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Smoking Cessation in Relation to Total Mortality Rates in Women: A Prospective Cohort Study

Ichiro Kawachi, MB, ChB; Graham A. Colditz, MB BS; Meir J. Stampfer, MD; Walter C. Willett, MD; JoAnn E. Manson, MD; Bernard Rosner, PhD; David J. Hunter, MB BS; Charles H. Hennekens, MD; and Frank E. Speizer, MD
[+] Article, Author, and Disclosure Information

From Harvard Medical School, Brigham and Women's Hospital, and Harvard School of Public Health, Boston, Massachusetts. Request for Reprints: Ichiro Kawachi, MB ChB, Channing Laboratory, 180 Longwood Avenue, Boston, MA 02115-5899. Acknowledgments: The authors thank the participants in the Nurses' Health Study and Mark Shneyder, Karen Corsano, Gary Chase, Barbara Egan, and Lisa Dunn for data collection and management. Grant Support: By research grants HL 34594 and CA 40356 from the National Institutes of Health. Dr. Kawachi is the recipient of an Overseas Research Fellowship of the Health Research Council of New Zealand. Dr. Colditz is supported by a Faculty Research Award (FRA 398) from the American Cancer Society.

Copyright 2004 by the American College of Physicians

Ann Intern Med. 1993;119(10):992-1000. doi:10.7326/0003-4819-119-10-199311150-00005
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Objective: To examine the temporal relationship between stopping smoking and total mortality rates among middle-aged women.

Design: Prospective cohort study with 12 years of follow-up.

Setting: Registered nurses residing in the United States.

Participants: 117 001 female registered nurses, ages 30 to 55 years, who were free of manifest coronary heart disease, stroke, and cancer (except nonmelanoma skin cancer) in 1976.

Main Outcome Measures: Total mortality, further categorized into deaths from cardiovascular diseases, cancers, and violent deaths.

Results: A total of 2847 deaths (933 among never smokers, 799 among former smokers, and 1115 among current smokers) occurred during 1.37 million person-years of follow-up. The multivariate relative risks for total mortality compared with never smokers were 1.87 (95% CI, 1.65 to 2.13) for current smokers and 1.29 (CI, 1.14 to 1.46) former smokers. Participants who started smoking before the age of 15 years had the highest risks for total mortality (multivariate relative risk, 3.15; CI, 2.16 to 4.59), cardiovascular disease mortality (relative risk, 9.94; CI, 5.15 to 19.19), and deaths from external causes of injury (relative risk, 5.39; CI, 1.84 to 15.78). Compared with continuing smokers, former smokers had a 24% reduction in risk for cardiovascular disease mortality within 2 years of quitting. The excess risks for total mortality and both cardiovascular disease and total cancer mortality among former smokers approached the level of that for never smokers after 10 to 14 years of abstinence. The health benefits of cessation were clearly present regardless of the age at starting and daily number of cigarettes smoked.

Conclusions: The risk of cigarette smoking on total mortality among former smokers decreases nearly to that of never smokers 10 to 14 years after cessation.


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Figure 1.
Risk of total mortality by time since quitting.

Multivariate relative risk for total mortality by time since quitting (reference category: current smokers). Error bars represent 95% confidence intervals. Nonfatal coronary heart disease, stroke, and cancer (except nonmelanoma skin cancer) were excluded at baseline and at the beginning of each successive 2-year follow-up period. Variables in model include age in 5-year categories, follow-up period (1976 to 1978, 1978 to 1980.1986 to 1988), body mass index, history of hypertension, high cholesterol, diabetes, parental history of myocardial infarction before age 60 years, postmenopausal estrogen therapy, menopausal status, previous use of oral contraceptives, age at starting smoking, and daily number of cigarettes smoked during the period before cessation.

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