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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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“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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“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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“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]
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“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]
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“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]
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Nicotine Dependence among Chinese City Dwellers: A Population-Based Cross-Sectional Study
Yang, T., Shiffman, S., Rockett, I. R. H., Cui, X., & Cao, R. (2011) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntr040 · Cited by 36
Yach, D., & Wipfli, H. L. (2006) · Annals of Tropical Medicine and Parasitology · doi:10.1179/136485906x97462 · Cited by 36
“Following the publication of the report from Japan (Hirayama, 1981), the British Medical Journal was flooded with letters to the editor claiming that the study was flawed by misclassification, confounding and statistical error.”
BackgroundMannan, H. R., Stevenson, C., Peters, A., Walls, H., & McNeil, J. J. (2010) · Heart International · doi:10.4081/hi.2010.e11 · Cited by 38
“Other Framingham risk functions have shown themselves to recalibrate well in other samples.(10,11,28,29)”
BackgroundMethodReid, R. D., Pipe, A., Riley, D. L., & Sørensen, M. (2008) · Patient Education and Counseling · doi:10.1016/j.pec.2008.11.001 · Cited by 33
“A longitudinal follow-up study has shown that every year that smoking cessation is postponed after the age of 40 reduces a male smoker’s life expectancy by 3 months [3].”
BackgroundA risk table to assist health practitioners assess and prevent the onset of depression in later life
Almeida, O. P., Hankey, G. J., Yeap, B. B., Golledge, J., McCaul, K. A., & Flicker, L. A. (2013) · Preventive Medicine · doi:10.1016/j.ypmed.2013.09.021 · Cited by 39
“Similarly, the identification of smoking as a risk factor for lung cancer and mortality (Doll et al., 2004) has led to changes in health promotion and policy that have resulted in decreased morbidity and mortality not only from respiratory diseases, but also from cardiovascular events (Critchley…”
BackgroundAlonso‐Coello, P., Comas, D. R., Sanabria, A. J., Plaza, V., Miravitlles, M., & Martinez, L. (2013) · Archivos de Bronconeumología · doi:10.1016/j.arbres.2012.12.001 · Cited by 36
Bystander effects and their implications for clinical radiotherapy
Munro, A. J. (2009) · Journal of Radiological Protection · doi:10.1088/0952-4746/29/2a/s09 · Cited by 36
“did satisfactorily demonstrate the link between cigarette smoking and lung cancer [49]).”
BackgroundSmoking control: challenges and achievements
da Silva, L. C. C., de Araújo, A. J., de Queiroz, Â. M. D., Sales, M. D. P. U., & Castellano, M. V. C. D. O. (2016) · Jornal Brasileiro de Pneumologia · doi:10.1590/s1806-37562016000000145 · Cited by 36
Placebo-Controlled Trial of Cytisine for Smoking Cessation
West, R., Zatoński, W. A., Cedzyńska, M., Lewandowska, D., Pazik, J., Aveyard, P. N., & Stapleton, J. (2012) · Survey of Anesthesiology · doi:10.1097/01.sa.0000411903.07104.b3 · Cited by 35
Burden of current and past smoking across 28 European countries in 2017: A cross-sectional analysis
Teshima, A., Laverty, A. A., & Filippidis, F. T. (2022) · Tobacco Induced Diseases · doi:10.18332/tid/149477 · Cited by 37
Tobacco control efforts in Europe
Britton, J. R., & Bogdanovica, I. (2013) · The Lancet · doi:10.1016/s0140-6736(13)60814-4 · Cited by 35
Taggar, J., Lewis, S., Docherty, G., Bauld, L., McEwen, A., & Coleman, T. J. (2015) · Substance Abuse Treatment Prevention and Policy · doi:10.1186/s13011-015-0011-8 · Cited by 35
“Tobacco smoking is a major addiction which causes premature morbidity, mortality and impaired quality of life [3,4], the risks of which can be reduced by smoking cessation.”
BackgroundContinued Increases in the Relative Risk of Death From Smoking
Mehta, N. K., & Preston, S. H. (2012) · American Journal of Public Health · doi:10.2105/ajph.2011.300489 · Cited by 35
Second-hand smoke and the risk of tuberculosis: a systematic review and a meta-analysis
Dogar, O. F., PILLAI, N., Safdar, N., Shah, S., Zahid, R., & Siddiqi, K. (2015) · Epidemiology and Infection · doi:10.1017/s0950268815001235 · Cited by 35
Reduced-Nicotine Cigarettes in Young Smokers: Impact of Nicotine Metabolism on Nicotine Dose Effects
Faulkner, P., Ghahremani, D. G., Tyndale, R. F., Cox, C. M., Kazanjian, A. S., Paterson, N. E., Lotfipour, S., Hellemann, G., Petersen, N., Vigil, C., et al. (2017) · Neuropsychopharmacology · doi:10.1038/npp.2017.18 · Cited by 35
“Young smokers are of particular interest because the transition from intermittent to daily smoking generally occurs before age 25 (Benowitz and Henningfield, 1994), and smoking cessation before this age avoids most long-term negative consequences of smoking (Doll et al, 2004).”
