Smoking and Mortality — Beyond Established Causes

作者：Brian D. Carter, Christian C. Abnet, Diane Feskanich, Neal D. Freedman, Patricia Hartge, Cora E. Lewis, Judith K. Ockene, Ross L. Prentice, Frank E. Speizer, Michael J. Thun, Eric J. Jacobs · 发表于：New England Journal of Medicine · 年份：2015 · DOI：10.1056/nejmsa1407211 · 被引用次数：824 · 研究领域：Smoking Behavior and Cessation、Alcohol Consumption and Health Effects、Diabetes, Cardiovascular Risks, and Lipoproteins

BACKGROUND: Mortality among current smokers is 2 to 3 times as high as that among persons who never smoked. Most of this excess mortality is believed to be explained by 21 common diseases that have been formally established as caused by cigarette smoking and are included in official estimates of smoking-attributable mortality in the United States. However, if smoking causes additional diseases, these official estimates may significantly underestimate the number of deaths attributable to smoking. METHODS: We pooled data from five contemporary U.S. cohort studies including 421,378 men and 532,651 women 55 years of age or older. Participants were followed from 2000 through 2011, and relative risks and 95% confidence intervals were estimated with the use of Cox proportional-hazards models adjusted for age, race, educational level, daily alcohol consumption, and cohort. RESULTS: During the follow-up period, there were 181,377 deaths, including 16,475 among current smokers. Overall, approximately 17% of the excess mortality among current smokers was due to associations with causes that are not currently established as attributable to smoking. These included associations between current smoking and deaths from renal failure (relative risk, 2.0; 95% confidence interval [CI], 1.7 to 2.3), intestinal ischemia (relative risk, 6.0; 95% CI, 4.5 to 8.1), hypertensive heart disease (relative risk, 2.4; 95% CI, 1.9 to 3.0), infections (relative risk, 2.3; 95% CI, 2.0 to 2.7), various respira...