Jae Jeong Yang1, Danxia Yu1, Xiao-Ou Shu1, Wanqing Wen1, Shafiur Rahman2,3, Sarah Abe4, Eiko Saito5, Prakash C Gupta6, Jiang He7, Shoichiro Tsugane4, Yu-Tang Gao8, Jian-Min Yuan9, Woon-Puay Koh10,11, Atsuko Sadakane12, Yasutake Tomata13, Ichiro Tsuji13, Yumi Sugawara14, Keitaro Matsuo15,16, Yoon-Ok Ahn17, Sue K Park17,18,19, Yu Chen20, Manami Inoue3, Daehee Kang17,18,19, Wei Zheng1. 1. Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA. 2. Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. 3. Division of Prevention, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan. 4. Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan. 5. Division of Cancer Statistics and Integration, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan. 6. Healis-Sekhsaria Institute for Public Health, Mahape, Navi Mumbai, India. 7. Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA. 8. State Key Laboratory of Oncogene and Related Genes & Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China. 9. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA. 10. Health Services and Systems Research, Duke-NUS Medical School Singapore, Singapore, Republic of Singapore. 11. Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Republic of Singapore. 12. Radiation Effects Research Foundation, Hiroshima, Japan. 13. Division of Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Japan. 14. Department of Health Informatics and Public Health, Division of Epidemiology, Tohoku University School of Public Health, Graduate School of Medicine, Miyagi Prefecture, Japan. 15. Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan. 16. Division of Cancer Epidemiology, Nagoya University Graduate School of Medicine, Nagoya, Japan. 17. Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea. 18. Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea. 19. Cancer Research Institute, Seoul National University, Seoul, South Korea. 20. Department of Population Health, New York University School of Medicine, New York, NY, USA.
Abstract
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.
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.
Authors: Meredith S Duncan; Matthew S Freiberg; Robert A Greevy; Suman Kundu; Ramachandran S Vasan; Hilary A Tindle Journal: JAMA Date: 2019-08-20 Impact factor: 56.272
Authors: Prabhat Jha; Chinthanie Ramasundarahettige; Victoria Landsman; Brian Rostron; Michael Thun; Robert N Anderson; Tim McAfee; Richard Peto Journal: N Engl J Med Date: 2013-01-24 Impact factor: 91.245
Authors: Ute Mons; Aysel Müezzinler; Carolin Gellert; Ben Schöttker; Christian C Abnet; Martin Bobak; Lisette de Groot; Neal D Freedman; Eugène Jansen; Frank Kee; Daan Kromhout; Kari Kuulasmaa; Tiina Laatikainen; Mark G O'Doherty; Bas Bueno-de-Mesquita; Philippos Orfanos; Annette Peters; Yvonne T van der Schouw; Tom Wilsgaard; Alicja Wolk; Antonia Trichopoulou; Paolo Boffetta; Hermann Brenner Journal: BMJ Date: 2015-04-20