Quantifying the association of low-intensity and late initiation of tobacco smoking with total and cause-specific mortality in Asia

Jae Jeong Yang; Danxia Yu; Xiao Ou Shu; Neal D. Freedman; Wanqing Wen; Shafiur Rahman; Sarah K. Abe; Eiko Saito; Prakash C. Gupta; Jiang He; Shoichiro Tsugane; Yu Tang Gao; Yong Bing Xiang; Jian Min Yuan; Yasutake Tomata; Ichiro Tsuji; Yumi Sugawara; Keitaro Matsuo; Yoon Ok Ahn; Sue K. Park; Yu Chen; Wen Harn Pan; Mangesh Pednekar; Dongfeng Gu; Norie Sawada; Hui Cai; Hong Lan Li; Woon Puay Koh; Renwei Wang; Shu Zhang; Seiki Kanemura; Hidemi Ito; Myung Hee Shin; Pei Ei Wu; Keun Young Yoo; Habibul Ahsan; Kee Seng Chia; Paolo Boffetta; Manami Inoue; Daehee Kang; John D. Potter; Wei Zheng

doi:10.1136/tobaccocontrol-2019-055412

Quantifying the association of low-intensity and late initiation of tobacco smoking with total and cause-specific mortality in Asia

Jae Jeong Yang, Danxia Yu, Xiao Ou Shu, Neal D. Freedman, Wanqing Wen, Shafiur Rahman, Sarah K. Abe, Eiko Saito, Prakash C. Gupta, Jiang He, Shoichiro Tsugane, Yu Tang Gao, Yong Bing Xiang, Jian Min Yuan, Yasutake Tomata, Ichiro Tsuji, Yumi Sugawara, Keitaro Matsuo, Yoon Ok Ahn, Sue K. ParkYu Chen, Wen Harn Pan, Mangesh Pednekar, Dongfeng Gu, Norie Sawada, Hui Cai, Hong Lan Li, Woon Puay Koh, Renwei Wang, Shu Zhang, Seiki Kanemura, Hidemi Ito, Myung Hee Shin, Pei Ei Wu, Keun Young Yoo, Habibul Ahsan, Kee Seng Chia, Paolo Boffetta, Manami Inoue, Daehee Kang, John D. Potter, Wei Zheng

Urban Initiative

Research output: Contribution to journal › Article › peer-review

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.

Original language	English (US)
Pages (from-to)	328-335
Number of pages	8
Journal	Tobacco control
Volume	30
Issue number	3
DOIs	https://doi.org/10.1136/tobaccocontrol-2019-055412
State	Published - May 1 2021

Keywords

prevention
smoking caused disease
socioeconomic status
Prospective Studies
Humans
Middle Aged
Adult
Asia/epidemiology
Smoking/adverse effects
Tobacco Smoking/adverse effects
Cause of Death

ASJC Scopus subject areas

Health(social science)
Public Health, Environmental and Occupational Health

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10.1136/tobaccocontrol-2019-055412

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Yang, J. J., Yu, D., Shu, X. O., Freedman, N. D., Wen, W., Rahman, S., Abe, S. K., Saito, E., Gupta, P. C., He, J., Tsugane, S., Gao, Y. T., Xiang, Y. B., Yuan, J. M., Tomata, Y., Tsuji, I., Sugawara, Y., Matsuo, K., Ahn, Y. O., ... Zheng, W. (2021). Quantifying the association of low-intensity and late initiation of tobacco smoking with total and cause-specific mortality in Asia. Tobacco control, 30(3), 328-335. https://doi.org/10.1136/tobaccocontrol-2019-055412

Yang, JJ, Yu, D, Shu, XO, Freedman, ND, Wen, W, Rahman, S, Abe, SK, Saito, E, Gupta, PC, He, J, Tsugane, S, Gao, YT, Xiang, YB, Yuan, JM, Tomata, Y, Tsuji, I, Sugawara, Y, Matsuo, K, Ahn, YO, Park, SK, Chen, Y, Pan, WH, Pednekar, M, Gu, D, Sawada, N, Cai, H, Li, HL, Koh, WP, Wang, R, Zhang, S, Kanemura, S, Ito, H, Shin, MH, Wu, PE, Yoo, KY, Ahsan, H, Chia, KS, Boffetta, P, Inoue, M, Kang, D, Potter, JD & Zheng, W 2021, 'Quantifying the association of low-intensity and late initiation of tobacco smoking with total and cause-specific mortality in Asia', Tobacco control, vol. 30, no. 3, pp. 328-335. https://doi.org/10.1136/tobaccocontrol-2019-055412

