RT Journal Article
SR Electronic
T1 Quantifying the association of low-intensity and late initiation of tobacco smoking with total and cause-specific mortality in Asia
JF Tobacco Control
JO Tob Control
FD BMJ Publishing Group Ltd
SP tobaccocontrol-2019-055412
DO 10.1136/tobaccocontrol-2019-055412
A1 Yang, Jae Jeong
A1 Yu, Danxia
A1 Shu, Xiao-Ou
A1 Freedman, Neal D
A1 Wen, Wanqing
A1 Rahman, Shafiur
A1 Abe, Sarah K
A1 Saito, Eiko
A1 Gupta, Prakash C
A1 He, Jiang
A1 Tsugane, Shoichiro
A1 Gao, Yu-Tang
A1 Xiang, Yong-Bing
A1 Yuan, Jian-Min
A1 Tomata, Yasutake
A1 Tsuji, Ichiro
A1 Sugawara, Yumi
A1 Matsuo, Keitaro
A1 Ahn, Yoon-Ok
A1 Park, Sue K
A1 Chen, Yu
A1 Pan, Wen-Harn
A1 Pednekar, Mangesh
A1 Gu, Dongfeng
A1 Sawada, Norie
A1 Cai, Hui
A1 Li, Hong-Lan
A1 Koh, Woon-Puay
A1 Wang, Renwei
A1 Zhang, Shu
A1 Kanemura, Seiki
A1 Ito, Hidemi
A1 Shin, Myung-Hee
A1 Wu, Pei-Ei
A1 Yoo, Keun-Young
A1 Ahsan, Habibul
A1 Chia, Kee Seng
A1 Boffetta, Paolo
A1 Inoue, Manami
A1 Kang, Daehee
A1 Potter, John D
A1 Zheng, Wei
YR 2020
UL http://tobaccocontrol.bmj.com/content/early/2020/06/16/tobaccocontrol-2019-055412.abstract
AB Background Little is known about the health harms associated with low-intensity smoking in Asians who, on average, smoke fewer cigarettes and start smoking at a later age than their Western counterparts.Methods In this pooled analysis of 738 013 Asians from 16 prospective cohorts, we quantified the associations of low-intensity (<5 cigarettes/day) and late initiation (≥35 years) of smoking with mortality outcomes. HRs and 95% CIs were estimated for each cohort by Cox regression. Cohort-specific HRs were pooled using random-effects meta-analysis.Findings During a mean follow-up of 11.3 years, 92 068 deaths were ascertained. Compared with never smokers, current smokers who consumed <5 cigarettes/day or started smoking after age 35 years had a 16%–41% increased risk of all-cause, cardiovascular disease (CVD), respiratory disease mortality and a >twofold risk of lung cancer mortality. Furthermore, current smokers who started smoking after age 35 and smoked <5 cigarettes/day had significantly elevated risks of all-cause (HRs (95% CIs)=1.14 (1.05 to 1.23)), CVD (1.27 (1.08 to 1.49)) and respiratory disease (1.54 (1.17 to 2.01)) mortality. Even smokers who smoked <5 cigarettes/day but quit smoking before the age of 45 years had a 16% elevated risk of all-cause mortality; however, the risk declined further with increasing duration of abstinence.Conclusions Our study showed that smokers who smoked a small number of cigarettes or started smoking later in life also experienced significantly elevated all-cause and major cause-specific mortality but benefited from cessation. There is no safe way to smoke—not smoking is always the best choice.