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
.