Reduction in total and major cause-specific mortality from tobacco smoking cessation: a pooled analysis of 16 population-based cohort studies in Asia

Jae Jeong Yang, Danxia Yu, Xiao Ou Shu, Wanqing Wen, Shafiur Rahman, Sarah Abe, Eiko Saito, Prakash C. Gupta, Jiang He, Shoichiro Tsugane, Yu Tang Gao, Jian Min Yuan, Woon Puay Koh, Atsuko Sadakane, Yasutake Tomata, Ichiro Tsuji, Yumi Sugawara, Keitaro Matsuo, Yoon Ok Ahn, Sue K. ParkYu Chen, Manami Inoue, Daehee Kang, Wei Zheng

Research output: Contribution to journalArticlepeer-review


Background: Little is known about the time course of mortality reduction following smoking cessation in Asians who have smoking behaviours distinct from their Western counterparts. We evaluated the level of reduction in all-cause, cardiovascular disease (CVD) and lung cancer mortality by years since quitting smoking, in Asia. Methods: Using Cox regression, we analysed individual participant data (n = 709 151) from 16 prospective cohorts conducted in China, Japan, Korea/Singapore, and India/Bangladesh, separately by cohorts. Cohort-specific hazard ratios (HRs) were combined using a random-effects meta-analysis. Results: During a mean follow-up of 12.0 years, 108 287 deaths were ascertained - 35 658 from CVD and 7546 from lung cancer. Among Asian men, a dose-response relationship of risk reduction in deaths from all causes, CVD and lung cancer was observed with an increase in years after smoking cessation. Compared with never smokers, however, all-cause and CVD mortality among former smokers remained elevated 10-14 years after quitting [multivariable-adjusted HR (95% confidence interval (CI) = 1.25 (1.13-1.37) and 1.20 (1.02-1.41), respectively]. Lung cancer mortality stayed almost 2-fold higher than among never smokers 15-19 years after smoking cessation [1.97 (1.41-2.73)], particularly among former heavy smokers [2.62 (1.71-4.00)]. Women who quitted for ≥5 years retained a significantly elevated mortality from all causes, CVD and lung cancer. Overall patterns of the cessation-mortality associations were similar across countries. Conclusions: Our findings suggest that adverse effects of tobacco smoking persist for an extended time period, even for more than two decades, which is beyond the time windows defined in current clinical guidelines for risk assessment of lung cancer and CVD.

Original languageEnglish (US)
Pages (from-to)2070-2081
Number of pages12
JournalInternational Journal of Epidemiology
Issue number6
StatePublished - Dec 1 2021


  • Asia
  • Smoking cessation
  • cardiovascular disease
  • cohort
  • lung cancer
  • mortality

ASJC Scopus subject areas

  • Epidemiology


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