S22 1 hazards of smoking and the benefits of stopping- sir richard peto

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hazards of smoking and benefits of cessation

hazards of smoking and benefits of cessation

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  • 1. Hazards of smoking and benefits of stopping: UK and worldwide Richard Peto, University of Oxford• Many young men started smoking in the first few decades of the 20th century, so full lifelong risks are now known.• Young women started smoking around mid-century, so hazards in later middle age only just became apparent
  • 2. Richard Doll: mortality and smoking in male British doctors born 1900-3034,000 men recruited in 1951 & followed up to 2001– Moderate hazard for smokers born 1851-1899, as they did not smoke substantial numbers of cigarettes when young– Bigger hazard for smokers born 1900-1930: about HALF eventually killed by tobacco– Those who stopped before age 40 (preferably well before 40) avoided nearly all the excess risk in later middle age
  • 3. THE UK MILLION WOMEN STUDYValerie Beral, Kirstin Pirie, Richard Peto, unpublishedFirst large prospective study of women who have smoked throughout adult lifeBig risks, even though UK cigarette yields have been lowered in recent decades
  • 4. THE UK MILLION WOMEN STUDY ‘ 3.4 Current vs never-smoker, all-cause mortality ratio* 2.6 1.8 *Fully standardised mortality ratio, by smoking habit at start of 12-year FU
  • 5. THE MILLION WOMEN STUDY All-cause mortality Ex-smokers and current smokers 3.1 2.1 1.7 1.2 1.06
  • 6. THE MILLION WOMEN STUDY Stopped at Current age 35-44 smokersAge at starting 18.8 19.0Cigarettes per day 14.7 15.3while smoking
  • 7. THE MILLION WOMEN STUDY Lung cancer mortality Ex-smokers and current smokers 24.6 13.0 6.4 3.5 1.5 1.8
  • 8. THE MILLION WOMEN STUDY All vascular mortality Ex-smokers and current smokers 3.7 2.0 1.8 1.2 1.0
  • 9. Hospital admissionwith any mention of disease/procedure Current versus never-smoker
  • 10. Illustration of the effects of a 3-fold difference in annual death rates on mortality at ages 35-79 * 78% 47%* Taking death rates in smokers to be twice the UK 2009 death rates, anddeath rates in non-smokers to be two-thirds of these national death rates
  • 11. Nationwide delay between increase in smoking by young adults & main increase in tobacco deaths when they reach middle & old age eg, USA 1900-2000
  • 12. Chinese cigarette increase 40 years after US increaseDelayed hazard: observed (1950, 1990)and predicted (2030) proportions of all deaths at ages 35-69 due to tobacco US (all adults) China (men) 1950 12% 1990 12% 1990 33% 2030 33%
  • 13. Product of domestic cigarettes in China Billion00 2000 billion00 1000 billion00 1949 1954 1959 1964 1969 1974 1979 1984 1989 1994 1999 2004
  • 14. INDIA: 1 million tobacco deaths per year during the 2010s Jha et al, NEJM 2008
  • 15. World tobacco deaths,if current smoking patterns continue 2000-2025 ~150M 2025-2050 ~300M 2050-2100 >500M TOTAL for the ~1000M 21st century (1 billion) Compare with ~100M 20th century total (0.1 billion)
  • 16. Prevention of a substantial proportion of the450 million tobacco deaths before 2050requires adult cessationContinuing to reduce the % children startingsmoking prevents many deaths,but its main effect will be on mortality in~2050 & later
  • 17. Worldwide, HIV, TOBACCO, ALCOHOL & OBESITYare the only big causes of death that have increased substantially since 1990 in some large populations. Death in old age is inevitable, but death before old age is not