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Cigarette Smoking and Mortality in Adults Aged 70 Years and Older: Results From the NIH-AARP Cohort

Published:November 29, 2016DOI:https://doi.org/10.1016/j.amepre.2016.09.036

      Introduction

      Tobacco use remains a leading modifiable cause of cancer incidence and premature mortality in the U.S. and globally. Despite increasing life expectancy worldwide, less is known about the effects of cigarette smoking on older populations. This study sought to determine the effects of smoking on mortality in older age.

      Methods

      Associations of mortality with self-reported age at smoking cessation, age at smoking initiation, and amount smoked after age 70 years were examined in 160,113 participants of the NIH-AARP Diet and Health Study aged >70 years. Participants completed a questionnaire detailing their smoking use in 2004–2005, and were followed for mortality through December 31, 2011. Analyses were conducted between 2014 and 2016.

      Results

      Relative to never smokers, current smokers were more likely to die during follow-up (hazard ratio, 3.18; 95% CI=3.04, 3.31). Furthermore, former smokers had lower risks than current smokers (hazard ratios for quitting between ages 30–39, 40–49, 50–59, and 60–69 years were 0.41 [95% CI=0.39, 0.43], 0.51 [95% CI=0.49, 0.54], 0.64 [95% CI=0.61, 0.67], and 0.77 [95% CI=0.73, 0.81], respectively). Among current smokers, mortality was inversely associated with age at initiation, but directly associated with the number of cigarettes smoked per day at age >70 years.

      Conclusions

      As among younger people, lifetime cigarette smoking history is a key determinant of mortality after age 70 years.
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      References

