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Tobacco May Cause More Deaths than Currently Estimated

Thousands of smokers die from diseases not currently linked to smoking

A new study, led by researchers at the American Cancer Society (ACS), suggests that current estimates significantly under-report the number of Americans who die from cigarette smoking each year. The study indicates that cigarette smoking may kill tens of thousands more from diseases that are not currently counted as caused by smoking.

Published in the New England Journal of Medicine, the study included data from nearly 1 million U.S. men and women 55 years of age or older enrolled in five U.S. cohort studies (the ACS’ Cancer Prevention Study-II, the Nurses’ Health Study, the Health Professionals Follow-up Study, the Women’s Health Initiative, and the National Institutes of Health–AARP Diet and Health Study).

More than 180,000 deaths occurred during approximately 10 years of follow-up. The researchers found that current smokers, as expected, had death rates nearly three times higher than “never smokers.” Most of the excess deaths in smokers were due to diseases that are established as being caused by smoking, including 12 types of cancer, coronary heart disease, stroke, and chronic obstructive pulmonary disease (COPD). But the investigators also found that approximately 17% of the excess deaths in smokers were due to diseases that have not yet been officially established by the U.S. Surgeon General as caused by smoking and are not counted in estimates of the death toll from smoking.

In particular, smoking was associated with at least a doubling of the risk of death from several causes, including renal failure, intestinal ischemia, hypertensive heart disease, infections, and various respiratory diseases other than COPD, which are not currently included in estimates of deaths caused by smoking. The excess risk of death from each of these diseases declined after quitting smoking.

The authors concluded that a substantial portion of excess mortality among smokers may be due to diseases not formally established as caused by smoking, and that, if supported by future research, some of these diseases should be included in future estimates of the death toll from smoking.

“The number of additional deaths potentially linked to cigarette smoking is substantial,” said co-author Eric J. Jacobs, PhD. “In our study, many excess deaths among smokers were from disease categories that are not currently established as caused by smoking, and we believe there is strong evidence that many of these deaths may have been caused by smoking. If the same is true nationwide, then cigarette smoking may be killing about 60,000 more Americans each year than previously estimated, a number greater than the total number who die each year of influenza or liver disease.”

Sources: NEJM; February 12, 2015; and ACS; February 11, 2015.

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