MORTALITY IN MIDDLE-AGED SMOKERS AND NON-SMOKERS

We assessed the relation of cigarette smoking to mortality in an 11-year follow-up study of 4004 men and women, 35 to 54 years of age, who responded to urging to have multiphasic health checkups. Accounting for 48 other characteristics, both individually and in combination, failed to eliminate the association of smoking with mortality from all causes or with mortality from coronary heart disease. The smoker-to-nonsmoker mortality ratios, crude and adjusted respectively, were 2.6 and 2.1 for all causes and 4.7 and 3.6 for coronary heart disease. This analysis did not support the counterhypothesis that the association of cigarette smoking with mortality is secondary to some underlying characteristic. (N Engl J Med 300:213–217, 1979) WITH few exceptions, follow-up studies have demonstrated a higher mortality rate in cigarette smokers than in nonsmokers.1 2 3 4 5 6 Most medical scientists now agree that cigarette smoking is an important factor in causing death from lung cancer and from chronic obstructive pulmonary disease. However, these conditions result in only a small fraction of the total mortality in the general population. A causal relation of cigarette smoking to coronary heart disease and other atherosclerotic diseases and to cancer of the upper respiratory tract is accepted by many, but the evidence is less strong. The state of knowledge and belief is similar for peptic-ulcer. © 1979, Massachusetts Medical Society. All rights reserved.