Smoking and Mortality Among Women With Type 2 Diabetes
The Nurses’ Health Study cohort
- Wael K. Al-Delaimy, MD, PHD1,
- Walter C. Willett, MD, DRPH123,
- JoAnn E. Manson, MD, DRPH234,
- Frank E. Speizer, DRPH3 and
- Frank B. Hu, MD, PHD1
- 1Department of Nutrition, Harvard School of Public Health, Boston
- 2Department of Epidemiology, Harvard School of Public Health, Boston
- 3Channing Laboratory, Division of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston
- 4Division of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts
Abstract
OBJECTIVE—To assess the relationship between cigarette smoking and mortality among women with type 2 diabetes in the Nurses’ Health Study cohort.
RESEARCH DESIGN AND METHODS—The Nurses’ Health Study, a prospective cohort of U.S. female registered nurses, included 7,401 women with type 2 diabetes diagnosed at baseline or during follow-up from 1976 to 1996. Total and cause-specific mortality of these diabetic women were the outcomes of interest.
RESULTS—We documented 724 deaths during 20 years of follow-up (67,420 person-years) among women with type 2 diabetes. In multivariate analyses, adjusting for age, history of high blood pressure and high cholesterol, and other cardiovascular risk factors, compared with never smokers, the RRs of mortality were 1.31 (95% CI 1.11–1.55) for past smokers, 1.43 (0.96–2.14) for current smokers of 1–14 cigarettes/day, 1.64 (1.24–2.17) for current smokers of 15–34 cigarettes/day, and 2.19 (1.32–3.65) for current smokers of ≥35 cigarettes/day (P for trend = 0.0002). Women with type 2 diabetes who had stopped smoking for ≥10 years had a mortality RR of 1.11 (0.92–1.35) compared with diabetic women who were never smokers.
CONCLUSIONS—Cigarette smoking is associated in a dose-response manner with an increased mortality among women with type 2 diabetes. Furthermore, quitting smoking appears to decrease this excess risk substantially. Diabetes patients should be strongly advised against smoking.
- CHD, coronary heart disease
- MI, myocardial infarction
- NDDG, National Diabetes Data Group
- NHS, Nurses’ Health Study
Footnotes
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Address correspondence and reprint requests to Wael K Al-Delaimy MD, Department of Nutrition, Harvard School of Public Health, 665 Huntington Ave., Boston, MA 02115. E-mail: wael{at}hsph.harvard.edu.
Received for publication 1 March 2001 and accepted in revised form 6 September 2001.
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