Excess mortality among cigarette smokers: changes in a 20-year interval.

CPS-I and CPS-II provide an unusual longitudinal perspective on changes in smoking-specific mortality since each included more than 200 000 current cigarette smokers and 480 000 lifelong nonsmokers at baseline, and both were similar with respect to selection and follow-up.'3 The present analyses extend follow-up of CPS-II for an additional 2 years and offer detailed comparative data on how death rates have changed in relation to smoking status, current daily consumption, and duration.'7-20

M J Thun

2008

Scholarcy highlights

  • Despite major changes in tobacco smoking patterns,1- cigarette ingredients, and mortality from cardiovascular diseases since the 1950s,9-" there are few comparative data on how smokingspecific death rates have changed
  • CPS-I and CPS-II provide an unusual longitudinal perspective on changes in smoking-specific mortality since each included more than 200 000 current cigarette smokers and 480 000 lifelong nonsmokers at baseline, and both were similar with respect to selection and follow-up.' The present analyses extend follow-up of CPS-II for an additional 2 years and offer detailed comparative data on how death rates have changed in relation to smoking status, current daily consumption, and duration.'
  • We found that premature mortality, as measured by the difference in all-cause death rates between active cigarette smokers and lifelong nonsmokers, doubled in women and continued unabated in men from the 1960s to the 1980s
  • For men aged 40 to 69, the overall death rate was about three times higher in smokers than in nonsmokers in CPS-II compared with twice as high in CPS-I.'6,18 About half of all deaths among CPS-II smokers were attributable to cigarette smoking
  • While remaining essentially constant in lifelong nonsmokers, lung cancer death rates nearly doubled among male cigarette smokers and increased almost sixfold among female smokers from CPS-I to CPS-II.' This increase in the 6-year follow-up of CPS-II was slightly larger than that seen in the 4-year CPS-II follow-up reported in the 1989 US surgeon general's report
  • Both analyses suggest that the epidemic of lung cancer in the United States has been largely confined to smokers, at least among the White, predominantly middle-class populations that CPS-I and CPS-II participants represent
  • The falling death rates from coronary heart disease and stroke in our study reflect major nationwide declines that began for coronary heart disease in the mid 1960s and for stroke in the 1940s or earlier. Our data suggest that much of the decline results from factors other than smoking cessation, since mortality decreased among both current smokers and lifelong nonsmokers, groups largely unaffected by smoking cessation

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