Smokers More Likely to Die in Middle Age

Summary:
A new study shows that people who smoke are more likely to die during middle age than people who never smoked or those who gave up the habit. The research was done in Norway and published in the Annals of Internal Medicine.

Why it's important:
Although many studies have shown that smoking causes premature death, most of those studies included only men. Less was known about how smoking affects women. This study looked at both genders, so it gives us a better idea of how smoking harms women, too.
It also shows why it is so important that smokers quit, and why younger people should never start smoking in the first place, according to Ronald M. Davis, MD, of the Henry Ford Health System in Detroit. He wrote an editorial about the study.

What's already known:
Smoking is the leading preventable cause of death in the world, causing about 5 million deaths worldwide each year, according to the World Health Organization. In the United States, some 438,000 people die from tobacco use each year. Smoking is responsible for most cases of lung cancer (both small cell and non-small cell), and is linked to at least 10 other cancers. It is also a major cause of heart disease, stroke, and other lung diseases such as emphysema.
"What this study does in a detailed way, with the advantage of outstanding long-term follow-up and health records, is clearly demonstrate the impact of smoking on the duration of life," said Len Lichtenfeld, MD, deputy chief medical officer for the American Cancer Society.

How this study was done:
Researchers from the University of Bergen studied smoking habits and causes of death in nearly 50,000 people in 3 rural counties in Norway. The men and women were between the ages of 35 and 49 when they were recruited for the study (between 1974 and 1978). They were asked about whether they smoked, how much they smoked, and when they'd started smoking. They were also asked about other factors like exercise, marital status, and education. The researchers used death certificates to see how many people in the group died, when they died, and what they died of: lung cancer, other smoking-related cancers, other cancers not linked to smoking, heart disease, alcohol abuse/liver disease, other medical conditions, and accidents/violence.

What was found:
Smokers were much more likely to die between the ages of 40 and 70 than nonsmokers. Just 9% of women who had never smoked died during that period of life, compared to 26% of women who smoked 20 or more cigarettes per day (heavy smokers). The difference was even greater for men: 14% of those who never smoked died in middle age, compared to 41% of the heavy smokers.
The more people smoked, the more likely they were to die in middle age. There were no significant differences in lung cancer deaths, or deaths from other smoking-related cancers, in men and women who smoked.
There was one piece of good news from the study. Quitting at any age lowered the risk of dying -- but those who quit in their 40s fared better than those who waited until their 50s or 60s to kick the habit.

The bottom line:
The Norwegian study serves as a powerful reminder of the dangers of smoking, and the importance of tobacco control efforts like the Framework Convention on Tobacco Control, experts say.
"Numbers can be dry and boring," Lichtenfeld noted, "but when you consider the real-life impact of the deaths reported in this study, you can begin to appreciate the impact cigarettes have on everyday folks."
Citation: "Smoking and Deaths between 40 and 70 Years of Age in Women and Men." Published in the March 21, 2006 Annals of Internal Medicine (Vol. 144, No. 6: 381-390. First author: Stein Emil Vollset, MD, DrPH, University of Bergen, Norway.
"Measuring the Health Impact of Smoking and Health Care Providers' Performance in Addressing the Problem." Published in the March 21, 2006 Annals of Internal Medicine (Vol. 144, No. 6: 444-446). First author: Ronald M. Davis, MD, Henry Ford Health System, Detroit.
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