Journal Article

Chronic Disease Mortality in a Cohort of Smokeless Tobacco Users

Neil A. Accortt, John W. Waterbor, Colleen Beall and George Howard

in American Journal of Epidemiology

Published on behalf of Johns Hopkins Bloomberg School of Public Health

Volume 156, issue 8, pages 730-737
Published in print October 2002 | ISSN: 0002-9262
Published online October 2002 | e-ISSN: 1476-6256 | DOI:
Chronic Disease Mortality in a Cohort of Smokeless Tobacco Users

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The purpose of this study was to characterize the relation between smokeless tobacco use and the risk of all-cause and disease-specific mortality. Using data from the First National Health and Nutrition Examination Survey Epidemiologic Followup Study, the authors assessed the 20-year mortality experience of smokeless tobacco users. Subjects aged 45 years or more at baseline (1971–1975) were categorized as either smokeless tobacco users (n = 1,068) or non-smokeless tobacco users (n = 5,737). Subjects were further stratified by smoking status and gender. Proportional hazard ratios were used to assess associations. After adjustment for confounders, no association between smokeless tobacco use and all-cause (hazard ratio = 1.1, 95% confidence interval (CI): 0.9, 1.3), all cancer (hazard ratio = 1.1, 95% CI: 0.6, 1.9), or all cardiovascular (hazard ratio = 1.1, 95% CI: 0.8, 1.5) mortality was found. There was an increase in all cancer mortality of borderline significance among female smokeless tobacco users (hazard ratio = 1.7, 95% CI: 1.0, 2.8). The lung cancer mortality rate among combined users (smokeless tobacco and cigarettes), based on the rates for exclusive smokeless tobacco users and exclusive smokers, was higher than expected, possibly because of heavier smoking among these subjects. The mortality experience of smokeless tobacco users was not significantly greater than that of non-tobacco users and was appreciably less than that of cigarette smokers. Furthermore, combined use of smokeless tobacco and cigarettes did not increase overall mortality beyond that expected from use of the individual products.

Keywords: cardiovascular diseases; mortality; neoplasms; tobacco, smokeless; Abbreviations: CI, confidence interval; ICD-9, International Classification of Diseases, Ninth Revision; NHANES I, First National Health and Nutrition Examination Survey; NHEFS, NHANES I Epidemiologic Followup Study.

Journal Article.  5946 words. 

Subjects: Public Health and Epidemiology

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