Death Risk Assessed With Contemporary Tobacco Product Use

For current non-daily cigarette smokers, there were statistically significant associations with death from lung cancer, oral cancer, circulatory death, cardiovascular death, cerebrovascular death (stroke), and chronic obstructive pulmonary disease.

The use of cigars, pipes, and cigarettes confers significant mortality risks, according to a new study published in JAMA Internal Medicine.

As tobacco products evolve, mortality risk estimates related to their use should remain current. To this end, researchers from Center for Tobacco Products, Food and Drug Administration aimed to determine the risks of current and past use of cigars, pipes, and cigarettes. 

They used the National Longitudinal Mortality Study (N=357,420) survey on tobacco use at baseline starting from 1985, and included a follow-up for mortality through the end of 2011. Participating patients reported exclusive use of cigars (little cigar, cigarillos, large cigar), traditional pipes, or cigarettes or never use of any tobacco product. 

The primary outcomes were all-cause and cause-specific mortality as identified as the primary cause of death from death certificate. In general, most current and former cigar and pipe smokers were male (79.3–98.0%). Cigarette smokers were more gender-even (46% male, 54% female). 

There were 51,150 recorded deaths during follow-up. Higher all-cause mortality risks were seen with exclusive current cigarette smokers (hazard ratio [HR] 1.98, 95% CI: 1.93–2.02) and exclusive current cigar smokers (HR 1.20, 95% CI: 1.03–1.38) compared with never tobacco users. 

A higher risk of dying from a tobacco-related cancer was associated with exclusive current cigarette smokers (HR, 4.06, 95% CI: 3.84–4.29), exclusive current cigar smokers (HR 1.61, 95% CI: 1.11–2.32), and exclusive current pipe smokers (HR, 1.58, 95% CI: 1.05–2.38).

For current non-daily cigarette smokers, there were statistically significant associations with death from lung cancer (HR 6.24, 95% CI: 5.17–7.54), oral cancer (HR 4.62; 95% CI: 1.84–11.58), circulatory death (HR 1.43, 95% CI: 1.30–1.57), cardiovascular death (HR 1.24; 95% CI: 1.11–1.39), cerebrovascular death (stroke) (HR 1.39, 95% CI: 1.12–1.74), and chronic obstructive pulmonary disease (HR 7.66, 95% CI: 6.09–9.64) as well as for daily smokers. 

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“These data underscore the importance of cessation to reduce mortality and morbidity from combustible tobacco use,” the authors concluded. “Given rapid changes in tobacco products available in the marketplace, our results provide information on the contemporary mortality risks of 2 noncigarette combustible tobacco products.”

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