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Mortality in relation to smoking: 50 years' observations on male British doctors
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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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Citations
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Improving smoking cessation approaches at the individual level
Aveyard, P. N., & Raw, M. (2012) · Tobacco Control · doi:10.1136/tobaccocontrol-2011-050348 · Cited by 54
“Cessation prior to the age of about 40 years avoids most of the harm, while continued smoking thereafter leads to a loss of 3 months of life for every year smoked.(8) Many people consult their primary care doctor at least annually and s/he (1)Primary Care Clinical Sciences,”
BackgroundLiang, W., & Chikritzhs, T. N. (2013) · PLoS ONE · doi:10.1371/journal.pone.0055881 · Cited by 53
Nohlert, E., Öhrvik, J., Tegelberg, Å., Tillgren, P., & Helgason, Á. R. (2013) · BMC Public Health · doi:10.1186/1471-2458-13-592 · Cited by 53
“There is strong evidence that quitting smoking improves health and reduces the risk of premature death [2-4].”
BackgroundReexamining the Dominance of Birth Cohort Effects on Mortality.
Murphy, M. (2010) · Population and Development Review · doi:10.1111/j.1728-4457.2010.00334.x · Cited by 48
Smoking cessation strategies in patients with COPD
Warnier, M. J., van Riet, E. E. S., Rutten, F. H., Bruin, M. L. D., & Sachs, A. P. E. (2012) · European Respiratory Journal · doi:10.1183/09031936.00014012 · Cited by 54
Best Practices for Smoking Cessation Interventions in Primary Care
McIvor, A., Kayser, J. W., Assaad, J., Brosky, G., Demarest, P., Desmarais, P., Hampson, C., Khara, M., Pathammavong, R., & Weinberg, R. (2009) · Canadian Respiratory Journal · doi:10.1155/2009/412385 · Cited by 53
Disparities in Current Cigarette Smoking Prevalence by Type of Disability, 2009–2011
Courtney‐Long, E. A., Stevens, A. C., Caraballo, R. S., Ramon, I., & Armour, B. S. (2014) · Public Health Reports · doi:10.1177/003335491412900307 · Cited by 53
The Exposome in Human Evolution: From Dust to Diesel
Trumble, B. C., & Finch, C. E. (2019) · The Quarterly Review of Biology · doi:10.1086/706768 · Cited by 54
Skeletal System Biology and Smoke Damage: From Basic Science to Medical Clinic
Tarantino, U., Cariati, I., Greggi, C., Gasbarra, E., Belluati, A., Ciolli, L., Maccauro, G., Momoli, A., Ripanti, S., Falez, F., et al. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms22126629 · Cited by 52
Ellis, L., Coleman, M. P., & Rachet, B. (2014) · British Journal of Cancer · doi:10.1038/bjc.2014.217 · Cited by 52
“The impact of life tables adjusted for smoking on the socio-economic difference in net survival for laryngeal and lung cancer”
BackgroundZimmermann, E., Kring, S. I. I., Berentzen, T. L., Holst, C., Pers, T. H., Hansen, T. F., Pedersen, O. B., Sørensen, T. I. A., & Jess, T. (2009) · PLoS ONE · doi:10.1371/journal.pone.0004428 · Cited by 53
“SNP, rs9939609, and all-cause mortality in middle-aged men of a magnitude similar to that of smoking”
BackgroundShabanzadeh, D. M., & Sørensen, L. T. (2015) · Surgical Infections · doi:10.1089/sur.2015.009 · Cited by 52
“Smoking is known to increase infections and mortality in general [24,25].”
He, Y., Jiang, B., Li, L. S., Li, L. S., Sun, D. L., Wu, L., Liu, M., He, S. F., Liang, B. Q., Hu, F. B., et al. (2014) · American Journal of Epidemiology · doi:10.1093/aje/kwu011 · Cited by 54
Danson, S. J., Rowland, C., Rowe, R., Ellis, S. P., Crabtree, C., Horsman, J. M., Wadsley, J., Hatton, M. Q. F., Woll, P. J., & Eiser, C. (2015) · Supportive Care in Cancer · doi:10.1007/s00520-015-2928-x · Cited by 53
“Furthermore, these data are consistent with previous findings that smokers present with more co-morbidities including respiratory and cerebrovascular disease that are probably attributable to chronic cigarette use [32].”
