Background
Methods
Study population
Definition of endpoints
Smoking exposure assessment
Statistical analyses
Results
COSM | EPIC-Elderly | ESTHER | HAPIEE | MORGAM | NIH-AARP | RS | SENECA | SMC | TROMSØ | VIP | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
DK | ES | GR | NL | CZ | LT | PO | RU | FI | NI | SE | |||||||||
N total | 45,906 | 15,355 | 5185 | 9863 | 6896 | 9949 | 8857 | 7161 | 10,728 | 9360 | 38,108 | 2745 | 5476 | 566,279 | 8121 | 2585 | 38,984 | 10,463 | 95,000 |
Follow-up (years)a | 13 | 13 | 13 | 10 | 13 | 11 | 8 | 4 | 7 | 6 | 17 | 16 | 11 | 12 | 12 | 8 | 13 | 13 | 14 |
Age (years)a | 59 | 63 | 62 | 67 | 64 | 63 | 59 | 62 | 57 | 58 | 46 | 54 | 53 | 63 | 69 | 74 | 61 | 62 | 50 |
Sex, % | |||||||||||||||||||
Male | 100 | 46 | 43 | 40 | 5 | 45 | 47 | 45 | 49 | 46 | 48 | 100 | 49 | 60 | 39 | 50 | 0 | 47 | 50 |
Female | 0 | 54 | 57 | 60 | 95 | 55 | 53 | 55 | 51 | 54 | 52 | 0 | 51 | 40 | 61 | 50 | 100 | 53 | 50 |
BMI (kg/m2)a | 25 | 26 | 29 | 29 | 26 | 27 | 28 | 29 | 28 | 28 | 26 | 26 | 27 | 26 | 26 | 27 | 24 | 26 | 25 |
Education, % | |||||||||||||||||||
Primary | 70 | 41 | 87 | 91 | 34 | 75 | 13 | 7 | 12 | 10 | 46 | 1 | 31 | 1 | 25 | 67 | 74 | 56 | 23 |
Secondary | 14 | 43 | 7 | 6 | 55 | 20 | 74 | 37 | 60 | 61 | 44 | 88 | 49 | 26 | 62 | 25 | 7 | 28 | 51 |
University | 16 | 16 | 6 | 3 | 11 | 5 | 14 | 56 | 29 | 29 | 9 | 11 | 20 | 73 | 8 | 8 | 18 | 16 | 26 |
Alcohol (g/day)a | 10 | 12 | 1 | 1 | 2 | 4 | 6 | 0 | 0 | 0 | 2 | 9 | 2 | 2 | 3 | 3 | 3 | 2 | 3 |
Vigorous physical activity, % | |||||||||||||||||||
Yes | 34 | 72 | 5 | 21 | 58 | 42 | 73 | 61 | 73 | 40 | n.a. | 12 | n.a. | 46 | 85 | 13 | 30 | 32 | 34 |
No | 66 | 28 | 95 | 79 | 42 | 58 | 27 | 39 | 27 | 60 | 88 | 54 | 15 | 87 | 70 | 68 | 66 | ||
History of diabetes, % | |||||||||||||||||||
Yes | 7 | 3 | 11 | 14 | 5 | 16 | 12 | 8 | 12 | 5 | 5 | 2 | 5 | 9 | 7 | 9 | 5 | 4 | 2 |
No | 93 | 97 | 89 | 86 | 95 | 84 | 88 | 92 | 88 | 95 | 95 | 98 | 95 | 91 | 93 | 91 | 95 | 96 | 98 |
Smoking status, % | |||||||||||||||||||
Never | 36 | 31 | 67 | 70 | 47 | 50 | 44 | 63 | 40 | 58 | 46 | 38 | 48 | 36 | 36 | 54 | 54 | 33 | 55 |
Former | 39 | 36 | 16 | 19 | 35 | 33 | 30 | 18 | 28 | 14 | 29 | 33 | 32 | 51 | 41 | 28 | 23 | 36 | 25 |
Current | 25 | 33 | 17 | 12 | 18 | 17 | 26 | 19 | 32 | 28 | 25 | 29 | 20 | 12 | 23 | 18 | 23 | 31 | 20 |
Time since smoking cessation, % | |||||||||||||||||||
≤9 years | 22 | 28 | 41 | 36 | 26 | 23 | 30 | 34 | 41 | 38 | n.a. | 36 | 38 | 26 | n.a. | 39 | 28 | 31 | 37 |
10–19 years | 29 | 22 | 30 | 31 | 29 | 28 | 29 | 23 | 29 | 26 | 35 | 26 | 74 | 30 | 28 | 24 | 32 | ||
≥20 years | 49 | 41 | 27 | 30 | 43 | 48 | 36 | 43 | 24 | 33 | 29 | 34 | 28 | 44 | 45 | 24 |
Association of smoking exposure with total and respiratory tract cancer incidence and mortality
