• Aysel Müezzinler, Ute Mons, Carolin Gellert, Ben Schöttker, Eugène Jansen, Frank Kee, Mark G O'Doherty, Kari Kuulasmaa, Neal D Freedman, Christian C Abnet, Alicja Wolk, Niclas Håkansson, Nicola Orsini, Tom Wilsgaard, Bas Bueno-de-Mesquita, Yvonne T van der Schouw, Peeters Petra H M PHM Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom., de Groot Lisette C P G M LCPGM Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands., Annette Peters, Philippos Orfanos, Allan Linneberg, Charlotta Pisinger, Abdonas Tamosiunas, Migle Baceviciene, Dalia Luksiene, Gailute Bernotiene, Pekka Jousilahti, Ulrika Petterson-Kymmer, Jan Håkan Jansson, Stefan Söderberg, Sture Eriksson, Nicole Jankovic, María-José Sánchez, Giovanni Veronesi, Susana Sans, Wojciech Drygas, Antonia Trichopoulou, Paolo Boffetta, and Hermann Brenner.
• Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Network Aging Research, University of Heidelberg, Heidelberg, Germany.
• Am J Prev Med. 2015 Nov 1; 49 (5): e53-e63.

IntroductionSmoking 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.MethodsRelative 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.ResultsA 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.ConclusionsSmoking 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.Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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