• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of tobcontTobacco ControlCurrent TOCInstructions for authors
Tob Control. Jun 2005; 14(Suppl 1): i28–i32.
PMCID: PMC1766175

Excess injury mortality among smokers: a neglected tobacco hazard


Objective: To assess the mortality risks from injuries for smokers and ex-smokers and to quantify the mortality burden of smoking from injury in Taiwan.

Methods: Smokers' (and ex-smokers') mortality risks from injuries were compared with that of non-smokers in a merged cohort from Taiwan. A total of 64 319 male subjects were followed up for 12–18 years. Relative risks (RR) (adjusted for age and alcohol use) and 95% confidence intervals (CI) for cause specific injury deaths were calculated using the Cox proportional hazard model. Relative risks of injury mortality were also calculated to assess the presence of dose–response relations with daily smoking quantity.

Results: Alcohol use adjusted relative mortality risks for all injuries (RR 1.69, 95% CI 1.39 to 2.05) including those from motor vehicle accidents (RR 1.88, 95% CI 1.44 to 2.45) and non-motor vehicle accidents (RR 1.48, 95% CI 1.11 to 1.99) were significantly higher for smokers than non-smokers. Mortality was also increased for most subtypes of non-motor vehicle injuries including falls, fires, and job related injuries. Furthermore, these increases were dose dependent, with the heaviest smokers having the highest risk and the lightest smokers the lowest risk, and ex-smokers, no increase. In 2001, over one fifth (23%) of all male injury deaths in Taiwan was associated with smoking.

Conclusion: This study demonstrated the significant association between fatal injuries and smoking. This relation adds further weight to smoking cessation campaigns.

