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INTRODUCTION: Smoking is known to be a major cause of death among middle-aged adults, but evidence on its impact and the benefits of smoking cessation among older adults has remained limited. There ...

Objective To provide a systematic review and meta-analysis of prospective, population-based cohort studies on the association of serum 25-hydroxyvitamin D (25(OH)D) and all-cause mortality. Methods Relevant studies were identified by systematically searching Medline, EMBASE and ISI Web of Knowledge. Reported hazard ratios (HRs) for 25(OH)D categories were recalculated employing comprehensive trend estimation from summarized dose-response data and pooled in a random effects model meta-analysis. Results Overall, 12 original studies were included in the review and meta-analysis comprising 32,142 mainly elderly study participants with measured 25(OH)D of whom 6921 died during follow-up. An inverse association between 25(OH)D levels and all-cause mortality was found in all but two studies that was statistically significant in several of the individual studies. In meta-analysis, 25(OH)D levels were significantly inversely associated with all-cause mortality with a pooled HR of 0.92 (95% confidence interval: 0.89–0.95) for a 20 nmol/l increase in 25(OH)D levels. Conclusion In this meta-analysis of prospective, population-based cohort studies, a 20 nmol/l increase in 25(OH)D levels was associated with an 8% lower mortality in the general elderly population. This agrees with results from meta-analyses on randomized controlled trials that found a decrease in mortality with vitamin D3 supplementation of a comparable magnitude.

Background and aims Standard epidemiological measures of the risk of premature death from smoking might be unsuitable for risk communication in actual counselling situations. The rate advancement period (RAP) is an epidemiologic metric that could be useful for conveying information on the benefits of quitting. More effective risk communication could motivate older smokers to make an attempt at quitting. We provide empirical evidence on the impact of smoking, and the benefits of quitting on all-cause mortality and RAPs for people aged 60 years and older in a large cohort of older adults. Methods Smoking information was obtained from 6545 participants aged 60–74 years of ESTHER, a population-based German cohort. Cox proportional hazards regression was applied to estimate associations of smoking status, amount of smoking and time since smoking cessation with all-cause mortality. Premature mortality was quantified by RAPs. Results Current smokers had a 2.5-fold increased risk for all-cause mortality (adjusted HR: 2.53, 95% CI 2.10 to 3.03) and an RAP of 10.7 years when compared with never smokers. Strong dose-response relationships were seen with both current and life-time amount of smoking. Compared with current smokers, significant mortality reductions by 30%, 39% and 59%, and rate advancement reductions of 4.0, 5.6 and 10.0 years within Conclusions Smoking remains a strong risk factor for premature mortality, and smoking cessation remains highly beneficial also at older ages.

Smoking is an established risk factor for cardiovascular events, such as myocardial infarction, stroke and cardiovascular death. However, most pertinent studies primarily relied on middle aged adults. We aimed to provide empirical evidence on the association of smoking with cardiovascular events and the benefits of smoking cessation in people aged 50 years or older. In a German population-based cohort study detailed information on lifetime smoking history was obtained from 8,807 individuals aged 50–74 years, without previous myocardial infarction (MI) or stroke. Cox proportional hazards regression was applied to estimate the impact of smoking on MI, stroke and cardiovascular death (CVD) as well as on the combined outcome of major cardiovascular events (MI, stroke or CVD). In addition, the impact of smoking and the benefits of smoking cessation were quantified by risk advancement periods (RAP). The cohort included 17.2 % current smokers, 31.7 % former smokers and 51.1 % never smokers. During a mean follow-up of 9.1 years, 261 participants experienced a first MI, 456 had a primary stroke and 274 died of cardiovascular reasons. Compared to never smokers, adjusted hazard ratios (95 % confidence intervals) of current smokers were 2.25 (1.62–3.12), 2.12 (1.65–2.73) and 2.45 (1.76–3.42) and RAPs were 19.3, 9.8 and 8.4 years for MI, stroke and CVD, respectively. Strong dose–response relationships were seen with both current and life-time amount of smoking. Most of the excess risk and risk advancement disappeared within 5 years after smoking cessation. Smoking is a strong risk factor for cardiovascular events even at older age. Smoking cessation is highly and rapidly beneficial also at advanced age.

Standard epidemiological measures of the risk of premature death from smoking might be unsuitable for risk communication in actual counselling situations. The rate advancement period (RAP) is an epidemiologic metric that could be useful for conveying information on the benefits of quitting. More effective risk communication could motivate older smokers to make an attempt at quitting. We provide empirical evidence on the impact of smoking, and the benefits of quitting on all-cause mortality and RAPs for people aged 60 years and older in a large cohort of older adults.Smoking information was obtained from 6545 participants aged 60-74 years of ESTHER, a population-based German cohort. Cox proportional hazards regression was applied to estimate associations of smoking status, amount of smoking and time since smoking cessation with all-cause mortality. Premature mortality was quantified by RAPs.Current smokers had a 2.5-fold increased risk for all-cause mortality (adjusted HR: 2.53, 95% CI 2.10 to 3.03) and an RAP of 10.7 years when compared with never smokers. Strong dose-response relationships were seen with both current and life-time amount of smoking. Compared with current smokers, significant mortality reductions by 30%, 39% and 59%, and rate advancement reductions of 4.0, 5.6 and 10.0 years within10 years, 10-19 years and ≥20 years after cessation were found for former smokers, respectively.Smoking remains a strong risk factor for premature mortality, and smoking cessation remains highly beneficial also at older ages.

BACKGROUND Smoking is an established risk factor of premature death. However, most pertinent studies primarily relied on middle-aged adults. We performed a systematic review and meta-analysis of the empirical evidence on the association of smoking with all-cause mortality in people 60 years and older. METHODS A systematic literature search was conducted in multiple databases including MEDLINE, EMBASE, and ISI Web of Knowledge and complemented by cross-referencing to identify cohort studies published before July 2011. Core items of identified studies were independently extracted by 2 reviewers, and results were summarized by standard methods of meta-analysis. RESULTS We identified 17 studies from 7 countries. Current smoking was associated with increased all-cause mortality in all studies. Relative mortality (RM) compared with never smokers ranged from 1.2 to 3.4 across studies and was 1.83 (95% CI, 1.65-2.03) in the meta-analysis. A decrease of RM of current smokers with increasing age was observed, but mortality remained increased up to the highest ages. Furthermore, a dose-response relationship of the amount of smoked cigarettes and premature death was observed. Former smokers likewise had an increased mortality (meta-analysis: RM, 1.34; 95% CI, 1.28-1.40), but excess mortality compared with never smokers clearly decreased with duration of cessation. Benefits of smoking cessation were evident in all age groups, including subjects 80 years and older. CONCLUSIONS Smoking remains a strong risk factor for premature mortality also at older age. Smoking cessation is beneficial at any age.