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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]
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]
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Citations
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Chen-Sankey, J. C., Kechter, A., Barrington‐Trimis, J. L., McConnell, R., Krueger, E. A., Cruz, T. B., Unger, J. B., Chaffee, B. W., & Leventhal, A. M. (2021) · Tobacco Control · doi:10.1136/tobaccocontrol-2021-056479 · Cited by 31
Hartmann‐Boyce, J., Ordóñez‐Mena, J. M., Livingstone‐Banks, J., Fanshawe, T. R., Lindson, N., Freeman, S. C., Sutton, A. J., Theodoulou, A., & Aveyard, P. N. (2022) · Addiction · doi:10.1111/add.15791 · Cited by 31
Høie, M. M., Moan, I. S., Rise, J., & Larsen, E. (2011) · Addiction Research & Theory · doi:10.3109/16066359.2011.557165 · Cited by 31
“Hence, if smokers quit by the age of 30, the risk of mortality caused by smoking can almost be reduced to zero (Doll et al., 2004).”
BackgroundRoss, S., & Williams, D. J. (2005) · Expert Opinion on Drug Safety · doi:10.1517/14740338.4.6.995 · Cited by 31
“It represents one of the leading causes of preventable death with > 3 million smokers worldwide dying each year from smoking-related illnesses [1,2].”
BackgroundRebuttal: When it comes to scientific inference, sometimes a cigar is just a cigar
Rothman, K. J., Gallacher, J., & Hatch, E. E. (2013) · International Journal of Epidemiology · doi:10.1093/ije/dyt124 · Cited by 32
Scheffels, J., & Schou, K. C. (2007) · Addiction Research & Theory · doi:10.1080/16066350601179464 · Cited by 31
“It is estimated that approximately half of all regular cigarette smokers who start in their teens and proceed beyond the age of 35 will eventually die from tobacco-related diseases (Doll et al. 2004).”
BackgroundResidential radon and lung cancer characteristics in never smokers
Torres‐Durán, M., Ruano‐Raviña, A., Parente-Lamelas, I., Leiro‐Fernández, V., Arca, J. A., Montero-Martínez, C., Pena, C., Castro‐Añón, O., Golpe-Gómez, A., Martínez, C., et al. (2015) · International Journal of Radiation Biology · doi:10.3109/09553002.2015.1047985 · Cited by 31
“Most of the studies on lung cancer epidemiology have been carried out in ever smokers because tobacco smoking is the main risk factor for this disease (Doll et al. 2004).”
BackgroundEvidence for Health I: Producing evidence for improving health and reducing inequities
Andermann, A. A. J., Pang, T., Newton, J. N., Davis, A. C., & Panisset, U. D. B. (2016) · Health Research Policy and Systems · doi:10.1186/s12961-016-0087-2 · Cited by 31
Endothelial progenitor cells as a biological marker of peripheral artery disease
Bitterli, L. P., Afan, S., Bühler, S., Santo, S. D., Zwahlen, M., Schmidlin, K., Yang, Z., Baumgärtner, I., Diehm, N., & Kalka, C. (2015) · Vascular Medicine · doi:10.1177/1358863x15611225 · Cited by 31
Competing risks and lifetime coronary heart disease incidence during 50years of follow-up
Puddu, P. E., Piras, P., & Menotti, A. (2016) · International Journal of Cardiology · doi:10.1016/j.ijcard.2016.05.043 · Cited by 31
Ploubidis, G. B., & Grundy, E. M. D. (2011) · Demography · doi:10.1007/s13524-011-0028-1 · Cited by 30
The Dirty Dozen: 12 Myths That Undermine Tobacco Control
Frieden, T. R., & Blakeman, D. E. (2005) · American Journal of Public Health · doi:10.2105/ajph.2005.063073 · Cited by 30
Reid, R. D., Malcolm, J., Wooding, E., Geertsma, A., Aitken, D., Arbeau, D., Blanchard, C., Gagnier, J.-A., Gupta, A., Mullen, K.-A., et al. (2018) · Diabetes Care · doi:10.2337/dc17-1809 · Cited by 30
Wang, Y., He, Y., Shi, Y., Qian, D. C., Gray, K. J., Winn, R. A., & Martin, A. R. (2024) · The American Journal of Human Genetics · doi:10.1016/j.ajhg.2024.04.002 · Cited by 34
Brown, J. (2013) · Worldviews on Evidence-Based Nursing · doi:10.1111/wvn.12000 · Cited by 30
Fighting Tobacco Smoking - a Difficult but Not Impossible Battle
Leung, C. M.-K., Leung, A. K. C., Hon, K. E., & Kong, A. Y. F. (2009) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph6010069 · Cited by 30
Disparities in health care utilization by smoking status in Canada
Azagba, S., Sharaf, M. F., & Liu, C. X. (2013) · International Journal of Public Health · doi:10.1007/s00038-013-0452-7 · Cited by 30
Graduate nurses and nursing student's behaviour: Knowledge and attitudes toward smoking cessation
Moxham, L. J., Dwyer, T., & Reid‐Searl, K. (2012) · Nurse Education Today · doi:10.1016/j.nedt.2012.11.024 · Cited by 30
Electronic Cigarettes for Smoking Cessation
Bullen, C. (2014) · Current Cardiology Reports · doi:10.1007/s11886-014-0538-8 · Cited by 29
Levy, D. T., Gallus, S., Blackman, K., Carreras, G., Vecchia, C. L., & Gorini, G. (2012) · BMC Public Health · doi:10.1186/1471-2458-12-709 · Cited by 32
“Both SAMMEC and Peto’s methods use relative risks of mortality for about 20 tobacco-related diseases from the CPS II study, and mortality figures for these specific causes.”
