of the 1950s (that is, among men born around the 1870s) but were 7% nu 33% (again a threefold death rate ratio) at the death rates of the 1990s (that is, among men born around the 1910s). CONCLUSION: A substantial progressive decrease in the mortality rates among non-smokers over the past half century (due to prevention and improved treatment of disease) has been wholly outweighed, among cigarette smokers, by a progressive increase in the smoker nu non-smoker death rate ratio due to earlier and more intensive use of cigarettes. Among the men born around 1920, prolonged cigarette smoking from early adult life tripled age specific mortality rates, but cessation at age 50 halved the hazard, and cessation at age 30 avoided almost all of it.
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“we found in our meta-analyses of risk reduction among former smokers that cessation shifts smokers into a lower-risk category, with greater reduction in risk for longer durations since cessation.40, 41, 42”
From Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019 (2021) · cites this paper as [42]
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“Relative risks of all-cause mortality from long-running cohort studies in the UK41, 42 and the USA43 indicate that up to two-thirds of long-term smokers will eventually die of a disease attributable to smoking.”
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In the citing paper
“The frequency or amount of a given behavior or activity is a potential objective indicator of control problems (eg, frequency of alcohol consumption45-47).”
From Assessment and treatment of compulsive sexual behavior disorder: a sexual medicine perspective (2024) · cites this paper as [47]
Experimental — accuracy not yet measuredIn the citing paper
“Specifically, it has been observed that quitting smoking at the age of 50 years reduces the risk of smoking-related death two-fold, and that cessation at the age of 30 years avoids any risk. In addition, stopping smoking at the age of 60, 50, 40, or 30 years has led to gains of about three years, six years, nine years, and ten years of survival, respectively [70].”
From Skeletal System Biology and Smoke Damage: From Basic Science to Medical Clinic (2021) · cites this paper as [70]
In the citing paper
“There is also evidence that former smokers reduce their risk to that of never-smokers over time [40].”
From The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors (2009) · cites this paper as [40]
In the citing paper
“After breaking the tobacco withdrawal cycle, through smoking cessation, these systems recover (Mamede et al., 2007), possibly in the same way that other systems damaged by smoking reverse after smoking cessation (Doll et al., 2004; Pirie et al., 2013).”
From An application of the stress-diathesis model: A review about the association between smoking tobacco, smoking cessation, and mental health (2023) · cites this paper as Doll et al., 2004
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Metadata
- Authors
- Doll, R., Peto, R., Boreham, J., & Sutherland, I.
- Affiliations
- University of Oxford (GB)
- Corresponding author
- Doll, Richard
- ORCID
- Peto, Richard
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2004-06-22
- Volume
- 328
- Issue
- 7455
- Pages
- 1519
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC437139
- OpenAlex
- W4292672078
- Cited by
- 2,920
- References
- 39
- Citations by year
- 2026: 81 · 2025: 79 · 2024: 125 · 2023: 135 · 2022: 127 · 2021: 134 · 2020: 159 · 2019: 135 · 2018: 158 · 2017: 134 · 2016: 153 · 2015: 165 · 2014: 146 · 2013: 182 · 2012: 162
- FWCI
- 59.98
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Cancer Research UK
- British Heart Foundation
- University of Oxford
- Medical Research Council
- 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
- cigarette smoking, mortality, smoking cessation, life expectancy, birth cohort differences, vascular disease, neoplasms, respiratory diseases, smoking intensity, cardiovascular disease, lung cancer, chronic obstructive pulmonary disease, alcohol consumption, tobacco control, smoking cessation counseling, smoking cessation interventions
- MeSH terms
- Adult, Aged, Aged, 80 and over, Cause of Death, Epidemiologic Methods, United Kingdom, Humans, Lung Neoplasms, Male, Middle Aged, Mortality, Neoplasms, Physicians, Prospective Studies, Smoking, Smoking Cessation, Age Distribution
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