Smoking in Relation to Mortality and Morbidity. Findings in First Thirty-Four Months of Follow-Up in a Prospective Study Started in 19592

Abstract

1) After answering detailed questionnaires, 442,094 men, aged 40–89, were traced for an average of 34.3 months. 2) Death rates were far higher in cigarette smokers than in nonsmokers, higher in those who started cigarette smoking at a young age than in those who started at an older age, and higher in current cigarette smokers than in excigarette smokers who had quit for a year or longer. Death rates increased with amount of cigarette smoking and degree of inhalation. 3) Death rates from the following diseases were much higher in cigarette smokers than in nonsmokers: cancer of the lung, buccal cavity, pharynx, larynx, esophagus, bladder, and pancreas; gastric ulcer; emphysema; and aortic aneurysm. Coronary artery disease death rates were highly related to cigarette smoking among men in the middle-age groups but less highly related among men in the old-age groups. In age group 40–59, the coronary artery disease death rate was 1.95 times as high among light cigarette smokers as among nonsmokers and 3.00 times as high among heavy cigarette smokers as among nonsmokers. 4) Death rates of cigarette smokers and nonsmokers were studied in relation to many other factors, such as longevity of parents and grandparents, cancer in parents and siblings, height, exercise, sleep, race, religion, education, marital status, nervous tension, and prior history of certain diseases. Within every group studied, the death rate of men who smoked 20 or more cigarettes a day was considerably higher than that of nonsmokers. 5) Nonsmokers were matched individually with men who smoked 20 or more cigarettes per day, the 2 men in each matched pair being similar in age, height, race, nativity, religion, marital status, residence (urban or rural), certain occupational exposures, education, drinking habits, nervous tension, use of tranquilizers, sleep, exercise, health at time of enrollment, and past history of cancer, heart disease, stroke, and high blood pressure. Altogether 36,975 such pairs were found. During the study, 1,385 of the 36,975 cigarette smokers died, while only 662 of the nonsmokers died. Of the cigarette smokers, 110 died with lung cancer and 654 with coronary artery disease, while, of the nonsmokers, 12 died with lung cancer and 304 with coronary artery disease. Emphysema caused the death of 15 cigarette smokers but only 2 nonsmokers. 6) The proportion of men hospitalized during the first 2 years of the study was considerably higher among cigarette smokers than among nonsmokers and increased with amount of cigarette smoking and degree of inhalation.