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Cigars and pipes raise mortality risk independent of cigarettes

Cigar, pipe, and cigarette use confers mortality risks, even among non-daily current cigarette users

Louise Prime

Wednesday, 21 February 2018

People who smoke only cigars or pipes have a higher risk of dying from tobacco-related cancers than never-smokers, as well as higher all-cause mortality, research has confirmed. The authors of the study*, published in JAMA Internal Medicine, said those who had quit smoking cigars or pipes lowered their risk, and their findings underscore the importance of cessation to reduce mortality and morbidity from combustible tobacco use.

A team of US researchers analysed data for 357,420 participants in the National Longitudinal Mortality Study – a longitudinal population-based, nationally representative health survey with mortality follow-up that includes demographic and other information from the Current Population Survey, tobacco product use information from the Tobacco Use Supplement, and mortality data from the National Death Index. Data were collected on current or former exclusive use of any cigar (little cigar, cigarillos, large cigar), traditional pipe, or cigarette and never tobacco use, as well as information on current daily and non-daily use. There were 51,150 recorded deaths during follow-up.

The researchers reported that exclusive current cigarette smokers had significantly higher all-cause mortality risks than never tobacco users (hazard ratio HR 1.98), as did exclusive current cigar smokers (HR 1.20). Exclusive current cigarette smokers (HR 4.06), exclusive current cigar smokers (HR 1.61), and exclusive current pipe smokers (HR 1.58) had an elevated risk of dying from a tobacco-related cancer (including bladder, oesophagus, larynx, lung, oral cavity, and pancreas).

They also found statistically significant associations among current non-daily cigarette users for deaths from lung cancer (HR 6.24), oral cancer (HR 4.62), circulatory death (HR 1.43), cardiovascular death (HR 1.24), cerebrovascular death (stroke) (HR 1.39), and chronic obstructive pulmonary disease (HR 7.66) as well as for daily smokers.

They pointed out that although they observed lower risks for daily pipe and cigar smoking than for daily cigarette smoking, their study provides further evidence that exclusive use of cigar, pipes, and cigarettes each confers significant mortality risks. Furthermore, they found lower risks among former than current users.

They concluded: “Our study provides further evidence that cigar, pipe, and cigarette use confers mortality risks, even among non-daily current cigarette users, with lower risks observed among former users than current users. These data underscore the importance of cessation to reduce mortality and morbidity from combustible tobacco use. … Given rapid changes in tobacco products available in the marketplace, our results provide information on the contemporary mortality risks of two non-cigarette combustible tobacco products.”


*Christensen CH, Rostron B, Cosgrove C, et al. Association of cigarette, cigar, and pipe use with mortality risk in the US population. JAMA Intern Med. Published online February 19, 2018. doi:10.1001/jamainternmed.2017.8625

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