Smoking continues to threaten US public health

Research published in TheNew England Journal of Medicine shows that disease and mortality due to smoking have continually increased over the past 50 years in the USA.

And, while the risks of smoking were previously lower in women than in men, women have now "caught up" and experience a comparable burden of smoking-related disease and death.

Commenting on the research in an accompanying editorial, Steven Schroeder (University of California, San Francisco, USA) says the findings highlight a continuing and urgent need for policies to reduce smoking.

"Because smoking has become a stigmatized behavior concentrated among persons of low social status, it risks becoming invisible to those who set health policies and research priorities," he cautions.

Michael Thun (American Cancer Society, Atlanta, Georgia, USA) and colleagues analyzed data from 2.2 million people, all of whom turned 55 years of age or older during follow up, over three time periods: 1959-65, 1982-88, and 2000-10.

They found that, since the 1960s, the relative risk for dying from lung cancer has dramatically increased among female smokers compared with never smokers, rising from a baseline of 2.7 to 12.7 in the 1980s, and to 25.7 in the contemporary cohort. This was sufficient to offset completely the 50% greater longevity observed in the overall population during this time, and made women's risk for lung cancer death comparable to the 25-fold increased risk among men.

"This finding is new and confirms the prediction that, in relative terms, 'women who smoke like men die like men,' " write Thun and colleagues, who add that, since the 1960s, patterns of female smoking have increasingly mirrored those of men.

Additionally, the risk for death from chronic obstructive pulmonary disease has nearly doubled in both men and women since the 1980s, rising from 10-fold that of never smokers to 25.6-fold in the contemporary male cohort, and from 10.4-fold that of never smokers to 22.4-fold among women.

In a separate study published in the same journal, Prabhat Jha (University of Toronto, Ontario, Canada) and colleagues found that, for smokers aged 25 to 79 years old, the overall risk for death was three times that of those who had never smoked.

"The findings from these studies have profound implications for many developing countries where cigarette smoking has become entrenched more recently than in the United States," concluded Thun in a press statement.

"Together they show that the epidemic of disease and death caused by cigarette smoking increases progressively over many decades, peaking fifty or more years after the widespread uptake of smoking in adolescence."

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