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INTRODUCTION: Smoking behaviors can be quantified using various indices. Previous studies have shown that these indices measure and predict health risks differently. Additionally, the choice of measure differs depending on the health outcome of interest. We compared how each smoking index predicted all-cause mortality and assessed the goodness-of-fit of each model. METHODS: A population-based retrospective cohort, the Korea National Health Examination Baseline Cohort, was used (N=6001607). Data from 2009 were utilized, and the participants were followed until 2021. Cox proportional hazards regression analyses were performed among all participants and ever smokers, respectively, to estimate all-cause mortality. Model fit was assessed by the Akaike Information Criterion. RESULTS: For men, smoking intensity showed the strongest effect size (hazard ratio HR=1.16; 95% CI: 1.14–1.18), while pack-years provided the best model fit for all-cause mortality. Among women, smoking intensity showed both the strongest effect size (HR=1.49; 95% CI: 1.28–1.74) and the best model fit. Smoking status (never/former/current) also showed comparable effect sizes (men, HR=1.14; 95% CI: 1.13–1.15; women, HR=1.14; 95% CI: 1.11– 1.18) with fair model fit. Analyses of people who ever smoked indicated that a model incorporating smoking status, duration, and intensity best described the mortality data. CONCLUSIONS: The smoking indices showed varying effect sizes and model fits by sex, making it challenging to recommend a single optimal measure. Smoking intensity may be preferred for capturing cumulative exposure, whereas smoking status is notable for its simplicity, comparable effect size, and model fit. Further research that includes biochemical measurements, additional health outcomes, and longer follow-up periods is needed to refine these findings. [ABSTRACT FROM AUTHOR]

Introduction: This study investigated the risks for all-cause death and death from cancer or cardiovascular diseases due to smoking status and behavior, focusing on differences in smoking duration and amount stratified by sex. Methods: The integrated Korean Genome and Epidemiology Study provided data for 209770 individuals who were classified as never, former, or current smokers, based on their current smoking status. Pack-years were computed using daily average smoking amount and total smoking duration, and were categorized into quantiles separately for men and women. Based on the number of deaths in 2018, hazard ratios (HRs) were estimated for all-cause mortality, as well as for death caused by all cancers, lung cancer, and cardiovascular diseases according to pack-years adjusted for age, household income, marital status, body mass index, physical activity, and alcohol consumption. Results: A significant increase in the risk of all-cause mortality was observed for current smokers (men HR=1.90; 95% CI: 1.69–2.14; women HR=2.25; 95% CI: 1.68–2.99) and former smokers (men HR=1.31; 95% CI: 1.17–1.47; women HR=2.35; 95% CI: 1.63–3.39) compared with that for those who had never smoked. Among men, HR for death from lung cancer was 3.13 (95% CI: 2.06– 4.75) in former smokers and tended to increase with each pack-year quantile (range HR: 5.72–17.11). Among women, the HR was estimated to be 17.20 (95% CI: 6.22–47.57) only for >3rd quantile. Conclusions: Smoking increases the risks of all-cause death. Considering the persistent risks post-smoking cessation, it is vital to focus on preventing smoking initiation and providing proactive support for successful smoking cessation and maintenance of a smoke-free lifestyle. [ABSTRACT FROM AUTHOR]

Objectives: Estimating the number of deaths caused by smoking is crucial for developing and evaluating tobacco control and smoking cessation policies. This study aimed to determine smoking-attributable mortality (SAM) in Korea in 2020., Methods: Four large-scale cohorts from Korea were analyzed. A Cox proportional-hazards model was used to determine the hazard ratios (HRs) of smoking-related death. By conducting a meta-analysis of these HRs, the pooled HRs of smoking-related death for 41 diseases were estimated. Population-attributable fractions (PAFs) were calculated based on the smoking prevalence for 1995 in conjunction with the pooled HRs. Subsequently, SAM was derived using the PAF and the number of deaths recorded for each disease in 2020., Results: The pooled HR for all-cause mortality attributable to smoking was 1.73 for current men smokers (95% confidence interval [CI], 1.53 to 1.95) and 1.63 for current women smokers (95% CI, 1.37 to 1.94). Smoking accounted for 33.2% of all-cause deaths in men and 4.6% in women. Additionally, it was a factor in 71.8% of men lung cancer deaths and 11.9% of women lung cancer deaths. In 2020, smoking was responsible for 53 930 men deaths and 6283 women deaths, totaling 60 213 deaths., Conclusions: Cigarette smoking was responsible for a significant number of deaths in Korea in 2020. Monitoring the impact and societal burden of smoking is essential for effective tobacco control and harm prevention policies.