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

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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.