BMJ 1995;311:1530-1533 (9 December)

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Mortality in relation to tar yield of cigarettes: a prospective study of four cohorts

Jin-Ling Tang, research fellow,a Joan K Morris, statistician,a Nicholas J Wald, professor,a David Hole, principal epidemiologist,b Martin Shipley, statistician,c Hugh Tunstall-Pedoe, professor d

a Department of Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, St Bartholomew's Hospital Medical College, London EC1M 6QB, b West of Scotland Cancer Surveillance Unit, Greater Glasgow Health Board, Ruchill Hospital, Glasgow G20 9NB, c Department of Epidemiology and Public Health, University College London Medical School, London WC1E 6BT, d Cardiovascular Epidemiology Unit, Ninewells Hospital and Medical School, Dundee DD1 9SY

Correspondence to: Professor Wald.

Abstract

Objective: To investigate relation between tar yield of manufactured cigarettes and mortality from smoking related diseases.
Design: Prospective epidemiological study of four cohorts of men studied between 1967 and 1982.
Setting: Combined data from British United Provident Association (BUPA) study (London), Whitehall study (London), Paisley-Renfrew study (Scotland), and United Kingdom heart disease prevention project (England and Wales).
Subjects: Of the 56255 men aged over 35 who were included in the studies, 2742 deaths occurred among 12400 smokers. Average follow up was 13 years.
Main outcome measures: Relative mortality from smoking related diseases according to tar yields of cigarettes smoked.
Results: Age adjusted mortality from smoking related diseases in smokers of filter cigarettes was 9% lower (95% confidence interval 1% to 17%) than in smokers of plain cigarettes (P=0.047). Mortality from smoking related diseases consistently decreased with decreasing tar yield. Relative mortality in cigarette smokers for a 15 mg decrease in tar yield per cigarette was 0.75 (0.52 to 1.09) for lung cancer, 0.77 (0.61 to 0.97) for coronary heart disease, 0.86 (0.50 to 1.50) for stroke, 0.78 (0.40 to 1.48) for chronic obstructive lung disease, 0.78 (0.65 to 0.93) for these smoking related diseases combined, and 0.77 (0.65 to 0.90) for all smoking related diseases.
Conclusion: About a quarter of deaths from lung cancer, coronary heart disease, and possibly other smoking related diseases would have been avoided by lowering tar yield from 30 mg per cigarette to 15 mg. Reducing cigarette tar yields in Britain has had a modest effect in reducing smoking related mortality.

Key messages

  • Key messages

  • We used data from four large British cohort studies to investigate effect of lowering tar yield on smoking related diseases

  • Mortality from smoking related diseases was reduced by about 23% for a reduction in tar yield of 15 mg per cigarette

  • Mortality from ischaemic heart disease was also reduced by 23%, and mortality from lung cancer was reduced by 25%

  • Britain's policy of reducing the tar yield of cigarettes has been associated with modest benefits, but these benefits are much less than that associated with stopping smoking completely


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