Original article
Mortality in relation to smoking history: 13 years' follow-up of 68,000 Norwegian men and women 35–49 years

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Abstract

A total of 44,290 men and 24,535 women aged 35–49 have been followed with respect to different causes of death during 13.3 years on average. A detailed history of smoking, together with other important risk factors, were recorded in a standardized way. Compared with the classical American and British studies, the excess mortality for the smokers was largely the same for the majority of causes. The exceptions were cerebrovascular mortality and suicides and accidents, which were more strongly related to smoking in this study. Furthermore, men who smoked only pipe, had nearly the same coronary heart disease mortality as men who smoked only cigarettes. The same applies to lung cancer mortality. Among men who had quit cigarette smoking, the coronary heart disease mortality decreased with time since quitting to almost the level of the never cigarette smokers after 5 years or more.

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      However, the magnitude of the risk reduction and the length of cessation required remain poorly understood. While the risk seems to decrease immediately after smoking cessation (Dobson et al., 1991; Doll et al., 2004; Honjo et al., 2010; Mannan et al., 2010; Negri et al., 1994; Novello, 1990; Ockene et al., 1990; Office of the Surgeon General (US) and Office on Smoking and Health (US), 2004; Shields et al., 2013; Shields and Wilkins, 2013; Teo et al., 2006; Tverdal et al., 1993; Wannamethee et al., 1995), it is not clear when or even whether the risk reverts to that of lifelong non-smokers. While some studies have shown that the risk of coronary heart disease reverts to that of lifelong non-smokers within 3–5 years (Dobson et al., 1991; Mannan et al., 2010; Novello, 1990; Tverdal et al., 1993) or within 10–20 years (Honjo et al., 2010; Shields and Wilkins, 2013), other studies have identified a remaining risk in former smokers after 10 or even 20 years of continuous smoking cessation (Negri et al., 1994; Teo et al., 2006; Wannamethee et al., 1995).

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