title: Smoking in young women in Scotland and future burden of hospital admission and death: a nested cohort study.
abstract: BACKGROUND
  Many women smoke, yet few longitudinal studies have examined the non-fatal burden of smoking in women.
  
  
  OBJECTIVE
  To investigate smoking in young women, and hospital admission and death in Scotland; and to compare mortality risk with elsewhere in the UK.
  
  
  METHODS
  Nested cohort study: Royal College of General Practitioners' Oral Contraception Study, UK.
  
  
  METHODS
  A total of 4121 women categorised by smoking habits and living in Scotland at recruitment (1968-1969) were followed until March 2009. Cox regression was used to investigate smoking and survival time; mortality from cancer, circulatory, or respiratory disease, and all other causes; and hospitalisation for any reason, and for specific reasons. The number and type of hospital admissions and bed-days were examined by smoking status. Life tables and Cox regression were used to compare the mortality risk of women living in Scotland with that of women living elsewhere.
  
  
  RESULTS
  All-cause mortality was increased in women who smoked <15 cigarettes daily (adjusted hazard ratio = 1.99, 95% confidence interval [CI] = 1.74 to 2.27) and those who smoked ≥15 cigarettes daily (adjusted HR = 2.81, 95% CI = 2.47 to 3.20). Smoking any amount increased death from cancer, circulatory, respiratory, and other causes. Increased risk estimates were seen in one or both smoking groups for hospitalisation for any cause, and for several specific causes. More smokers than non-smokers were admitted to hospital, for four or more reasons, and had a longer total stay. The median survival age among smokers was lower in Scotland than elsewhere. Higher adjusted hazard ratios for mortality were found among smokers in Scotland.
  
  
  CONCLUSIONS
  This study provides a powerful reminder of the burden of smoking in young women. In the UK, harmful effects appear to be worse in smokers in Scotland.
authors: Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen. l.iversen@abdn.ac.uk
authors: Lisa
authors: L
authors: Iversen
authors: Shona
authors: S
authors: Fielding
authors: Philip C
authors: PC
authors: Hannaford
mesh_terms: D000328:Adult; D017281:Cost of Illness; D004812:Epidemiologic Methods; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D012606:Scotland / Q000453:epidemiology; D012907:Smoking / Q000009:adverse effects / Q000401:mortality*; D012923:Social Class
references: J Epidemiol Community Health. 1998 Jul;52(7):420-4
references: 9799875
references: Ann Intern Med. 1993 Nov 15;119(10):992-1000
references: 8214996
references: Br Med J. 1980 Apr 5;280(6219):967-71
references: 7417764
references: J Public Health (Oxf). 2005 Jun;27(2):199-204
references: 15774571
references: Am J Public Health. 1995 Sep;85(9):1223-30
references: 7661229
references: Lancet. 2013 Jan 12;381(9861):133-41
references: 23107252
references: Tob Control. 2000 Dec;9(4):389-96
references: 11106708
references: Am J Public Health. 1999 May;89(5):691-8
references: 10224980
references: Lancet. 2003 Jul 19;362(9379):185-91
references: 12885478
references: Nicotine Tob Res. 2010 Apr;12(4):365-73
references: 20156886
references: J Public Health (Oxf). 2007 Dec;29(4):405-12
references: 17916551
references: J Epidemiol Community Health. 2008 Dec;62(12):1051-6
references: 18450766
references: J Epidemiol Community Health. 2003 Feb;57(2):134-40
references: 12540690
references: Aust N Z J Public Health. 2002;26(3):225-30
references: 12141617