NEJM

SPECIAL ARTICLE

21st-Century Hazards of Smoking and Benefits of Cessation in the United States

Figure 2. Survival Probabilities for Current Smokers and for Those Who Never Smoked among Men and Women 25 to 80 Years of Age.

The overall mortality among smokers of both sexes in the United States is about three times as high as that among otherwise similar persons who never smoked, and the smokers lose, on average, at least a decade of life. The women in this cohort represent the first generation of women in the United States in which those who smoked began early in life and smoked for decades, and the risks of death for these women are about 50% greater than the risks reported in the 1980s studies.4,5 For both female and male smokers, the tripling of the relative risk of death and the reduction in survival by at least a decade are similar to the risks in four other studies: a study of male British doctors born between 1900 and 1930,17,18 the large U.K. study of women born between 1930 and 1950,19 a meta-analysis of several other U.S. cohort studies,20 and a study in Japan of people born between 1920 and 1945.21 Although the relative risks were similarly tripled across the studies, the absolute death rates (for both current smokers and those who had never smoked) were much higher in our study than in other U.S. studies,20 since the NHIS is more representative of the general U.S. population. Thus, in the NHIS, the large absolute differences in risk between current smokers and those who never smoked, as well as the gains in years of life for those who quit smoking, are likely to be true for the U.S. population as a whole. The hazards associated with smoking are substantial, even though in recent decades, most smokers in the United States have smoked cigarettes with relatively low levels of tar, as measured by machine testing, as compared with the cigarettes smoked in earlier decades.22

Figure 3. Effect of Smoking Cessation on Survival to 80 Years of Age, According to Age at the Time of Quitting.