Mortality in relation to smoking: 22 years' observations on female British doctors.

Abstract 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% ν24% (a twofold death rate ratio) for those born in 1900-1909, but were 43% ν 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% ν 12% at the death rates of the 1950s (that is, among men born around the 1870s) but were 7% ν 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 ν 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.

[1]  R. Doll,et al.  A survey of doctors' attitudes to smoking. , 1969, British journal of preventive & social medicine.

[2]  J. Loewen,et al.  The health consequences of smoking. , 1970, The Journal of the Arkansas Medical Society.

[3]  J. Kaldor,et al.  Risk factors for cervical cancer in Colombia and Spain , 1992, International journal of cancer.

[4]  Cameron Gd DEPARTMENT of National Health and Welfare. , 1959, Medical services journal, Canada.

[5]  W. F. Wassink Origin conditions for lung cancer. , 1948 .

[6]  R. Peto,et al.  Mortality and smoking in Hong Kong: case-control study of all adult deaths in 1998 , 2001, BMJ : British Medical Journal.

[7]  R. Doll,et al.  Randomised trial of prophylactic daily aspirin in British male doctors , 1988, British medical journal.

[8]  R. Peto Influence of dose and duration of smoking on lung cancer rates. , 1986, IARC scientific publications.

[9]  L. Fratiglioni,et al.  Alcohol and tobacco consumption as risk factors for Alzheimer's disease: a collaborative re-analysis of case-control studies. EURODEM Risk Factors Research Group. , 1991, International journal of epidemiology.

[10]  E. C. Hammond,et al.  "Tar" and nicotine content of cigarette smoke in relation to death rates. , 1976, Environmental research.

[11]  L. Baker,et al.  Tobacco smoking as an etiologic factor in disease; cancer. , 1950, Cancer research.

[12]  R. Doll,et al.  Cigarette smoking and bronchial carcinoma: dose and time relationships among regular smokers and lifelong non-smokers. , 1978, Journal of epidemiology and community health.

[13]  E. C. Hammond,et al.  Smoking in relation to the death rates of one million men and women. , 1966, National Cancer Institute monograph.

[14]  M. Newhouse,et al.  A case control study of carcinoma of the ovary. , 1977, British journal of preventive & social medicine.

[15]  I. Bross,et al.  A study of the etiological factors in cancer of the mouth , 1957, Cancer.

[16]  R. Doll,et al.  Lung Cancer and Other Causes of Death in Relation to Smoking , 1956, British medical journal.

[17]  C. Fletcher,et al.  SMOKING AND HEALTH , 1972 .

[18]  S. Shapiro,et al.  ORAL-CONTRACEPTIVE USE IN RELATION TO MYOCARDIAL INFARCTION , 1979, The Lancet.

[19]  J. Stockman,et al.  The Mortality of Doctors in Relation to Their Smoking Habits: A Preliminary Report , 2006 .

[20]  J. Maxwell The incidence of cancer of the larynx in relation to the incidence of cancer of the bronchi. , 1955, Lancet.

[21]  R. Doll,et al.  Study of the Aetiology of Carcinoma of the Lung , 1952, British medical journal.

[22]  Michael P. Todaro,et al.  World Development Report 1990. , 1990 .

[23]  E. A. Graham,et al.  Tobacco smoking as a possible etiologic factor in bronchiogenic carcinoma. , 1950, Bulletin of the World Health Organization.

[24]  Robert Schrek,et al.  Tobacco Smoking as an Etiologic Factor in Disease , 1952, Angiology.

[25]  R Doll,et al.  Mortality of British doctors in relation to smoking: observations on coronary thrombosis. , 1966, National Cancer Institute monograph.

[26]  Education Welfare.,et al.  Smoking and Health. Report of the Advisory Committee to the Surgeon General of the Public Health Service. , 1964 .

[27]  Clarence E. Pearson,et al.  Critical Issues in Global Health , 2000 .

[28]  R. Peto,et al.  Emerging tobacco hazards in China: 1. Retrospective proportional mortality study of one million deaths , 1998, BMJ.

[29]  J Smith,et al.  Tobacco and cancer: recent epidemiological evidence. , 2004, Journal of the National Cancer Institute.