Cancer site | Smoking exposure | Cancer incidence | Cancer mortality | ||||||
---|---|---|---|---|---|---|---|---|---|
Totalc | Cases | HR (95 % CI) | RAP (95 % CI) | Totalc | Cases | HR (95 % CI) | RAP (95 % CI) | ||
Total cancer | Smoking status | ||||||||
Never | 321984 | 43449 | 1.00 (reference) | 0.00 (reference) | 346559 | 13398 | 1.00 (reference) | 0.00 (reference) | |
Former | 353311 | 64797 |
1.15 (1.09 ; 1.21)
***
|
2.67 (1.65 ; 3.70)
**
| 368808 | 24365 |
1.39 (1.26 ; 1.54)
***
|
4.03 (2.85 ; 5.22)
***
| |
Current | 128615 | 26007 |
1.44 (1.28 ; 1.63)
***
|
7.92 (5.58 ; 10.3)
***
| 140672 | 13450 |
2.19 (1.83 ; 2.63)
***
|
9.92 (7.84 ; 12.0)
***
| |
Years since smoking cessation (reference: current smokers)d | |||||||||
≤9 years | 19049 | 2704 |
0.90 (0.86 ; 0.94)
|
-1.62 (-2.41; -0.83)
| 22693 | 1351 |
0.83 (0.77 ; 0.89)
|
-2.09 (-2.86 ; -1.31)
| |
10–19 years | 18511 | 2613 |
0.80 (0.74 ; 0.88)
**
|
-4.01 (-5.73; -2.29)
**
| 21361 | 1145 |
0.66 (0.59 ; 0.73)
|
-4.81 (-6.01 ; -3.62)
| |
≥20 years | 24651 | 3904 |
0.75 (0.70 ; 0.81)
**
|
-5.27 (-6.69; -3.86)
*
| 28057 | 1507 |
0.52 (0.47 ; 0.58)
*
|
-7.54 (-8.59 ; -6.49)
| |
P linear trend |
<0.0001
|
<0.0001
| |||||||
Lung cancer | Smoking status | ||||||||
Never | 321984 | 923 | 1.00 (reference) | 0.00 (reference) | 346559 | 863 | 1.00 (reference) | 0.00 (reference) | |
Former | 353311 | 6785 |
4.06 (3.13 ; 5.26)
**
|
16.4 (12.2 ; 20.7)
***
| 368808 | 6967 |
4.10 (3.14 ; 5.36)
***
|
15.3 (11.7; 18.9)
**
| |
Current | 128615 | 6333 |
13.1 (9.90 ; 17.3)
***
|
30.0 (24.1 ; 35.9)
***
| 140672 | 6165 |
11.5 (8.21 ; 16.1)
***
|
26.2 (21.5; 30.8)
***
| |
Years since smoking cessation (reference: current smokers)d | |||||||||
≤9 years | 19049 | 306 |
0.60 (0.48 ; 0.73)
*
|
-5.26 (-7.91; -2.61)
*
| 22693 | 373 |
0.70 (0.56 ; 0.87)
**
|
-3.45 (-5.33 ; -1.56)
| |
10–19 years | 18511 | 191 |
0.33 (0.25 ; 0.44)
**
|
-12.3 (-16.4; -8.20)
**
| 21361 | 233 |
0.40 (0.31 ; 0.51)
*
|
-8.99 (-12.2 ; -5.77)
**
| |
≥20 years | 24651 | 139 |
0.15 (0.12 ; 0.19)
|
-21.9 (-28.1; -15.8)
**
| 28057 | 168 |
0.18 (0.14 ; 0.24)
*
|
-17.0 (-21.3 ; -12.7)
**
| |
P linear trend |
<0.0001
|
<0.0001
| |||||||
Head and neck cancer | Smoking status | ||||||||
Never | 321984 | 636 | 1.00 (reference) | 0.00 (reference) | 346559 | 155 | 1.00 (reference) | 0.00 (reference) | |
Former | 353311 | 1503 |
1.73 (1.57 ; 1.92)
|
7.77 (4.24 ; 11.3)
| 368808 | 388 |
2.10 (1.70 ; 2.61)
|
9.01 (4.36 ; 13.6)
| |
Current | 128615 | 1051 |
2.89 (1.98 ; 4.21)
**
| 9.10 (-2.34 ; 20.5)
***
| 140672 | 359 |
3.74 (2.38 ; 5.89)
|
14.0 (4.53 ; 23.5)
**
| |
Years since smoking cessation (reference: current smokers)d | |||||||||
≤9 years | 19049 | 64 | 1.08 (0.80 ; 1.47) | -0.77 (-3.97 ; 3.66) | 22693 | 22 | 1.35 (0.75 ; 2.44) | -2.64 (-4.11 ; 9.40) | |
