What determines mortality risk in male former cigarette smokers?

OBJECTIVES. The purpose of this study was to examine what factors determine the mortality experience of male ex-cigarette smokers, those who no longer smoke at all and those who changed to pipe or cigar smoking. METHODS. A cohort study was undertaken with 18-year mortality data on 19,018 men. RESULTS. Ex-cigarette smokers had an intermediate mortality risk compared with never and current smokers. Ex-cigarette smokers who switched to pipe smoking had higher mortality than those who no longer smoked at all. The mortality rates for pipe and cigar smokers who were former cigarette smokers were higher than those for pipe or cigar smokers who had never smoked cigarettes. Ex-cigarette smokers who consumed more than 20 cigarettes per day for more than 20 years experienced increased mortality for both coronary heart disease and neoplasms, even after 30 years of cessation. CONCLUSIONS. These results support the notion that an elevated mortality risk may be seen for ex-cigarette smokers, even after they have given up smoking for many years. Ex-cigarette smokers who change to a pipe have a greater mortality risk than those who no longer smoke at all.