Quantifying the association of low-intensity and late initiation of tobacco smoking with total and cause-specific mortality in Asia. Issue 3 (16th June 2020)

• Record Type: Journal Article
• Authors: Yang, Jae Jeong; Yu, Danxia; Shu, Xiao-Ou; Freedman, Neal D; Wen, Wanqing; Rahman, Shafiur; Abe, Sarah K; Saito, Eiko; Gupta, Prakash C; He, Jiang; Tsugane, Shoichiro; Gao, Yu-Tang; Xiang, Yong-Bing; Yuan, Jian-Min; Tomata, Yasutake; Tsuji, Ichiro; Sugawara, Yumi; Matsuo, Keitaro; Ahn, Yoon-Ok; Park, Sue K; Chen, Yu; Pan, Wen-Harn; Pednekar, Mangesh; Gu, Dongfeng; Sawada, Norie; Cai, Hui; Li, Hong-Lan; Koh, Woon-Puay; Wang, Renwei; Zhang, Shu; Kanemura, Seiki; Ito, Hidemi; Shin, Myung-Hee; Wu, Pei-Ei; Yoo, Keun-Young; Ahsan, Habibul; Chia, Kee Seng; Boffetta, Paolo; Inoue, Manami; Kang, Daehee; Potter, John D; Zheng, Wei;
• Is Part Of: Tobacco control. Volume 30:Issue 3(2021)
• Page Start: 328
• Page End: 335
• Publication Date: 2020-06-16
• Subjects: smoking caused disease -- prevention -- socioeconomic status; Tobacco use -- Prevention -- Periodicals; Tobacco use -- Periodicals; Smoking -- Law and legislation -- Periodicals; Smoking -- prevention & control -- Periodicals; Tobacco Use Disorder -- prevention & control -- Periodicals; Tobacco -- Periodicals; Electronic journals; 613.85
• DOI: 10.1136/tobaccocontrol-2019-055412
• Languages: English
• ISSNs: 0964-4563

Abstract

Abstract : 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.