10–19 years | 18511 | 33 |
0.61 (0.40 ; 0.92)
| -5.71 (-15.4 ; 1.19) | 21361 | 14 | 1.35 (0.62 ; 2.90) | 3.45 (-7.93 ; 14.8) | |
≥20 years | 24651 | 53 |
0.55 (0.34 ; 0.91)
| -2.75 (-9.26 ; 3.76) | 28057 | 20 | 0.58 (0.31 ; 1.07) | -3.59 (-10.1 ; 2.91) | |
P linear trend |
0.0039
| 0.0676 |
Association of smoking exposure with digestive tract cancer incidence and mortality
Cancer site | Smoking exposure | Cancer incidence | Cancer mortality | ||||||
---|---|---|---|---|---|---|---|---|---|
Totalc | Cases | HR (95 % CI) | RAP (95 % CI) | Totalc | Cases | HR (95 % CI) | RAP (95 % CI) | ||
Colorectal cancer | Smoking status | ||||||||
Never | 321984 | 4359 | 1.00 (reference) | 0.00 (reference) | 346559 | 1702 | 1.00 (reference) | 0.00 (reference) | |
Former | 353311 | 6273 |
1.20 (1.15 ; 1.25)
|
2.62 (2.00 ; 3.24)
| 368808 | 2264 |
1.22 (1.13 ; 1.31)
|
2.19 (1.35 ; 3.02)
| |
Current | 128615 | 2064 |
1.20 (1.07 ; 1.34)
*
|
3.64 (2.81 ; 4.46)
| 140672 | 912 |
1.35 (1.16 ; 1.58)
|
4.61 (3.53 ; 5.68)
| |
Years since smoking cessation (reference: current smokers)d | |||||||||
≤9 years | 19049 | 318 | 1.00 (0.87 ; 1.16) | -0.11 (-1.94 ; 1.72) | 22693 | 152 | 1.07 (0.86 ; 1.32) | 0.22 (-2.09 ; 2.53) | |
10–19 years | 18511 | 365 | 1.11 (0.97 ; 1.27) | 1.16 (-0.53 ; 2.84) | 21361 | 167 | 1.07 (0.87 ; 1.31) | 0.31 (-1.83 ; 2.45) | |
≥20 years | 24651 | 514 | 0.88 (0.78 ; 1.00) |
-1.95 (-3.58 ; -0.32)
| 28057 | 205 |
0.76 (0.63 ; 0.93)
|
-3.18 (-5.24 ; -1.11)
| |
P linear trend | 0.1885 |
0.0134
| |||||||
Gastric cancer | Smoking status | ||||||||
Never | 321984 | 598 | 1.00 (reference) | 0.00 (reference) | 346559 | 463 | 1.00 (reference) | 0.00 (reference) | |
Former | 353311 | 880 | 1.18 (0.95; 1.46) | 1.80 (-0.31 ; 3.91) | 368808 | 631 |
1.31 (1.02 ; 1.68)
|
2.08 (0.02 ; 4.14)
| |
Current | 128615 | 388 |
1.74 (1.50; 2.02)
|
5.62 (3.85 ; 7.39)
| 140672 | 302 |
1.73 (1.36 ; 2.19)
|
5.22 (3.08 ; 7.36)
| |
Years since smoking cessation (reference: current smokers)d | |||||||||
≤9 years | 19049 | 54 | 0.85 (0.60 ; 1.20) | -3.02 (-6.43 ; 0.40) | 22693 | 61 | 1.13 (0.80 ; 1.58) | -0.59 (-3.90 ; 2.72) | |
10–19 years | 18511 | 51 | 0.68 (0.41 ; 1.12) | -3.48 (-7.00 ; 0.05) | 21361 | 45 | 0.72 (0.46 ; 1.14) | -2.62 (-6.57 ; 1.32) | |
≥20 years | 24651 | 77 |
0.69 (0.51 ; 0.93)
| -2.42 (-5.08 ; 0.24) | 28057 | 77 | 0.87 (0.64 ; 1.19) | -1.89 (-5.25 ; 1.47) | |
P linear trend |
0.0461
| 0.2355 | |||||||
Pancreatic cancer | Smoking status | ||||||||
Never | 321984 | 921 | 1.00 (reference) | 0.00 (reference) | 346559 | 1186 | 1.00 (reference) | 0.00 (reference) | |
Former | 353311 | 1216 | 1.13 (0.95 ; 1.35) | 1.45 (0.23 ; 2.67) | 368808 | 1609 | 1.19 (0.98 ; 1.45) | 1.85 (0.85 ; 2.86) | |