ResultDoing Excellent Social Research with Documents
Grant, A. (2018) · Routledge eBooks · doi:10.4324/9781315177274 · Cited by 86
Burstein, A. H., Fullerton, T., Clark, D. J., & Faessel, H. M. (2006) · The Journal of Clinical Pharmacology · doi:10.1177/0091270006291837 · Cited by 52
Smoking habits and associated factors among Greek physicians
Sotiropoulos, A., Gikas, A., Spanou, E., Dimitrelos, D., Karakostas, F., Skliros, E., Apostolou, O., Politakis, P., & Pappas, S. I. (2007) · Public Health · doi:10.1016/j.puhe.2006.10.013 · Cited by 53
Relapse among Cigarette Smokers: The CARDIA longitudinal study - 1985–2011
Caraballo, R. S., Kruger, J., Asman, K., Pederson, L., Widome, R., Kiefe, C. I., Hitsman, B., & Jacobs, D. R. (2014) · Addictive Behaviors · doi:10.1016/j.addbeh.2013.08.030 · Cited by 51
Smoking impact on HPV driven head and neck cancer’s oncological outcomes?
Mirghani, H., Leroy, C., Chekourry, Y., Casiraghi, O., Auperin, A., Tao, Y., Nguyen, F., Even, C., Breuskin, I., Moya‐Plana, A., et al. (2018) · Oral Oncology · doi:10.1016/j.oraloncology.2018.05.007 · Cited by 51
Wan, E., Chin, W. Y., Yu, E., Wong, I., Chan, E., Li, S. X., Cheung, N. K., Wang, Y., & Lam, C. (2020) · Diabetes Care · doi:10.2337/dc19-2137 · Cited by 51
“The average life expectancy loss for men and women with stroke, heart diseases and severe CKD within the age group of 40 to 60 (decrease by 37 years and 21 years, respectively) were surprising in that they were larger than the 10-year loss for lifelong smokers and 11-year loss for those with HIV infection.(40-42).”
BackgroundTarabichi, M., Antoniou, A., Saiselet, M., Pita, J. M. G., Andry, G., Dumont, J. E., Detours, V., & Maenhaut, C. (2013) · Cancer and Metastasis Reviews · doi:10.1007/s10555-013-9431-y · Cited by 51
Long, G. H., Cooper, A., Wareham, N. J., Griffin, S. J., & Simmons, R. K. (2014) · Diabetes Care · doi:10.2337/dc13-1731 · Cited by 51
“Smoking status is a wellknown modifiable risk factor for early death (40), but the low number of patients who reported smoking cessation between baseline and 1 year (n = 15) precluded analysis of the impact of a change in smoking status on 5-year CVD risk.”
Research Governance: Where did it Come From, What Does it Mean?
Shaw, S. E., Boynton, P., & Greenhalgh, T. (2005) · Journal of the Royal Society of Medicine · doi:10.1177/014107680509801110 · Cited by 51
Emberson, J. R., Whincup, P. H., Morris, R. W., Wannamethee, S. G., & Shaper, A. G. (2005) · European Heart Journal · doi:10.1093/eurheartj/ehi224 · Cited by 50
“The 50 year report showed that when compared with non-smokers, men who smoked throughout the study had two to three times the risk of dying in middle age (35–69 years).(3) For physical activity, a meta-analysis of its effects on CHD risk published in 1990 found that those in ‘active’ occupations had approximately half…”
ResultTranslational Cancer Research: Balancing Prevention and Treatment to Combat Cancer Globally
Wild, C. P., Bucher, J. R., de Jong, B. W. D., Dillner, J., von Gertten, C., Groopman, J. D., Herceg, Z., Holmes, E. C., Holmila, R. J., Olsen, J. H., et al. (2014) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/dju353 · Cited by 50
Causes of death of patients with laryngeal cancer
Ferlito, A., Haigentz, M., Bradley, P. J., Suarez, C. M., Strojan, P., Wolf, G. T., Olsen, K. D., Mendenhall, W. M., Mondin, V., Rodrigo, J. P., et al. (2013) · European Archives of Oto-Rhino-Laryngology · doi:10.1007/s00405-013-2478-0 · Cited by 50
“Smoking in particular, with all its associated diseases, significantly degrades life expectancy [14].”
