UNDERLYING AND MULTIPLE CAUSES OF DEATH RELATED TO SMOKING

Although smoking has been linked to various causes of death, there is no systematic account of the underlying and multiple cause-of-death di stributions associated with various smoking statuses. We analyze such patterns by age and gender for the USA in 1986. Our study is based on a one-percent random sample of decedents 25 and over in the USA for wh om survey data from informants were linked to death certificate data. Smoking is related to several underlying causes of death, the most com mon being circulatory diseases. Lung cancer is less prevalent than cir culatory diseases or other cancers among ever smokers. Multiple medica l conditions are common for both smokers and nonsmokers, but particula r combinations vary among persons with different smoking statuses. For mer smokers who quit soon before death and were under frequent medical care are most likely to have had lung cancer. Amount of smoking is ti ed to variations in cause-of-death patterns. Differences by age and ge nder are not substantial, although other cancers appear frequently for both smokers and non-smokers among women. The distribution of medical causes of death for ever smokers is not radically different from that of never smokers. However, differences in cause patterns are seen whe n smoking statuses are detailed by amount of smoking and timing of qui tting. These similarities and differences in cause patterns must be re lated to the fundamental fact that the average smoker will die earlier than the average nonsmoker. Such findings should especially influence programs for diseases whose links to smoking have been underestimated .