Association of Cigarette, Cigar, and Pipe Use With Mortality Risk in the US Population

JAMA Intern Med. 2018 Apr 1;178(4):469-476. doi: 10.1001/jamainternmed.2017.8625.


Importance: Tobacco products have changed in recent years. Contemporary mortality risk estimates of combustible tobacco product use are needed.

Objective: To investigate the mortality risks associated with current and former use of cigars, pipes, and cigarettes.

Design, setting, and participants: The National Longitudinal Mortality Study is 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. In this study, participants provided tobacco use information at baseline in surveys starting from 1985 and were followed for mortality through the end of 2011. The study includes 357 420 participants who reported exclusively using cigar, pipes, or cigarettes or reported never using any type of tobacco product.

Exposures: Current or former exclusive use of any cigar (little cigar, cigarillos, large cigar), traditional pipe, or cigarette and never tobacco use. Information on current daily and nondaily use was also collected. Estimates adjusted for age, sex, race/ethnicity, education, and survey year.

Main outcomes and measures: All-cause and cause-specific mortality as identified as the primary cause of death from death certificate information.

Results: Of the 357 420 persons included in the analysis, the majority of current and former cigar and pipe smokers were male (79.3%-98.0%), and smokers were more evenly divided by sex (46% of current daily smokers were male). There were 51 150 recorded deaths during follow-up. Exclusive current cigarette smokers (hazard ratio [HR], 1.98; 95% CI, 1.93-2.02) and exclusive current cigar smokers (HR, 1.20; 95% CI, 1.03-1.38) had higher all-cause mortality risks than never tobacco users. Exclusive current cigarette smokers (HR, 4.06; 95% CI, 3.84-4.29), exclusive current cigar smokers (HR, 1.61; 95% CI, 1.11-2.32), and exclusive current pipe smokers (HR, 1.58; 95% CI, 1.05-2.38) had an elevated risk of dying from a tobacco-related cancer (including bladder, esophagus, larynx, lung, oral cavity, and pancreas). Among current nondaily cigarette users, statistically significant associations were observed with deaths from lung cancer (HR, 6.24; 95% CI, 5.17-7.54), oral cancer (HR, 4.62; 95% CI, 1.84-11.58), circulatory death (HR, 1.43; 95% CI, 1.30-1.57), cardiovascular death (HR, 1.24; 95% CI, 1.11-1.39), cerebrovascular death (stroke) (HR, 1.39; 95% CI, 1.12-1.74), and chronic obstructive pulmonary disease (HR, 7.66; 95% CI, 6.09-9.64) as well as for daily smokers.

Conclusions and relevance: This study provides further evidence that exclusive use of cigar, pipes, and cigarettes each confers significant mortality risks.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / mortality*
  • Cigar Smoking / epidemiology*
  • Cigarette Smoking / epidemiology*
  • Cohort Studies
  • Female
  • Gastrointestinal Neoplasms / epidemiology
  • Gastrointestinal Neoplasms / mortality
  • Head and Neck Neoplasms / epidemiology
  • Head and Neck Neoplasms / mortality
  • Humans
  • Longitudinal Studies
  • Lung Neoplasms / epidemiology
  • Lung Neoplasms / mortality
  • Male
  • Middle Aged
  • Mortality*
  • Neoplasms / epidemiology
  • Neoplasms / mortality*
  • Pancreatic Neoplasms / epidemiology
  • Pancreatic Neoplasms / mortality
  • Pipe Smoking / epidemiology*
  • Proportional Hazards Models
  • Pulmonary Disease, Chronic Obstructive / epidemiology
  • Pulmonary Disease, Chronic Obstructive / mortality*
  • United States / epidemiology
  • Urinary Bladder Neoplasms / epidemiology
  • Urinary Bladder Neoplasms / mortality