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A 26-Year Prospective Study

Arto Y. Strandberg, MD; Timo E. Strandberg, MD, PhD; Kaisu Pitkälä, MD, PhD; Veikko V. Salomaa, MD, PhD; Reijo S. Tilvis, MD, PhD; Tatu A. Miettinen, MD, PhD

Arch Intern Med. 2008;168(18):1968-1974.

Background  Smoking shortens life expectancy by 7 to 10 years. However, it is unclear whether the enhanced longevity of nonsmokers produces increased disability and decreased quality of life during these extra final years. This study evaluates the long-term effect of smoking in midlife on health-related quality of life (HRQoL) in old age.

Methods  Prospective cohort study with a 26-year follow-up of 1658 white men (born 1919-1934) of similar socioeconomic status who were participating in the Helsinki Businessmen Study. All men were healthy at baseline in 1974, when cardiovascular risk factors and smoking habits were assessed. The participants were reevaluated with the use of mailed questionnaires in 2000; HRQoL was measured with the use of the RAND 36-Item Health Survey (similar to the Medical Outcomes Study Short-Form Health Survey) and related to the baseline smoking status. Total mortality through 2000 was determined from Finnish national registers.

Results  Participants who had never smoked (n = 614) lived a mean of 10 years longer than heavy smokers (>20 cigarettes daily; n = 188). Among survivors in 2000 (n = 1131), the never-smokers had the highest (ie, best) scores on all RAND 36-Item Health Survey scales. The differences were greatest between never-smokers and heavy smokers, ranging from 4 points on the scale of social functioning to 14 points on the physical functioning scale. The physical component summary score showed a graded deterioration of HRQoL with an increasing number of cigarettes smoked daily (P = .01).

Conclusions  During the 26-year follow-up of this socioeconomically homogeneous male cohort, HRQoL deteriorated with an increase in daily cigarettes smoked in a dose-dependent manner. Never-smokers lived longer than heavy smokers, and their extra years were of better quality.

Author Affiliations: Geriatric Clinic, Department of Medicine, University of Helsinki (Drs A. Y. Strandberg, Pitkälä, Tilvis, and Miettinen), and National Public Health Institute (Dr Salomaa), Helsinki, Finland; and Department of Health Sciences/Geriatrics, University of Oulu, and Unit of General Practice, Oulu University Hospital, Oulu, Finland (Dr T. E. Strandberg).

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