Elsevier

Preventive Medicine

Volume 28, Issue 3, March 1999, Pages 255-259
Preventive Medicine

Regular Article
Might Stopping Smoking Reduce Injury Death Risks? A Meta-analysis of Randomized, Controlled Trials,☆☆

https://doi.org/10.1006/pmed.1998.0412Get rights and content

Abstract

Background.Smokers have excesses of injuries. Randomized, controlled trials (RCT) could assess whether cigarette smoking (smoking) causes (and smoking cessation (cessation) prevents) those injuries. We analyzed injury, accident, suicide, and homicide deaths as secondary endpoints in RCT that induced cessation.

Methods.RCT were sought via MEDLINE, bibliographies, the CDC Smoking and Health database, and the GLOBALink Tobacco listserver. RCT were included if (1) net (intervention minus control) cessation totaled over 10% of all intervention smokers and (2) injury data were available. Relative risks (RR) were summarized by fixed effects modeling.

Results.Three trials were located (the Lung Health Study, MRFIT, and Whitehall RCT). In-trial annual point prevalence cessation averaged 41, 46, and 59% in the intervention group smokers versus 17, 22, and 28% in the respective controls. Intervention (cessation) was associated with pooled injury RR of 0.65 within the trials (95% confidence interval (CI) 0.36–1.19) and 0.68 (95% CI 0.43–1.09) with additional follow-up in the Lung Health and MRFIT populations.

Conclusions.The smoking/injury death association is of borderline statistical significance in currently available RCT data. It modestly supports the significant forensic, cohort, case-control, cross-sectional, challenge–rechallenge,in vitro, and animal data suggesting that smoking may cause injury. Direct tests of the hypothesis could strengthen this inference.

References (42)

  • R Doll et al.

    Mortality in relation to smoking: 40 years' observations on male British doctors

    BMJ

    (1994)
  • RevMan 3.1. 3.1 ed, Oxford, UK, Cochrane Collaboration,...
  • G Rose et al.

    A randomised controlled trial of anti-smoking advice: 10-year results

    J Epidemiol Community Health

    (1982)
  • JAMA

    (1982)
  • NR Anthonisen et al.

    Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1. The Lung Health Study [see comments]

    JAMA

    (1994)
  • MF Muldoon et al.

    Lowering cholesterol concentrations and mortality: a quantitative review of primary prevention trials [see comments]

    BMJ

    (1990)
  • TE Strandberg et al.

    Long-term mortality after 5-year multifactorial primary prevention of cardiovascular diseases in middle-aged men [see comments]

    JAMA

    (1991)
  • S Ebrahim et al.

    Systematic review of randomised controlled trials of multiple risk factor interventions for preventing coronary heart disease

    BMJ

    (1997)
  • L Wilhelmsen et al.

    The multifactor primary prevention trial in Goteborg, Sweden

    Eur Heart J

    (1986)
  • Eur Heart J

    (1982)
  • Cited by (0)

    We acknowledge helpful comments from Dr. Ellen Gold and assistance from Kyle Noderer. This paper uses data supplied by the U.S. National Heart, Lung, and Blood Institute, NIH, DHHS. The views expressed in this paper are those of the authors and do not necessarily reflect the views of the National Heart, Lung, and Blood Institute.

    ☆☆

    Financial support from the Departments of Epidemiology and Preventive Medicine, Employee Health, and Internal Medicine, University of California, Davis (B.N.L.) and from the British Heart Foundation (M.J.S.) is acknowledged.

    2

    To whom reprint requests should be addressed at 1 Shields Av., TB 168, Department of Epidemiology and Preventive Medicine, University of California, Davis, CA 95616-8638. Fax: 916/752-3239. E-mail:[email protected].

    View full text