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The 13th World Conference on Tobacco OR Health
Building capacity for a tobacco-free world
July 12-15, 2006, Washington, DC, USA
Objective: The correlation between regular tobacco consumption and a higher mortality risk is abundantly documented. However, smokers also tend to have an unhealthier lifestyle in terms of numerous other aspects. These other factors therefore need to be addressed as confounders when interpreting the mortality risk. The aim of this longitudinal study is to identify, on the basis of a regionally representative sample of German adult males, the extent to which a higher risk of mortality among smokers is attributable to coincidental lifestyle factors (such as workplace stress, higher alcohol consumption, physical inactivity, etc.).
Methods: The database was a German WHO cohort study involving two baseline surveys performed in 1984/85 and 1989/90 and mortality follow-up statistics from 1997/98. The dataset comprised a total of 4,233 German nationals aged 25 to 74 whose mortality risk was analyzed using event-based proportional hazards models (Cox regressions).
Results: Daily tobacco consumption is associated with a 200% higher mortality risk during the follow-up period. Former smokers have a 46% higher subsequent mortality risk (p<0.01; reference category: never smoked). Adjusting these analysis by the stated lifestyle and work-related confounders only slightly reduces the tobacco-associated risk effect for daily smokers to +174% (p<0.01). The effect for ex-smokers remains virtually unchanged (+47%; p<0.01). In addition, alcohol abuse (more than 80g/day), physical inactivity, and low socioeconomic status are also associated with a significantly higher risk (p<0.01) of dying during the follow-up period. Tobacco consumption is by far the most significant solitary risk factor for mortality.