BackgroundRussell, C., Dickson, T., & McKeganey, N. (2017) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntx176 · Cited by 35
Intensive Cardiac Rehabilitation: an Underutilized Resource
Freeman, A. M., Taub, P. R., Lo, H. C., & Ornish, D. M. (2019) · Current Cardiology Reports · doi:10.1007/s11886-019-1104-1 · Cited by 36
Predicting Mortality From Human Faces
Dykiert, D., Bates, T. C., Gow, A. J., Penke, L., Starr, J. M., & Deary, I. J. (2012) · Psychosomatic Medicine · doi:10.1097/psy.0b013e318259c33f · Cited by 35
“One factor associated with both accelerated skin aging (30) and mortality (31,32) is smoking.”
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Cost-effectiveness of pharmacogenetic testing to tailor smoking-cessation treatment
Heitjan, D. F., Asch, D. A., Ray, R., Rukstalis, M. R., Patterson, F., & Lerman, C. E. (2008) · The Pharmacogenomics Journal · doi:10.1038/sj.tpj.6500492 · Cited by 36
Cardiovascular risk factors predict survival in middle-aged men during 50years
Menotti, A., Puddu, P. E., Lanti, M., Maiani, G., & Fidanza, F. (2012) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2012.08.004 · Cited by 35
“In the last 25 years a small number of papers mentioned a 50-year study or a 50-year follow-up [1–9], but only a few were truly longitudinal population studies.”
BackgroundThe Association of Smoking and Cardiovascular Disease in a Population With Low Cholesterol Levels
Lawlor, D. A., Song, Y., Sung, J., Ebrahim, S. B. J., & Smith, G. D. (2008) · Stroke · doi:10.1161/strokeaha.107.494823 · Cited by 35
Diverging trends in female old-age mortality: A reappraisal
Staetsky, L. (2009) · Demographic Research · doi:10.4054/demres.2009.21.30 · Cited by 35
“Both types of reductions are possibly related to anti-smoking public health campaigns that took place since the 1970s in countries that were forerunners of smoking epidemic (Doll et al. 2004, Preston and Wang 2006).”
Shankar, A., Yuan, J., Koh, W., Lee, H.-P., & Yu, M. C. (2007) · European Journal of Cancer · doi:10.1016/j.ejca.2007.10.015 · Cited by 35
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“cardiovascular and respiratory diseases [42–44]”
Tamakoshi, A., Kawado, M., Ozasa, K., Tamakoshi, K., Lin, Y., Yagyu, K., Kikuchi, S., & Hashimoto, S. (2010) · Journal of Epidemiology · doi:10.2188/jea.je20100017 · Cited by 35
Time trends and educational differences in the incidence of quitting smoking in Spain (1965–2000)
Schiaffino, A., Fernández, E., Kunst, A. E., Borrell, C., García, M., Borràs, J. M., & Mackenbach, J. P. (2007) · Preventive Medicine · doi:10.1016/j.ypmed.2007.05.009 · Cited by 36
Biomedical risk assessment as an aid for smoking cessation
Bize, R., Burnand, B., Mueller, Y. K., Walther, M. R., & Cornuz, J. (2005) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004705.pub2 · Cited by 35
Mesolimbic Dopamine and Habenulo-Interpeduncular Pathways in Nicotine Withdrawal
Dani, J. A., & De Biasi, M. (2013) · Cold Spring Harbor Perspectives in Medicine · doi:10.1101/cshperspect.a012138 · Cited by 34
Daoud, N., Hayek, S., Muhammad, A. S., Abu-Saad, K., Osman, A., Thrasher, J. F., & Kalter‐Leibovici, O. (2015) · BMC Public Health · doi:10.1186/s12889-015-1950-8 · Cited by 34
“On average, the life expectancy of smokers is reduced by almost 10 years [4].”
BackgroundLife-style and self-rated global health in Sweden: A prospective analysis spanning three decades
Mood, C. (2013) · Preventive Medicine · doi:10.1016/j.ypmed.2013.09.002 · Cited by 32
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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