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title = "Quantifying the association of low-intensity and late initiation of tobacco smoking with total and cause-specific mortality in Asia",

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.",

keywords = "prevention, smoking caused disease, socioeconomic status, Prospective Studies, Humans, Middle Aged, Adult, Asia/epidemiology, Smoking/adverse effects, Tobacco Smoking/adverse effects, Cause of Death",

author = "Yang, {Jae Jeong} and Danxia Yu and Shu, {Xiao Ou} and Freedman, {Neal D.} and Wanqing Wen and Shafiur Rahman and Abe, {Sarah K.} and Eiko Saito and Gupta, {Prakash C.} and Jiang He and Shoichiro Tsugane and Gao, {Yu Tang} and Xiang, {Yong Bing} and Yuan, {Jian Min} and Yasutake Tomata and Ichiro Tsuji and Yumi Sugawara and Keitaro Matsuo and Ahn, {Yoon Ok} and Park, {Sue K.} and Yu Chen and Pan, {Wen Harn} and Mangesh Pednekar and Dongfeng Gu and Norie Sawada and Hui Cai and Li, {Hong Lan} and Koh, {Woon Puay} and Renwei Wang and Shu Zhang and Seiki Kanemura and Hidemi Ito and Shin, {Myung Hee} and Wu, {Pei Ei} and Yoo, {Keun Young} and Habibul Ahsan and Chia, {Kee Seng} and Paolo Boffetta and Manami Inoue and Daehee Kang and Potter, {John D.} and Wei Zheng",

note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2021",

month = may,

day = "1",

doi = "10.1136/tobaccocontrol-2019-055412",

language = "English (US)",

volume = "30",

pages = "328--335",

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TY - JOUR

T1 - Quantifying the association of low-intensity and late initiation of tobacco smoking with total and cause-specific mortality in Asia

AU - Yang, Jae Jeong

AU - Yu, Danxia

AU - Shu, Xiao Ou

AU - Freedman, Neal D.

AU - Wen, Wanqing

AU - Rahman, Shafiur

AU - Abe, Sarah K.

AU - Saito, Eiko

AU - Gupta, Prakash C.

AU - He, Jiang

AU - Tsugane, Shoichiro

AU - Gao, Yu Tang

AU - Xiang, Yong Bing

AU - Yuan, Jian Min

AU - Tomata, Yasutake

AU - Tsuji, Ichiro

AU - Sugawara, Yumi

AU - Matsuo, Keitaro

AU - Ahn, Yoon Ok

AU - Park, Sue K.

AU - Chen, Yu

AU - Pan, Wen Harn

AU - Pednekar, Mangesh

AU - Gu, Dongfeng

AU - Sawada, Norie

AU - Cai, Hui

AU - Li, Hong Lan

AU - Koh, Woon Puay

AU - Wang, Renwei

AU - Zhang, Shu

AU - Kanemura, Seiki

AU - Ito, Hidemi

AU - Shin, Myung Hee

AU - Wu, Pei Ei

AU - Yoo, Keun Young

AU - Ahsan, Habibul

AU - Chia, Kee Seng

AU - Boffetta, Paolo

AU - Inoue, Manami

AU - Kang, Daehee

AU - Potter, John D.

AU - Zheng, Wei

PY - 2021/5/1

Y1 - 2021/5/1

N2 - 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.

AB - 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.

KW - prevention

KW - smoking caused disease

KW - socioeconomic status

KW - Prospective Studies

KW - Humans

KW - Middle Aged

KW - Adult

KW - Asia/epidemiology

KW - Smoking/adverse effects

KW - Tobacco Smoking/adverse effects

KW - Cause of Death

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SN - 0964-4563

VL - 30

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EP - 335

JO - Tobacco control

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ER -

Quantifying the association of low-intensity and late initiation of tobacco smoking with total and cause-specific mortality in Asia

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Keywords

ASJC Scopus subject areas

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