[30]  T. Chalmers,et al.  A meta-analysis of alcoholic beverage consumption in relation to risk of colorectal cancer , 1990, Cancer Causes & Control.

[31]  I. Macdonald,et al.  Health issues related to alcohol consumption , 1999 .

[32]  J. Peto The Biology of Cancer—A New Approach , 1977, British Journal of Cancer.

[33]  M. Thun,et al.  Cigarette tar yields in relation to mortality from lung cancer in the cancer prevention study II prospective cohort, 1982-8 , 2004, BMJ : British Medical Journal.

[34]  J. Lellouch,et al.  Results of a French survey on the role of tobacco, particularly inhalation, in different cancer sites. , 1961, Journal of the National Cancer Institute.

[35]  R. Peto,et al.  Smoking and mortality from tuberculosis and other diseases in India: retrospective study of 43 000 adult male deaths and 35 000 controls , 2003, The Lancet.

[36]  R. Doll,et al.  Mortality in Relation to Smoking: Ten Years' Observations of British Doctors , 1964, British medical journal.

[37]  H. Eysenck,et al.  Smoking and Personality* , 1960, British medical journal.

[38]  R. Doll,et al.  Mortality in relation to smoking: 20 years' observations on male British doctors. , 1976, British medical journal.

[39]  R. Doll,et al.  Smoking and Carcinoma of the Lung , 1950, Acta - Unio Internationalis Contra Cancrum.

[40]  P. Gupta,et al.  Cohort study of all-cause mortality among tobacco users in Mumbai, India. , 2000, Bulletin of the World Health Organization.

[41]  B. Schneider MANUAL of the international statistical classification of diseases, injuries, and causes of death. Addendum 1. Supplementary interpretations and instructions for coding causes of death. , 1953, Bulletin of the World Health Organization. Supplement.

[42]  P. Wright,et al.  The Natural History of Chronic Bronchitis and Emphysema , 1977 .

[43]  Education Welfare. The health consequences of smoking. A Public Health Service Review: 1967. , 1967 .

[44]  Richard Doll,et al.  The Mortality of Doctors in Relation to Their Smoking Habits , 1954, British medical journal.

[45]  Alan D. Lopez,et al.  The future world-wide health effects of current smoking patterns , 2004 .

[46]  M. Newhouse,et al.  Combined effect of asbestos exposure and smoking on mortality from lung cancer in factory workers. , 1972, Lancet.

[47]  M. Marmot,et al.  Alcohol and cardiovascular disease: the status of the U shaped curve. , 1991, BMJ.

[48]  R. Peto,et al.  The natural history of chronic airflow obstruction. , 1977, British medical journal.

[49]  R. Doll,et al.  Mortality in relation to consumption of alcohol: 13 years' observations on male British doctors , 1994, BMJ.

[50]  R. Doll,et al.  Alcoholic beverages and cancers of the digestive tract and larynx , 1999 .

[51]  Alan D. Lopez,et al.  Alcohol consumption and mortality among middle-aged and elderly U.S. adults. , 1997, The New England journal of medicine.

[52]  R. Godwin-Austen,et al.  Smoking and Parkinson's disease. , 1982, Journal of neurology, neurosurgery, and psychiatry.

[53]  M. Jarvis A profile of tobacco smoking. , 1994, Addiction.

[54]  R. Heidel,et al.  Reducing the Health Consequences of Smoking: 25 Years of Progress. A Report of the Surgeon General. , 1989 .

[55]  M. Kelly Smoking: The Cancer Controversy. Some Attempts to Assess the Evidence. , 1963 .

[56]  M. Nefzger,et al.  A retrospective study of smoking in Parkinson's disease. , 1968, American journal of epidemiology.

[57]  Richard Doll,et al.  Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case-control studies , 2000, BMJ : British Medical Journal.

[58]  B. Margetts,et al.  Interactions between people's diet and their smoking habits: the dietary and nutritional survey of British adults. , 1993, BMJ.

[59]  J. Lister Smoking and Health Now , 1971, Royal Society of Health journal.

[60]  I. Bross,et al.  A study of etiological factors in cancer of the esophagus , 1961, Cancer.

