Lifetime Smoking History and Cause-Specific Mortality in a Cohort Study with 43 Years of Follow-Up

• Published in: PloS one Vol. 11; no. 4; p. e0153310
• Main Authors: Taghizadeh, Niloofar, Vonk, Judith M, Boezen, H Marike
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 07.04.2016; Public Library of Science (PLoS)
• Subjects: Adult; Aged; Biology and Life Sciences; Body mass; Breast cancer; Cancer; Cardiovascular diseases; Cardiovascular Diseases - etiology; Cardiovascular Diseases - mortality; Cause of Death; Chronic obstructive pulmonary disease; Cigarette smoking; Cigarettes; Cohort analysis; Cohort Studies; Colorectal cancer; Complications and side effects; Demographic aspects; Drug addiction; Epidemiology; Female; Follow-Up Studies; Habits; Health risk assessment; Health risks; Heart diseases; Humans; Lung cancer; Lung diseases; Male; Males; Medicine and Health Sciences; Middle Aged; Mortality; Mortality risk; Neoplasms - etiology; Neoplasms - mortality; Netherlands; Obstructive lung disease; Prognosis; Prostate cancer; Pulmonary Disease, Chronic Obstructive - etiology; Pulmonary Disease, Chronic Obstructive - mortality; Regression analysis; Regression models; Risk; Risk Factors; Sex; Smoking; Smoking - adverse effects; Smoking cessation; Studies; Survival Rate; Time Factors; Tobacco Use Disorder - etiology; Tobacco Use Disorder - mortality; Young Adult; Netherlands
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0153310

In general, smoking increases the risk of mortality. However, it is less clear how the relative risk varies by cause of death. The exact impact of changes in smoking habits throughout life on different mortality risks is less studied. We studied the impact of baseline and lifetime smoking habits, and duration of smoking on the risk of all-cause mortality, mortality of cardiovascular diseases (CVD), chronic obstructive pulmonary disease (COPD), any cancer and of the four most common types of cancer (lung, colorectal, prostate, and breast cancer) in a cohort study (Vlagtwedde-Vlaardingen 1965-1990, with a follow-up on mortality status until 2009, n = 8,645). We used Cox regression models adjusted for age, BMI, sex, and place of residence. Since previous studies suggested a potential effect modification of sex, we additionally stratified by sex and tested for interactions. In addition, to determine which cause of death carried the highest risk we performed competing-risk analyses on mortality due to CVD, cancer, COPD and other causes. Current smoking (light, moderate, and heavy cigarette smoking) and lifetime persistent smoking were associated with an increased risk of all-cause, CVD, COPD, any cancer, and lung cancer mortality. Higher numbers of pack years at baseline were associated with an increased risk of all-cause, CVD, COPD, any cancer, lung, colorectal, and prostate cancer mortality. Males who were lifetime persistent pipe/cigar smokers had a higher risk of lung cancer [HR (95% CI) = 7.72 (1.72-34.75)] as well as all-cause and any cancer mortality. A longer duration of smoking was associated with a higher risk of COPD, any and lung cancer [HR (95% CI) = 1.06 (1.00-1.12), 1.03 (1.00-1.06) and 1.10 (1.03-1.17) respectively], but not with other mortality causes. The competing risk analyses showed that ex- and current smokers had a higher risk of cancer, CVD, and COPD mortality compared to all other mortality causes. In addition, heavy smokers had a higher risk for COPD mortality compared to cancer, and CVD mortality. Our study indicates that lifetime numbers of cigarettes smoked and the duration of smoking have different impacts for different causes of mortality. Moreover, our findings emphasize the importance of smoking-related competing risks when studying the smoking-related cancer mortality in a general population and that smoking cessation immediately effectively reduces the risk of all-cause and any cancer mortality.