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Reduction in total and major cause-specific mortality from tobacco smoking cessation: a pooled analysis of 16 population-based cohort studies in Asia

Journal Article · · International Journal of Epidemiology
DOI:https://doi.org/10.1093/ije/dyab087· OSTI ID:1979492
 [1];  [2];  [2];  [2];  [3];  [4];  [5];  [6];  [7];  [4];  [8];  [9];  [10];  [11];  [12];  [12];  [13];  [14];  [15];  [16] more »;  [17];  [18];  [16];  [2] « less
  1. Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA; OSTI
  2. Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
  3. Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Division of Prevention, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
  4. Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
  5. Division of Cancer Statistics and Integration, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
  6. Healis—Sekhsaria Institute for Public Health, Mahape, Navi Mumbai, India
  7. Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
  8. State Key Laboratory of Oncogene and Related Genes & Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China
  9. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
  10. Health Services and Systems Research, Duke-NUS Medical School Singapore, Singapore, Republic of Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Republic of Singapore
  11. Radiation Effects Research Foundation, Hiroshima, Japan
  12. Division of Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Japan
  13. Department of Health Informatics and Public Health, Division of Epidemiology, Tohoku University School of Public Health, Graduate School of Medicine, Miyagi Prefecture, Japan
  14. Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan; Division of Cancer Epidemiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
  15. Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea
  16. Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea; Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea; Cancer Research Institute, Seoul National University, Seoul, South Korea
  17. Department of Population Health, New York University School of Medicine, New York, NY, USA
  18. Division of Prevention, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
+ Show Author Affiliations
Little is known about the time course of mortality reduction following smoking cessation in Asians who have smoking behaviours distinct from their Western counterparts. We evaluated the level of reduction in all-cause, cardiovascular disease (CVD) and lung cancer mortality by years since quitting smoking, in Asia. Using Cox regression, we analysed individual participant data (n = 709 151) from 16 prospective cohorts conducted in China, Japan, Korea/Singapore, and India/Bangladesh, separately by cohorts. Cohort-specific hazard ratios (HRs) were combined using a random-effects meta-analysis. During a mean follow-up of 12.0 years, 108 287 deaths were ascertained—35 658 from CVD and 7546 from lung cancer. Among Asian men, a dose-response relationship of risk reduction in deaths from all causes, CVD and lung cancer was observed with an increase in years after smoking cessation. Compared with never smokers, however, all-cause and CVD mortality among former smokers remained elevated 10–14 years after quitting [multivariable-adjusted HR (95% confidence interval (CI) = 1.25 (1.13–1.37) and 1.20 (1.02–1.41), respectively]. Lung cancer mortality stayed almost 2-fold higher than among never smokers 15–19 years after smoking cessation [1.97 (1.41–2.73)], particularly among former heavy smokers [2.62 (1.71–4.00)]. Women who quitted for ≥5 years retained a significantly elevated mortality from all causes, CVD and lung cancer. Overall patterns of the cessation-mortality associations were similar across countries. Our findings suggest that adverse effects of tobacco smoking persist for an extended time period, even for more than two decades, which is beyond the time windows defined in current clinical guidelines for risk assessment of lung cancer and CVD.
Research Organization:
National Academy of Sciences, Washington, DC (United States)
Sponsoring Organization:
USDOE Office of Environment, Health, Safety and Security (AU)
Contributing Organization:
remaining authors are listed at the end of the paper
DOE Contract Number:
HS0000031
OSTI ID:
1979492
Journal Information:
International Journal of Epidemiology, Journal Name: International Journal of Epidemiology Journal Issue: 6 Vol. 50; ISSN 0300-5771
Publisher:
Oxford University Press
Country of Publication:
United States
Language:
English

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