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Original Investigation
April 2018

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

Author Affiliations
  • 1Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
  • 2United States Census Bureau, Suitland, Maryland
  • 3National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
  • 4Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
  • 5Information Management Services, Inc
  • 6Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
JAMA Intern Med. 2018;178(4):469-476. doi:10.1001/jamainternmed.2017.8625
Key Points

Question  What is the association of cigar, pipe, and cigarette use with mortality risk in the US population?

Findings  In this nationally representative longitudinal cohort study of 357 420 participants comparing exclusive cigar, pipe, and cigarette use with mortality risk, a statistically significantly elevated risk of tobacco-related cancer mortality among exclusive current and former cigarette smokers, current cigar smokers, and current pipe smokers, as well as a statistically significantly elevated risk of mortality from most examined causes of death among both current daily and nondaily cigarette smokers, were demonstrated.

Meaning  Use of cigar, pipe, and cigarettes each confers mortality risks.


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.