ResultInfluentialTransitions in Smoking Status Over Time in a Population-Based Panel Study of Smokers
Bondy, S. J., Victor, J. C., Diemert, L. M., Mecredy, G. C., Chaiton, M., Brown, K. S., Cohen, J. E., McDonald, P., Ferrence, R. G., Garcia, J., et al. (2012) · Nicotine & Tobacco Research · doi:10.1093/ntr/nts259 · Cited by 32
Agyemang, C. O., Stronks, K., Tromp, N., Bhopal, R., Zaninotto, P., Unwin, N. C., Nazroo, J. Y., & Kunst, A. E. (2010) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntq044 · Cited by 30
Relationships between chronic obstructive pulmonary disease and lung cancer: biological insights
Barreiro, E., Bustamante, V., Curull, V., Gea, J., López-Campos, J. L., & Muñoz, X. (2016) · Journal of Thoracic Disease · doi:10.21037/jtd.2016.09.54 · Cited by 30
“As such, compared to lifelong non-smokers, the risk of LC was estimated to be four-fold higher among former smokers, while it was 14-fold greater among current smokers (44).”
BackgroundCaponnetto, P., DiPiazza, J., Aiello, M. R., & Polosa, R. (2017) · Health Psychology Open · doi:10.1177/2055102917736429 · Cited by 30
“Death is mainly caused by lung cancer, coronary heart disease, chronic obstructive pulmonary disease, and stroke (Doll et al., 2004; US Department of Health Human Services, 2004).”
BackgroundContent analysis of tobacco content in UK television
Barker, A. B., Whittamore, K. H., Britton, J. R., & Cranwell, J. (2018) · Tobacco Control · doi:10.1136/tobaccocontrol-2018-054427 · Cited by 30
Akter, S., Nakagawa, T., Honda, T., Yamamoto, S., Kuwahara, K., Okazaki, H., Hu, H., Imai, T., Nishihara, A., Miyamoto, T., et al. (2018) · Circulation Journal · doi:10.1253/circj.cj-18-0404 · Cited by 30
Impact of tobacco use on health and work productivity in Malaysia
Tan, Q. Y., Zomer, E., Owen, A. J., Chin, K. L., & Liew, D. (2019) · Tobacco Control · doi:10.1136/tobaccocontrol-2018-054677 · Cited by 32
Cancers Attributable to Modifiable Risk Factors: A Road Map for Prevention
Collatuzzo, G., & Boffetta, P. (2022) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-052220-124030 · Cited by 33
Occupational Exposures and Lung Cancer
Richardson, D. B. (2010) · Epidemiology · doi:10.1097/ede.0b013e3181c6f7d9 · Cited by 30
Rios, L. E., Herval, Á. M., Ferreira, R. C., & Freire, M. D. C. M. (2018) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2018.09.005 · Cited by 30
Smoking Among Young Urban Malaysian Women and its Risk Factors
Manaf, R. A., & Shamsuddin, K. (2008) · Asia Pacific Journal of Public Health · doi:10.1177/1010539508316973 · Cited by 29
A New Policy on Tobacco Papers
Editors, T. P. M. (2010) · PLoS Medicine · doi:10.1371/journal.pmed.1000237 · Cited by 30
Bidra, A. S. (2013) · Dental Clinics of North America · doi:10.1016/j.cden.2013.09.001 · Cited by 30
Ten Critical Reasons for Treating Tobacco Dependence in Inpatient Psychiatry
Prochaska, J. J. (2009) · Journal of the American Psychiatric Nurses Association · doi:10.1177/1078390309355318 · Cited by 29
Brown, J., Michie, S., Raupach, T., & West, R. (2013) · Journal of Medical Internet Research · doi:10.2196/jmir.2342 · Cited by 29
“Almost all these deaths could be avoided if smokers quit before their mid-30s [2].”
BackgroundBladder cancer: A portal into men׳s health
Skeldon, S., & Goldenberg, S. L. (2014) · Urologic Oncology Seminars and Original Investigations · doi:10.1016/j.urolonc.2013.12.005 · Cited by 28
“As reported in the male British Doctor's Study, quitting smoking at 40 years of age can add 9 years of life expectancy to a man [51].”
BackgroundFarsalinos, K. E., & Romagna, G. (2013) · Clinical Medicine Insights Case Reports · doi:10.4137/ccrep.s11175 · Cited by 29
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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