BackgroundEffect of a nicotine-free inhalator as part of a smoking-cessation programme
Caponnetto, P., Cibella, F., Mancuso, S., Campagna, D., Arcidiacono, G., & Polosa, R. (2011) · European Respiratory Journal · doi:10.1183/09031936.00109610 · Cited by 50
Sabbag, A., Matetzky, S., Porter, A., Iakobishvili, Z., Moriel, M., Zwas, D. R., Fefer, P., Asher, E., Beigel, R., Gottlieb, S., et al. (2017) · The American Journal of Medicine · doi:10.1016/j.amjmed.2017.05.028 · Cited by 50
Ramadas, K., Sauvaget, C., Thomas, G., Fayette, J.-M., Somanathan, T., & Sankaranarayanan, R. (2010) · Cancer Epidemiology · doi:10.1016/j.canep.2010.04.006 · Cited by 51
“Although tobacco and alcohol information is widely available for industrialised countries [1–4], few data are available from India and other developing countries.”
BackgroundBalkau, B., Vierron, E., Vernay, M., Born, C., Arondel, D., Petrella, A., & Ducimetière, P. (2006) · European Journal of Cardiovascular Prevention & Rehabilitation · doi:10.1097/01.hjr.0000214614.37232.f0 · Cited by 50
Weiss, R. A. (2004) · British Journal of Cancer · doi:10.1038/sj.bjc.6602318 · Cited by 50
“A summary of the 50-year follow-up of general mortality in that cohort led by Sir Richard Doll and Sir Richard Peto was recently published (Doll et al, 2004) and further analyses specific to cancer mortality will be published in the BJC early in 2005 (Doll et al, 2005) with a separate editorial by…”
MethodPersonality and all cause mortality: Evidence for indirect links
Ploubidis, G. B., & Grundy, E. (2009) · Personality and Individual Differences · doi:10.1016/j.paid.2009.02.022 · Cited by 49
Overdiagnosis of hepatocellular carcinoma: Prevented by guidelines?
Rich, N. E., & Singal, A. G. (2021) · Hepatology · doi:10.1002/hep.32284 · Cited by 48
Benefits of smoking cessation with focus on cardiovascular and respiratory comorbidities
Godtfredsen, N. S., & Prescott, E. (2011) · The Clinical Respiratory Journal · doi:10.1111/j.1752-699x.2011.00262.x · Cited by 52
“Health benefits of smoking cessation on overall mortality and morbidity has been thoroughly documented in large cohort studies (2, 3).”
BackgroundSlow-growing lung cancer as an emerging entity: from screening to clinical management
Infante, M. V., Berghmans, T., Heuvelmans, M. A., Hillerdal, G., & Oudkerk, M. (2013) · European Respiratory Journal · doi:10.1183/09031936.00186212 · Cited by 49
Taylor, A. H., Thompson, T., Greaves, C. J., Taylor, R. S., Green, C., Warren, F. C., Kandiyali, R., Aveyard, P. N., Ayres, R., Byng, R., et al. (2014) · Health Technology Assessment · doi:10.3310/hta18040 · Cited by 53
Scheffels, J. (2008) · Tobacco Control · doi:10.1136/tc.2007.021592 · Cited by 51
Reduction and Cessation of Cigarette Smoking and Risk of Cancer: A Cohort Study of Korean Men
Song, Y., Sung, J., & Cho, H. (2008) · Journal of Clinical Oncology · doi:10.1200/jco.2008.17.0498 · Cited by 49
Mangoni, A. A., Baghdadi, L. R., Shanahan, E. M., Wiese, M. D., Tommasi, S., Elliot, D. J., & Woodman, R. J. (2017) · Therapeutic Advances in Musculoskeletal Disease · doi:10.1177/1759720x17719850 · Cited by 51
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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