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Eur J Epidemiol. 2007;22(5):301-9. Epub 2007 May 30.

Mortality risks among heavy-smokers with special reference to women: a long-term follow-up of an urban population.

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Department of Respiratory Medicine and Allergology, Lund University Hospital, University of Lund, Lund, 221 85, Sweden.


Increased mortality risks associated with smoking are well established among men. There are very few population-based studies comprising a sufficient number of heavily smoking women, measuring the direct effect of smoking on mortality risks. Between 1974 and 1992, 8,499 women and 13,888 men attended a health screening programme including reporting of smoking habits. Individuals were followed for total mortality until 2005. All-cause, cancer, cardiovascular, lung cancer and respiratory mortality were calculated in smoking categories <10 g per day, 10-19 g per day, and > or =20 g per day with never-smokers as a reference group and with adjustments for co-morbidities, socio-economic and marital status. For respiratory mortality and lung cancer adjustments for FEV(1), socio-economic and marital status were performed. Smoking was associated with a two to almost threefold increased mortality risk among women and men. The relative risk (RR) with 95% confidence interval, (CI) for women who smoked 10-19 g per day was 2.44 (2.07-2.87), and for those who smoked 20 g per day or more the RR (95% CI) was 2.42 (2.00-2.92). Smoking was a strong risk factor for cardiovascular mortality among women, the RR (95% CI) for women who smoked 10-19 g per day was 4.52 (3.07-6.64). Ex-smoking women showed increased risks of all-cause mortality; RR (95% CI) 1.26 (1.04-1.52) cancer (excluding lung cancer); RR (95% CI) 1.42 (1.07-1.88) and lung cancer RR (95% CI) 2.71 (1.02-7.23) mortality. However, the cardiovascular; RR (95% CI) 1.18 (0.69-2.00) and respiratory; RR (95% CI) 0.79 (0.16-3.84) mortality risks were not statistically significant. This study confirms that as for men, middle-aged heavily smoking women have a two to threefold increased mortality risk. Adjustments for co-morbidity, socio-economic and marital status did not change these results.

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