Continued Increases in the Relative Risk of Death From Smoking

OBJECTIVES: We examined changes in the relative risk of death among current and former smokers over recent decades in the United States. METHODS: Data from the National Health Interview Survey (NHIS) and National Health and Nutrition Examination Survey (NHANES) were linked to subsequent deaths. We calculated age-standardized death rates by gender and smoking status, and estimated multivariate discrete time logit regression models. RESULTS: The risk of death for a smoker compared with that for a never-smoker increased by 25.4% from 1987 to 2006 based on NHIS data. Analysis of NHANES data from 1971 to 2006 showed an even faster annual increase in the relative risk of death for current smokers. Former smokers also showed an increasing relative risk of death, although the increase was slower than that among current smokers and not always statistically significant. These trends were not related to increasing educational selectivity of smokers or increased smoking intensity or duration among current smokers. Smokers may have become more adversely selected on other health-related variables. CONCLUSIONS: A continuing increase in the relative risk of death for current and former smokers suggests that the contribution of smoking to national mortality patterns is not decreasing as rapidly as would be implied by the decreasing prevalence of smoking among Americans.