        • Holford T.R.
        • Meza R.
        • Warner K.E.
        • et al.
        Tobacco control and the reduction in smoking-related premature deaths in the United States, 1964-2012.
        JAMA. 2014; 311: 164-171https://doi.org/10.1001/jama.2013.285112
        • American Cancer Society
        Cancer Facts and Figures 2014.
        American Cancer Society, Atlanta, GA2014
      1. The Health Consequences of Smoking–50 Years of Progress: A Report of the Surgeon General.
        DHHS, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, GA2014
        • Carter B.D.
        • Abnet C.C.
        • Feskanich D.
        • et al.
        Smoking and mortality–beyond established causes.
        N Engl J Med. 2015; 372: 631-640https://doi.org/10.1056/NEJMsa1407211
        • WHO
        WHO global report: mortality attributable to tobacco.
        WHO Press, Geneva, Switzerland2012
        • Oppeltz R.F.
        • Jatoi I.
        Tobacco and the escalating global cancer burden.
        J Oncol. 2011; 2011: 408104https://doi.org/10.1155/2011/408104
      2. Ending the tobacco epidemic: a tobacco control strategic action plan for the U.S..
        DHHS, Washington D.C.2010
        • Koh H.K.
        • Sebelius K.G.
        Ending the tobacco epidemic.
        JAMA. 2012; 308: 767-768https://doi.org/10.1001/jama.2012.9741
        • Ortman J.M.
        • Velkoff V.A.
        • Hogan H.
        An Aging Nation: The Older Population in the United States.
        U.S. Census Bureau, Washington, DC2014: 25-1140
        • Escobedo L.G.
        • Peddicord J.P.
        Smoking prevalence in U.S. birth cohorts: the influence of gender and education.
        Am J Public Health. 1996; 86: 231-236https://doi.org/10.2105/AJPH.86.2.231
        • Harris J.E.
        Cigarette smoking among successive birth cohorts of men and women in the United States during 1900-80.
        J Natl Cancer Inst. 1983; 71: 473-479
        • Gellert C.
        • Schottker B.
        • Brenner H.
        Smoking and all-cause mortality in older people: systematic review and meta-analysis.
        Arch Intern Med. 2012; 172: 837-844https://doi.org/10.1001/archinternmed.2012.1397
        • Gellert C.
        • Schottker B.
        • Holleczek B.
        • Stegmaier C.
        • Muller H.
        • Brenner H.
        Using rate advancement periods for communicating the benefits of quitting smoking to older smokers.
        Tob Control. 2013; 22: 227-230https://doi.org/10.1136/tobaccocontrol-2012-050572
        • Schatzkin A.
        • Subar A.F.
        • Thompson F.E.
        • et al.
        Design and serendipity in establishing a large cohort with wide dietary intake distributions: the National Institutes of Health-American Association of Retired Persons Diet and Health Study.
        Am J Epidemiol. 2001; 154: 1119-1125https://doi.org/10.1093/aje/154.12.1119
        • Salive M.E.
        • Cornoni-Huntley J.
        • LaCroix A.Z.
        • Ostfeld A.M.
        • Wallace R.B.
        • Hennekens C.H.
        Predictors of smoking cessation and relapse in older adults.
        Am J Public Health. 1992; 82: 1268-1271https://doi.org/10.2105/AJPH.82.9.1268
        • Whitson H.E.
        • Heflin M.T.
        • Burchett B.M.
        Patterns and predictors of smoking cessation in an elderly cohort.
        J Am Geriatr Soc. 2006; 54: 466-471https://doi.org/10.1111/j.1532-5415.2005.00641.x
        • Pirie K.
        • Peto R.
        • Reeves G.K.
        • Green J.
        • Beral V.
        • Million Women Study Collaborators
        The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK.
        Lancet. 2013; 381: 133-141https://doi.org/10.1016/S0140-6736(12)61720-6
        • Jha P.
        • Ramasundarahettige C.
        • Landsman V.
        • et al.
        21st-century hazards of smoking and benefits of cessation in the United States.
        N Engl J Med. 2013; 368: 341-350https://doi.org/10.1056/NEJMsa1211128
        • Thun M.J.
        • Carter B.D.
        • Feskanich D.
        • et al.
        50-year trends in smoking-related mortality in the United States.
        N Engl J Med. 2013; 368: 351-364https://doi.org/10.1056/NEJMsa1211127
        • Taylor Jr., D.H.
        • Hasselblad V.
        • Henley S.J.
        • Thun M.J.
        • Sloan F.A.
        Benefits of smoking cessation for longevity.
        Am J Public Health. 2002; 92: 990-996https://doi.org/10.2105/AJPH.92.6.990
        • LaCroix A.Z.
        • Lang J.
        • Scherr P.
        • et al.
        Smoking and mortality among older men and women in three communities.
        N Engl J Med. 1991; 324: 1619-1625https://doi.org/10.1056/NEJM199106063242303
        • Paganini-Hill A.
        • Hsu G.
        Smoking and mortality among residents of a California retirement community.
        Am J Public Health. 1994; 84: 992-995https://doi.org/10.2105/AJPH.84.6.992
        • Vogt M.T.
        • Cauley J.A.
        • Scott J.C.
        • Kuller L.H.
        • Browner W.S.
        Smoking and mortality among older women: the study of osteoporotic fractures.
        Arch Intern Med. 1996; 156: 630-636https://doi.org/10.1001/archinte.1996.00440060050006
        • Warren G.W.
        • Alberg A.J.
        • Kraft A.S.
        • Cummings K.M.
        The 2014 Surgeon General’s report: “The health consequences of smoking–50 years of progress”: a paradigm shift in cancer care.
        Cancer. 2014; 120: 1914-1916https://doi.org/10.1002/cncr.28695
        • Kenfield S.A.
        • Stampfer M.J.
        • Rosner B.A.
        • Colditz G.A.
        Smoking and smoking cessation in relation to mortality in women.
        JAMA. 2008; 299: 2037-2047https://doi.org/10.1001/jama.299.17.2037
        • Hegmann K.T.
        • Fraser A.M.
        • Keaney R.P.
        • et al.
        The effect of age at smoking initiation on lung cancer risk.
        Epidemiology. 1993; 4: 444-448https://doi.org/10.1097/00001648-199309000-00010
        • Huxley R.R.
        • Yatsuya H.
        • Lutsey P.L.
        • Woodward M.
        • Alonso A.
        • Folsom A.R.
        Impact of age at smoking initiation, dosage, and time since quitting on cardiovascular disease in African Americans and whites: the Atherosclerosis Risk in Communities Study.
        Am J Epidemiol. 2012; 175: 816-826https://doi.org/10.1093/aje/kwr391
        • Lam T.H.
        • Li Z.B.
        • Ho S.Y.
        • et al.
        Smoking, quitting and mortality in an elderly cohort of 56,000 Hong Kong Chinese.
        Tob Control. 2007; 16: 182-189https://doi.org/10.1136/tc.2006.019505