As individuals increase the number of cigarettes smoked per day, health-related quality of life tends to deteriorate, according to a study published in the October issue of Archives of Internal Medicine. Researchers also found that health-related quality of life decreased even in people who eventually quit smoking.

Previous studies have shown that smoking can reduce a man’s life by seven to 10 years. In addition, the activity has been associated with poorer nutrition, lower socioeconomic status, and other factors that can reduce quality of life.

To investigate smoking’s effects on quality of life, Arto Y. Strandberg, M.D. (University of Helsinki) and colleagues studied 1,658 white men who were born between 1919 and 1934. The men were considered healthy during an assessment in 1974 and received follow-up surveys in 2000 that asked about their current smoking status, health, and quality of life. The researchers used the Finnish national register to track deaths in the sample.

By the year 2000, 22.4% (372 men) had died. Heavy smokers – those who consumed more than 20 cigarettes per day – lived about 10 years less than never-smokers. Participants who never smoked had the best scores on all health-related quality of life measures and the highest scores on measures associated with physical functioning. As the number of cigarettes smoked per day increased, physical health became worse at an increasing rate. Further, heavy smokers experienced a decline in physical health that is similar to 10 years of aging.

“Although many smokers had quit smoking between the baseline investigation in 1974 and the follow-up examination in 2000, the effect of baseline smoking status on mortality and the quality of life in old age remained strong,” write Strandberg and colleagues. “In all, the results presented here are troubling for those who were smoking more than 20 cigarettes daily 26 years earlier; in spite of the 68.9 percent cessation rate during follow-up, 44.1 percent of the originally heavy smokers had died, and those who survived to the mean [average] age of 73 years had a significantly lower physical health-related quality of life than never-smokers.”

The researchers hope that while encouraging smokers to stop the habit, their results might also highlight the public health implications of smoking. They write that, “The argument of better quality of life may be especially meaningful for the aging smoker but, as our results show, for the best health-related quality of life, the habit should not be started at all.”

“The highly addictive nature of nicotine is revealed by the persistence of the smoking habit in spite of the declining health-related quality of life among older heavy smokers. For those not able to quit smoking, reduction may also be beneficial because mortality and health-related quality of life showed a dose-dependent trend according to the number of cigarettes smoked daily,” conclude Strandberg and colleagues.

In an accompanying editorial, David M. Burns, M.D., (Del Mar, California) writes that, “Smoking remains the largest avoidable cause of death and disability in the United States, but it is a problem against which we are making steady albeit far too slow progress.”

He concludes by emphasizing that, “Smoking cessation is one of the most important changes needed to achieve the goal so often articulated by Dr. Ernst Wynder, one of the founders of the field of preventive medicine: die young as late in life as possible.”

The Effect of Smoking in Midlife on Health-Related Quality of Life in Old Age: A 26-Year Prospective Study
Arto Y. Strandberg; Timo E. Strandberg; Kaisu Pitkälä; Veikko V. Salomaa; Reijo S. Tilvis; Tatu A. Miettinen
Archives of Internal Medicine (2008). 168(18):1968-1974.
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Written by: Peter M Crosta