Current | 128615 | 635 |
1.90 (1.48 ; 2.43)
*
|
7.57 (4.31 ; 10.8)
*
| 140672 | 808 |
2.19 (1.74 ; 2.75)
**
|
8.50 (6.45 ; 10.5)
| |
Years since smoking cessation (reference: current smokers)d | |||||||||
≤9 years | 19049 | 74 | 0.83 (0.62 ; 1.11) | -2.16 (-6.01 ; 1.69) | 22693 | 93 |
0.72 (0.56 ; 0.93)
|
-3.78 (-6.73 ; -0.84)
| |
10–19 years | 18511 | 62 |
0.71 (0.52 ; 0.96)
|
-4.82 (-9.11 ; -0.53)
| 21361 | 81 |
0.63 (0.48 ; 0.82)
|
-5.57 (-8.74 ; -2.40)
| |
≥20 years | 24651 | 65 |
0.47 (0.31 ; 0.70)
|
-9.72 (-15.3 ; -4.15)
| 28057 | 104 |
0.48 (0.35 ; 0.67)
|
-10.4 (-13.7 ; -7.16)
| |
P linear trend |
<0.0001
|
<0.0001
|
Association of smoking exposure with sex-specific cancer incidence and mortality
Cancer site | Smoking exposure | Cancer incidence | Cancer mortality | ||||||
---|---|---|---|---|---|---|---|---|---|
Totalc | Cases | HR (95 % CI) | RAP (95 % CI) | Totalc | Cases | HR (95 % CI) | RAP (95 % CI) | ||
Breast cancer | Smoking status | ||||||||
Never | 174507 | 7121 | 1.00 (reference) | 0.00 (reference) | 191907 | 1197 | 1.00 (reference) | 0.00 (reference) | |
Former | 116656 | 5428 |
1.08 (1.04 ; 1.12)
|
2.37 (0.68 ; 4.06)
| 121725 | 905 |
1.15 (1.05 ; 1.27)
|
2.71 (0.78 ; 4.63)
| |
Current | 59755 | 2536 |
1.07 (1.00 ; 1.15)
|
3.83 (1.76 ; 5.91)
| 64470 | 466 |
1.28 (1.06 ; 1.55)
|
5.10 (2.47 ; 7.72)
| |
Years since smoking cessation (reference: current smokers)d | |||||||||
≤9 years | 8348 | 275 | 0.97 (0.84 ; 1.13) | -2.49 (-7.49 ; 2.52) | 9726 | 49 | 0.98 (0.57 ; 1.67) | -1.82 (-8.21; 4.57) | |
10–19 years | 7044 | 253 | 1.03 (0.81 ; 1.31) | -3.87 (-9.84 ; 2.10) | 8092 | 43 | 1.02 (0.70 ; 1.49) | 0.51 (-7.55 ; 8.57) | |
≥20 years | 8437 | 333 | 1.03 (0.85 ; 1.24) | -3.77 (-10.2 ; 2.66) | 9539 | 61 | 1.23 (0.69 ; 2.21) | -0.56 (-8.57 ; 1.48) | |
P linear trend | 0.7293 | 0.4549 | |||||||
Prostate cancer | Smoking status | ||||||||
Never | 147477 | 11090 | 1.00 (reference) | 0.00 (reference) | 154652 | 920 | 1.00 (reference) | 0.00 (reference) | |
Former | 236655 | 17257 |
0.88 (0.82 ; 0.95)
*
|
-1.67 (-2.80; -0.54)
**
| 247083 | 1644 | 1.04 (0.94 ; 1.15) | 0.29 (-0.33 ; 0.91) | |
Current | 68860 | 3701 |
0.81 (0.72 ; 0.91)
**
|
-2.89 (-4.81; -0.97)
**
| 76202 | 589 | 1.26 (0.97 ; 1.64)
**
|
1.88 (0.25 ; 3.51)
| |
Years since smoking cessation (reference: current smokers)d | |||||||||
≤9 years | 10701 | 536 | 1.00 (0.90 ; 1.12) | 0.51 (-0.83 ; 1.84) | 12967 | 98 | 0.94 (0.64 ; 1.37) | -1.03 (-3.35 ; 1.30) | |
10–19 years | 11467 | 702 | 1.03 (0.89 ; 1.19) | 1.09 (-0.17 ; 2.35) | 13269 | 130 | 0.95 (0.74 ; 1.20) | -0.43 (-2.18 ; 1.32) | |
≥20 years | 16214 | 1227 | 1.08 (0.99 ; 1.18) | 0.75 (-0.38 ; 1.88) | 18518 | 228 | 0.82 (0.67 ; 1.00) |
-1.71 (-3.18; -0.24)
| |
P linear trend |
0.0480
| 0.0838 |