Smoking and All-cause Mortality in Older Adults: Results From the CHANCES Consortium

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• 作者：Aysel Mü ; ezzinler ; PhD¹ ; ² ; Ute Mons ; PhD¹ ; ^{u.mons@dkfz.de" class="auth_mail" title="E-mail the corresponding author} ; Carolin Gellert ; PhD¹ ; Ben Schö ; ttker ; PhD¹ ; Eugè ; ne Jansen ; PhD³ ; Frank Kee ; MD⁴ ; Mark G. O&rsquo ; Doherty ; PhD⁴ ; Kari Kuulasmaa ; PhD⁵ ; Neal D. Freedman ; PhD ; MPH⁶ ; Christian C. Abnet ; PhD ; MPH⁶ ; Alicja Wolk ; DMSc⁷ ; Niclas Hå ; kansson ; PhD⁷ ; Nicola Orsini ; PhD⁷ ; Tom Wilsgaard ; PhD⁸ ; Bas Bueno-de-Mesquita ; MD ; PhD ; MPH³ ; ⁹ ; ¹⁰ ; ¹¹ ; Yvonne T. van der Schouw ; PhD¹² ; Petra H.M. Peeters ; MD ; PhD¹² ; Lisette C.P.G.M. de Groot ; PhD¹³ ; Annette Peters ; PhD¹⁴ ; Philippos Orfanos ; PhD¹⁵ ; ¹⁶ ; Allan Linneberg ; PhD¹⁷ ; ¹⁸ ; ¹⁹ ; Charlotta Pisinger ; PhD ; MPH¹⁷ ; Abdonas Tamosiunas ; MD ; PhD²⁰ ; Migle Baceviciene ; PhD²⁰ ; Dalia Luksiene ; PhD²⁰ ; Gailute Bernotiene ; PhD²⁰ ; Pekka Jousilahti ; MD ; PhD⁵ ; Ulrika Petterson-Kymmer ; MD ; PhD²¹ ; ²² ; Jan Hå ; kan Jansson ; MD ; PhD²¹ ; Stefan Sö ; derberg ; MD ; PhD²¹ ; Sture Eriksson ; MD ; PhD²³ ; Nicole Jankovic ; MSc¹³ ; Marí ; a-José ; Sá ; nchez ; MD ; PhD²⁴ ; ²⁵ ; Giovanni Veronesi ; PhD²⁶ ; Susana Sans ; MD ; PhD²⁷ ; Wojciech Drygas ; MD ; PhD²⁸ ; Antonia Trichopoulou ; MD ; PhD¹⁵ ; ¹⁶ ; Paolo Boffetta ; MD ; MPH¹⁵ ; ²⁹ ; Hermann Brenner ; MD ; MPH¹
• 刊名：American Journal of Preventive Medicine
• 出版年：2015
• 出版时间：November 2015
• 年：2015
• 卷：49
• 期：5
• 页码：e53-e63
• 全文大小：1144 K

文摘

Smoking is known to be a major cause of death among middle-aged adults, but evidence on its impact and the benefits of smoking cessation among older adults has remained limited. Therefore, we aimed to estimate the influence of smoking and smoking cessation on all-cause mortality in people aged ≥60 years.

Methods

Relative mortality and mortality rate advancement periods (RAPs) were estimated by Cox proportional hazards models for the population-based prospective cohort studies from Europe and the U.S. (CHANCES [Consortium on Health and Ageing: Network of Cohorts in Europe and the U.S.]), and subsequently pooled by individual participant meta-analysis. Statistical analyses were performed from June 2013 to March 2014.

Results

A total of 489,056 participants aged ≥60 years at baseline from 22 population-based cohort studies were included. Overall, 99,298 deaths were recorded. Current smokers had 2-fold and former smokers had 1.3-fold increased mortality compared with never smokers. These increases in mortality translated to RAPs of 6.4 (95% CI=4.8, 7.9) and 2.4 (95% CI=1.5, 3.4) years, respectively. A clear positive dose−response relationship was observed between number of currently smoked cigarettes and mortality. For former smokers, excess mortality and RAPs decreased with time since cessation, with RAPs of 3.9 (95% CI=3.0, 4.7), 2.7 (95% CI=1.8, 3.6), and 0.7 (95% CI=0.2, 1.1) for those who had quit <10, 10 to 19, and ≥20 years ago, respectively.

Conclusions

Smoking remains as a strong risk factor for premature mortality in older individuals and cessation remains beneficial even at advanced ages. Efforts to support smoking abstinence at all ages should be a public health priority.