[61]  W. Willett,et al.  A prospective study of cigarette smoking and risk of colorectal adenoma and colorectal cancer in U.S. women. , 1994, Journal of the National Cancer Institute.

[62]  E. C. Hammond,et al.  Asbestos‐associated disease in United States shipyards , 1978, CA: a cancer journal for clinicians.

[63]  J. Spangler Smoking and hormone-related disorders. , 1999, Primary care.

[64]  D. Zaridze,et al.  TOBACCO: A MAJOR INTERNATIONAL HEALTH HAZARD , 1986 .

[65]  GENERAL REMARKS Future worldwide health effects of current smoking patterns , 2022 .

[66]  C A MILLS,et al.  Tobacco smoking habits and cancer of the mouth and respiratory system. , 1950, Cancer research.

[67]  E. Rogot Cardiorespiratory disease mortality among British and Norwegian migrants to the United States. , 1978, American journal of epidemiology.

[68]  R. Doll,et al.  The causes of cancer: quantitative estimates of avoidable risks of cancer in the United States today. , 1981, Journal of the National Cancer Institute.

[69]  N. Wald,et al.  International Smoking Statistics , 2002 .

[70]  R. Peto,et al.  Tobacco—the growing epidemic , 1999, Nature Medicine.

[71]  L. Kinlen Mortality from smoking in developed countries 1950-2000 , 1996, British Journal of Cancer.

[72]  H Schultz,et al.  Tobacco or health: A global status report. , 1998, Annals of Saudi medicine.

[73]  J. Horm,et al.  Negative moods as correlates of smoking and heavier drinking: implications for health promotion. , 1993, Advance data.

[74]  E. J. Grace Tobacco smoking and cancer of the lung , 1943 .

[75]  Alan D. Lopez,et al.  Mortality from tobacco in developed countries: indirect estimation from national vital statistics , 1992, The Lancet.

[76]  T. Cooper Department of Health, Education, and Welfare. , 1976, Military medicine.

[77]  J. Stockman,et al.  Mortality in Relation to Smoking: 50 Years' Observations on Male British Doctors , 2006 .

[78]  D. Wood,et al.  Cigarette Smoking and Food and Nutrient Intakes in Relation to Coronary Heart Disease , 1992, Nutrition Research Reviews.

[79]  A. Dayan Tobacco. A Major International Health Hazard , 1988 .

[80]  E. Schairer,et al.  Lungenkrebs und Tabakverbrauch , 1944, Zeitschrift für Krebsforschung.

[81]  E. A. Graham,et al.  Tobacco smoking as a possible etiologic factor in bronchiogenic carcinoma; a study of 684 proved cases. , 1950, Journal of the American Medical Association.

[82]  Sir Richard Doll Professor Tobacco: A medical history , 2006, Journal of Urban Health.

[83]  M. Pike,et al.  Trends in Mortality among British Doctors in Relation to Their Smoking Habits , 1972, Journal of the Royal College of Physicians of London.

[84]  J. Neaton,et al.  Diabetes, Other Risk Factors, and 12-Yr Cardiovascular Mortality for Men Screened in the Multiple Risk Factor Intervention Trial , 1993, Diabetes Care.

[85]  E. Quoix,et al.  [Lung cancer in women]. , 2005, Revue des maladies respiratoires.

[86]  R Doll,et al.  Mortality in relation to smoking: 40 years' observations on male British doctors , 1994, BMJ.

[87]  Hueper Wc Lung cancer and the tobacco smoking habit. , 1954 .

[88]  D. Rubin,et al.  Smoking and inflammatory bowel disease. , 2000, European journal of gastroenterology & hepatology.

[89]  V. E. Archer,et al.  RESPIRATORY DISEASE MORTALITY AMONG URANIUM MINERS , 1976, Annals of the New York Academy of Sciences.

[90]  R. Peto,et al.  Reviews and Notes: Epidemiology: Mortality from Smoking in Developed Countries 1950-2000: Indirect Estimates from National Vital Statistics , 1995, Annals of Internal Medicine.

[91]  R. Korteweg Mortality from Tobacco , 1959 .

[92]  R. Doll,et al.  Mortality in Relation to Smoking: Ten Years' Observations of British Doctors , 1964, British medical journal.