Smoking Deaths Now Equal in Women and Men
Action Points
- The risk of death from cigarette smoking continues to increase among women, and the increased risks are now nearly identical for men and women as compared with persons who have never smoked, a study has found.
- Note that individuals who quit between ages 25 and 34 had a 10-year increase in life expectancy.
In one national survey, the rate of all-cause mortality was three times higher for smokers than for nonsmokers, with a hazard ratio of 2.8 (95% CI 2.4 to 3.1) for men and 3 (95% CI 2.7 to 3.3) for women, according to Prabhat Jha, MD, of the Center for Global Health Research in Toronto, and colleagues.
In a second study, the relative risk of death from any cause among a contemporary cohort of smokers was 2.80 (95% CI 2.72 to 2.88) for men and 2.76 (95% CI 2.69 to 2.84) for women, reported Michael J. Thun, MD, of the American Cancer Society in Atlanta, and colleagues.
"Most people in the U.S. assume that smoking is on its way out. But the grim reality is that smoking still exerts an enormous toll on the health of Americans," Steven A. Schroeder, MD, of the University of California San Francisco, wrote in an editorial accompanying the studies in the Jan. 24 New England Journal of Medicine.
The study by Jha and colleagues included 216,917 adults who participated in the U.S. National Health Interview Survey during the years 1997 to 2004.
Those who reported current smoking had less education, were less likely to be overweight or obese, and drank more alcohol.
Women in this cohort were less likely than men to quit smoking.
During about 7 years of follow-up, 7,479 men and 8,236 women in the cohort died.
Analysis of the mortality data revealed that people who had never smoked were twice as likely to live to age 80 compared with current smokers.
Among men, the likelihood of living to 80 was 61% (95% CI 55 to 67) for nonsmokers, falling to 26% (95% CI 18 to 33) for those who continued to smoke.
For women, the corresponding numbers were 70% (95% CI 64 to 76) and 38% (95% CI 30 to 45), according to Jha and colleagues.
Hazard ratios for death from lung cancer were "notably high" for both women (HR 17.8, 95% CI 11.4 to 27.8) and men (HR 14.6, 95% CI 9.1 to 23.4), the researchers found.
In addition, hazard ratios for death from ischemic heart disease among current smokers were 3.5 (95% CI 2.7 to 4.6) for women and 3.2 (95% CI 2.5 to 4.1) for men.
Jha and colleagues also examined the effects of smoking cessation and found that individuals who quit between ages 25 and 34 had a 10-year increase in life expectancy, while those who quit at ages 35 to 44 had a 9-year increase.
Even those who quit at ages 45 to 54 had a gain of 6 years, and those who stopped between ages 55 and 64 could expect an additional 4 years.
Overall, smoking cessation by about age 40 reduced the risk of death by 90%, the researchers found.
Between 1965 and 2010 the prevalence of smoking among American adults fell from 42% to 19%, but 30 million people worldwide begin smoking each year.
"On the basis of current rates of smoking initiation and cessation, smoking, which killed about 100 million people in the 20th century, will kill about 1 billion in the 21st century," Jha and colleagues predicted.
Limitations of the study included the possibility of confounding variables and cause of death misclassification.
The study by Thun and colleagues compared mortality rates in several historical and contemporary cohorts over three time periods, 1959 to 1965, 1982 to 1988, and 2000 to 2010.
In the earliest time period, the relative risk for lung cancer-related mortality among smokers was 12.22 for men but only 2.73 for women, yet by the latest period the risk for men was 24.97 and had risen to 25.66 for women.
Between the 1980s and the later periods there also was a doubling of mortality risk associated with chronic obstructive pulmonary disease in men, from a relative risk of 9.98 to 25.61, and in women, from 10.35 to 22.35.
This increase may relate to the different design of cigarettes today, which allow deeper inhalation into the lung parenchyma, the investigators wrote.
In the latest cohort, risks of death from ischemic heart disease also rose among smokers, to 2.86 for women and 2.50 for men.
The researchers noted that the finding of "nearly identical" risks for women and men in the latest time period was "new and confirms the prediction that, in relative terms, 'women who smoke like men die like men,'" meaning that they begin earlier and smoke more heavily than in the past.
Limitations of this study included its population of predominantly white adults who were mostly 50 and older.
In his editorial, Schroeder emphasized the increased importance of smoking as a health hazard for women.
"More women die of lung cancer than of breast cancer. But there is no 'race for the cure' for lung cancer, no brown ribbon, and no group analogous to the Susan G. Komen Breast Cancer Foundation," he pointed out.
In addition, the growing stigma associated with smoking has resulted in the habit being concentrated among the less privileged, and "it risks becoming invisible to those who set health policies and research priorities," he wrote.
Further efforts toward smoking prevention and cessation remain an urgent need, he concluded.
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