Association Between Smoking, Smoking Cessation, and Mortality by Race, Ethnicity, and Sex among US A
Thursday, November 17, 2022
Posted by: Natalia Gromov
Thomson
B, Emberson J, Lacey B, et al.
Association Between
Smoking, Smoking Cessation, and Mortality by Race, Ethnicity, and Sex among US
Adults.
JAMA Netw Open. 2022;5(10):e2231480. Published 2022 Oct 3.
doi:10.1001/jamanetworkopen.2022.31480
Importance. Patterns
of cigarette smoking and smoking cessation vary considerably across demographic
groups in the US, but there is limited evidence on whether the hazards of
smoking and benefits of quitting vary across these groups. Population-specific
evidence on the benefits of quitting smoking may motivate cessation among
groups historically underrepresented in medical research.
Objective. To
quantify the association between smoking, smoking cessation, and mortality by
race, ethnicity, and sex.
Design, setting, and
participants. This nationally representative, prospective
cohort study used data from the US National Health Interview Survey collected
via questionnaire between January 1997 and December 2018 among adults aged 25
to 84 years at recruitment. Participants were followed up for cause-specific
mortality through December 31, 2019.
Exposures. Self-reported
smoking status at recruitment, age at quitting smoking, and years since
quitting smoking.
Main outcomes and
measures. The main outcomes were all-cause mortality and
mortality from cancer, cardiovascular disease, and lower respiratory disease.
Adjusted mortality rate ratios comparing never, former, and current smokers
were calculated using Cox proportional hazards regression. Weighted analyses
were conducted by race, ethnicity, and sex as reported by participants.
Results. Among
the 551 388 participants in the main analyses, the mean (SD) age at recruitment
was 48.9 (15.3) years; 307 601 (55.8%) were women, 87 207 (15.8%) were
Hispanic, 75 545 (13.7%) were non-Hispanic Black, 355 782 (64.5%) were
non-Hispanic White, and 32 854 (6.0%) identified as other non-Hispanic race and
ethnicity. There were 74 870 deaths among participants aged 25 to 89 years
during follow-up (36 792 [49.1%] among men; 38 078 [50.9%] among women). The
all-cause mortality rate ratio (RR) for current vs never smoking was 2.80 (95%
CI, 2.73-2.88) overall. The RRs were similar by sex but varied by race and
ethnicity: Hispanic, 2.01 (95% CI, 1.84-2.18); non-Hispanic Black, 2.19 (95%
CI, 2.06-2.33); non-Hispanic White, 3.00 (95% CI, 2.91-3.10); and other
non-Hispanic race and ethnicity, 2.16 (95% CI, 1.88-2.47). When comparing those
who quit smoking before age 45 years with never smokers, all-cause mortality
RRs were 1.15 (95% CI, 1.03-1.28) among Hispanic individuals, 1.16 (95% CI,
1.07-1.25) among non-Hispanic Black individuals, 1.11 (95% CI, 1.08-1.15) among
non-Hispanic White individuals, and 1.17 (95% CI, 0.99-1.39) among other
non-Hispanic individuals.
Conclusions and
relevance. In this prospective cohort study, among men and
women from diverse racial and ethnic groups, current smoking was associated
with at least twice the all-cause mortality rate of never smoking. Quitting
smoking, particularly at younger ages, was associated with substantial reductions
in the relative excess mortality associated with continued smoking.
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