BACKGROUND AND PURPOSE: 

• There is data available on cigarette smoking and mortality, but limited information on other tobacco products such as pipes and cigars  
• 12.5 million people in the United States aged 12 years or older are cigar smokers (2015) 
• Products such as cigars have evolved over time and more current research is needed  
• Christensen et al. (JAMA Internal Medicine, 2018) examined the mortality risks associated with current and former use of cigars, pipes, and cigarettes 

METHODS: 

• Data subset from The National Longitudinal Mortality Study (NLMS) 
  • Sample of the civilian, noninstitutionalized US population consisting of the Annual Social and Economic Supplements (March 1973 to March 2011) | Tobacco Use Supplement to the Current Population Survey (TUS-CPS) | Census data linked to mortality data from the National Death Index (through 2011) 
• Participants provided tobacco use information at baseline in surveys in 1985 and followed for mortality until end of 2011 
• Tobacco use classified as  
  • Exclusive current or former use of cigarettes 
  • Any cigar (little cigar, cigarillos, large cigar) 
  • Traditional pipe 
  • Never use tobacco 
• Current daily and nondaily use was also collected 
• Estimates were adjusted based on age, sex, race/ethnicity, education, and survey year 
• Primary outcome: All-cause and cause-specific mortality as identified as the primary cause of death from death certificate information 

RESULTS: 

• Data was collected from 375,420 participants 
  • The majority of former cigar and pipe smokers were male (79.3-98.0%) 
  • Smokers were more evenly divided by sex (54% female) 
• There were 51,150 deaths during follow-up 
• Compared to never tobacco users, both 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  
• 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 the following tobacco-related cancers 
  • Bladder | Esophagus | Larynx | Lung | Oral cavity | Pancreas 
•  Among current nondaily and daily 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) 
  • Chronic obstructive pulmonary disease (HR, 7.66; 95% CI, 6.09-9.64) 

CONCLUSION: 

• Exclusive use of cigar, pipes, and cigarettes each carries significant mortality risks 
• Risks exist even in nondaily users  
• Cigars and pipe smoking are also associated with increased mortality and cancer risks 

Learn More – Primary Sources: 

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

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