title: Smoking and All-cause Mortality in Older Adults: Results From the CHANCES Consortium.
abstract: BACKGROUND
  Smoking is known to be a major cause of death among middle-aged adults, but evidence on its impact and the benefits of smoking cessation among older adults has remained limited. Therefore, we aimed to estimate the influence of smoking and smoking cessation on all-cause mortality in people aged ≥60 years.
  
  
  METHODS
  Relative mortality and mortality rate advancement periods (RAPs) were estimated by Cox proportional hazards models for the population-based prospective cohort studies from Europe and the U.S. (CHANCES [Consortium on Health and Ageing: Network of Cohorts in Europe and the U.S.]), and subsequently pooled by individual participant meta-analysis. Statistical analyses were performed from June 2013 to March 2014.
  
  
  RESULTS
  A total of 489,056 participants aged ≥60 years at baseline from 22 population-based cohort studies were included. Overall, 99,298 deaths were recorded. Current smokers had 2-fold and former smokers had 1.3-fold increased mortality compared with never smokers. These increases in mortality translated to RAPs of 6.4 (95% CI=4.8, 7.9) and 2.4 (95% CI=1.5, 3.4) years, respectively. A clear positive dose-response relationship was observed between number of currently smoked cigarettes and mortality. For former smokers, excess mortality and RAPs decreased with time since cessation, with RAPs of 3.9 (95% CI=3.0, 4.7), 2.7 (95% CI=1.8, 3.6), and 0.7 (95% CI=0.2, 1.1) for those who had quit <10, 10 to 19, and ≥20 years ago, respectively.
  
  
  CONCLUSIONS
  Smoking remains as a strong risk factor for premature mortality in older individuals and cessation remains beneficial even at advanced ages. Efforts to support smoking abstinence at all ages should be a public health priority.
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Network Aging Research, University of Heidelberg, Heidelberg, Germany.
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authors.lastname: Müezzinler
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany. Electronic address: u.mons@dkfz.de.
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authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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authors.affiliation: National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
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authors.affiliation: UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
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authors.affiliation: UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
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authors.affiliation: National Institute for Health and Welfare, Helsinki, Finland.
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authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
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authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
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authors.affiliation: Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Alicja
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authors.affiliation: Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
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authors.affiliation: Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
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authors.affiliation: Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
authors.forename: Tom
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authors.affiliation: National Institute for Public Health and the Environment, Bilthoven, the Netherlands; Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Epidemiology, Julius Center, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Bas
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authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
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authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
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authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands.
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authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München, Neuherberg, Germany.
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authors.affiliation: Hellenic Health Foundation, Athens, Greece; Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.
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authors.affiliation: Research Centre for Prevention and Health, Glostrup University Hospital, Glostrup, Denmark; Department of Clinical Experimental Research, Glostrup University Hospital, Glostrup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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authors.affiliation: Laboratory of Population Studies, Institute of Cardiology of Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
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authors.affiliation: Laboratory of Population Studies, Institute of Cardiology of Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
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authors.forename: Ulrika
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authors.affiliation: Department of Public Health and Clinical Medicine, Medicine, Skellefteå Research Unit, Cardiology, Umeå University, Umeå, Sweden.
authors.forename: Stefan
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authors.affiliation: Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
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authors.forename: María-José
authors.initials: MJ
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authors.affiliation: Department of Clinical and Experimental Medicine, Research Center in Epidemiology and Preventive Medicine, University of Insubria, Varese, Italy.
authors.forename: Giovanni
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authors.forename: Wojciech
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authors.affiliation: Hellenic Health Foundation, Athens, Greece; Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.
authors.forename: Antonia
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mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D016016:Proportional Hazards Models; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D016540:Smoking Cessation; D014481:United States