Full Text

The Full Text of this article is available as a PDF (140K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Peto R, Lopez AD, Boreham J, Thun M, Heath C, Jr, Doll R. Mortality from smoking worldwide. Br Med Bull. 1996 Jan;52(1):12–21. [PubMed]
  • Tsai SP, Cowles SR, Ross CE. Smoking and morbidity frequency in a working population. J Occup Med. 1990 Mar;32(3):245–249. [PubMed]
  • Ryan J, Zwerling C, Orav EJ. Occupational risks associated with cigarette smoking: a prospective study. Am J Public Health. 1992 Jan;82(1):29–32. [PMC free article] [PubMed]
  • Tverdal A, Thelle D, Stensvold I, Leren P, Bjartveit K. Mortality in relation to smoking history: 13 years' follow-up of 68,000 Norwegian men and women 35-49 years. J Clin Epidemiol. 1993 May;46(5):475–487. [PubMed]
  • Doll R, Peto R, Wheatley K, Gray R, Sutherland I. Mortality in relation to smoking: 40 years' observations on male British doctors. BMJ. 1994 Oct 8;309(6959):901–911. [PMC free article] [PubMed]
  • Kawachi I, Colditz GA, Stampfer MJ, Willett WC, Manson JE, Rosner B, Hunter DJ, Hennekens CH, Speizer FE. Smoking cessation in relation to total mortality rates in women. A prospective cohort study. Ann Intern Med. 1993 Nov 15;119(10):992–1000. [PubMed]
  • Rogot E, Murray JL. Smoking and causes of death among U.S. veterans: 16 years of observation. Public Health Rep. 1980 May-Jun;95(3):213–222. [PMC free article] [PubMed]
  • Ross RK, Bernstein L, Trent L, Henderson BE, Paganini-Hill A. A prospective study of risk factors for traumatic deaths in a retirement community. Prev Med. 1990 May;19(3):323–334. [PubMed]
  • Kaufman KR, Brodine S, Shaffer R. Military training-related injuries: surveillance, research, and prevention. Am J Prev Med. 2000 Apr;18(3 Suppl):54–63. [PubMed]
  • Sacks JJ, Nelson DE. Smoking and injuries: an overview. Prev Med. 1994 Jul;23(4):515–520. [PubMed]
  • Leistikow BN, Martin DC, Jacobs J, Rocke DM. Smoking as a risk factor for injury death: a meta-analysis of cohort studies. Prev Med. 1998 Nov-Dec;27(6):871–878. [PubMed]
  • Leistikow BN, Martin DC, Samuels SJ. Injury death excesses in smokers: a 1990-95 United States national cohort study. Inj Prev. 2000 Dec;6(4):277–280. [PMC free article] [PubMed]
  • Liaw KM, Chen CJ. Mortality attributable to cigarette smoking in Taiwan: a 12-year follow-up study. Tob Control. 1998 Summer;7(2):141–148. [PMC free article] [PubMed]
  • Wen Chi-Pang, Tsai Shan Pou, Chen Chien-Jen, Cheng Ting-Yuan. The mortality risks of smokers in Taiwan: Part I: cause-specific mortality. Prev Med. 2004 Sep;39(3):528–535. [PubMed]
  • Yang Ming-Jen. The Chinese drinking problem: a review of the literature and its implication in a cross-cultural study. Kaohsiung J Med Sci. 2002 Nov;18(11):543–550. [PubMed]
  • Shultz JM, Novotny TE, Rice DP. Quantifying the disease impact of cigarette smoking with SAMMEC II software. Public Health Rep. 1991 May-Jun;106(3):326–333. [PMC free article] [PubMed]
  • Tyndale Rachel F. Genetics of alcohol and tobacco use in humans. Ann Med. 2003;35(2):94–121. [PubMed]
  • Bien TH, Burge R. Smoking and drinking: a review of the literature. Int J Addict. 1990 Dec;25(12):1429–1454. [PubMed]
  • Watkins SS, Koob GF, Markou A. Neural mechanisms underlying nicotine addiction: acute positive reinforcement and withdrawal. Nicotine Tob Res. 2000 Feb;2(1):19–37. [PubMed]
  • Waters AJ, Jarvis MJ, Sutton SR. Nicotine withdrawal and accident rates. Nature. 1998 Jul 9;394(6689):137–137. [PubMed]
  • Sommese T, Patterson JC. Acute effects of cigarette smoking withdrawal: a review of the literature. Aviat Space Environ Med. 1995 Feb;66(2):164–167. [PubMed]
  • Brison RJ. Risk of automobile accidents in cigarette smokers. Can J Public Health. 1990 Mar-Apr;81(2):102–106. [PubMed]
  • DiFranza JR, Winters TH, Goldberg RJ, Cirillo L, Biliouris T. The relationship of smoking to motor vehicle accidents and traffic violations. N Y State J Med. 1986 Sep;86(9):464–467. [PubMed]
  • Grout P, Cliff KS, Harman ML, Machin D. Cigarette smoking, road traffic accidents and seat belt usage. Public Health. 1983 Mar;97(2):95–101. [PubMed]
  • Ding SL, Wang JD, Chen KT. [Estimation of case fatality rate and incidence rate of traffic injury in Taiwan--analysis of 4,329 victims at a medical center]. J Formos Med Assoc. 1993 Jun;92 (Suppl 2):S76–S81. [PubMed]
  • Patton D, Barnes GE, Murray RP. A personality typology of smokers. Addict Behav. 1997 Mar-Apr;22(2):269–273. [PubMed]
  • Tsai SP, Gilstrap EL, Cowles SR, Waddell LC, Jr, Ross CE. Personal and job characteristics of musculoskeletal injuries in an industrial population. J Occup Med. 1992 Jun;34(6):606–612. [PubMed]
  • Leistikow BN, Shipley MJ. Might stopping smoking reduce injury death risks? A meta-analysis of randomized, controlled trials. Prev Med. 1999 Mar;28(3):255–259. [PubMed]
  • Parrott AC. Smoking cessation leads to reduced stress, but why? Int J Addict. 1995 Sep;30(11):1509–1516. [PubMed]
  • Møller Ann M, Villebro Nete, Pedersen Tom, Tønnesen Hanne. Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet. 2002 Jan 12;359(9301):114–117. [PubMed]
  • Mościcki EK. Epidemiology of suicidal behavior. Suicide Life Threat Behav. 1995 Spring;25(1):22–35. [PubMed]
  • Smith GD, Phillips AN, Neaton JD. Smoking as "independent" risk factor for suicide: illustration of an artifact from observational epidemiology? Lancet. 1992 Sep 19;340(8821):709–712. [PubMed]
  • Covey LS, Glassman AH, Stetner F. Cigarette smoking and major depression. J Addict Dis. 1998;17(1):35–46. [PubMed]
  • Glassman AH, Helzer JE, Covey LS, Cottler LB, Stetner F, Tipp JE, Johnson J. Smoking, smoking cessation, and major depression. JAMA. 1990 Sep 26;264(12):1546–1549. [PubMed]
  • Hemmingsson Tomas, Kriebel David. Smoking at age 18-20 and suicide during 26 years of follow-up-how can the association be explained? Int J Epidemiol. 2003 Dec;32(6):1000–1004. [PubMed]

Articles from Tobacco Control are provided here courtesy of BMJ Group


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...