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Studies on Smoking and Mortality Rates

The mortality among the current individuals who smoke is 2 to 3 times higher as compared to individuals who do not smoke. The majority of the superfluous death is argued to be elucidated by various diseases that are triggered by cigarette smoking and are incorporated in the official approximations of smoking-attributable mortality (Aungkulanon et al., 2019). Conversely, if smoking cigarettes are attributed to additional diseases, the official death estimates might be undermined. For the high-income states, the leading cause of premature death is connected to smoking manufactured cigarettes (Drope et al., 2018). The smoking-related diseases have been linked to 41 million deaths in Canada, the UK, and the US. Additionally, up to two-thirds of deaths experienced among smokers are avoidable.

The clinical question was, "if smoking increases the mortality rates as compared to non-smokers in the period of two years". The clinical question was formulated due to various debates on how the diseases linked to smoking increase the mortality rates among individuals from different states. The researchers will compare various studies and research conducted in the past years. The Cumulative Index to Nursing and Allied Health Literature (CINAHL) was searched to do this. Other databases that was searched included PubMed, Googlescholar, MCD and MeSH. Some of the MeSH terms used included smoking, diseases related to smoking, smoking and mortality rates, mortality, and smoking variables. The search limits were further used to enable the researchers to narrow down the search. Only the articles with the keywords and title searchers were selected to do this. Besides, the articles that were not linked to smoking and mortality rates were eliminated from the search. Additionally, those that showed some bias were removed. After the search,  there was ten studies that was effective for the research.a


Study Design


Major findings

Strength and Limitations

Kim et al., (2018)

Systematic literature review

The total number of non-smokers  in the cancer control groups and the number of unadjusted odds ratios of individuals exposed to second-hand smoke were recorded

Second-hand smoking was determined to be harmful and a risk factor to the health of individuals. It is linked to cancer, which is among the leading cause of deaths

A strength of the study is it used a meta-analysis literature review.

A limitation of the study is the studies had different main heterogenic.

Carter et al., (2015)

Cohort studies

421, 378 men and 532, 651 women aged 55 years and above.

A significant number of the current smokers were linked to diseases that have been associated  with deaths

A strength of the study is it used a large size that allowed it to examine cases of death

A limitation of the study is the majority of participants were white.

Banks et al., (2015)

Prospective study

204, 953 individuals aged above 45 years sampled from New South Wales, Australia

Deaths among individuals were linked to smoking.

A strength of the study is it provides long-term effects of smoking

A limitation of the study is that it is restricted to New South Wales, Australia

Amere et al., (2018)

Cross-sectional data

Adult males and females aged 15 and above

Tobacco is linked to increased cases of TB

A strength of the study is tobacco control policies were used

A limitation of the study was it relied on data collected from WHO

Aungkulanon et al., (2019)

Markov chain model

Smoking prevalence, and initiation rate were collected from recent smoking and drinking behavior

Smoking is linked to increased mortality

A strength of the study is it used Markov chain

A limitation of the study was results were underestimated

Drope et al., (2018)

Search terms

Articles that were evidence-based were collected

Tobacco has adverse impacts on health of individuals

A strength of the study is competence was determined

Kim et al. (2018) argue that secondhand smoke is often viewed as harmful to health and the environmental risks factors in terms of public health. There is also a lack of meta-analysis of its impacts on the increase of cancer among humans. Tobacco is linked to being a primary cause of cancer. It has resulted in the exposure of about 7000 kinds of chemicals and about 70 types of carcinogens like chloroethene and nitrosamine. With such elements, the typical carcinogens like nitrosamine are activated metabolically through the cytochrome P-450 enzymes and their metabolites combined with the DNA (Teng et al., 2020). Secondhand smoking is also grouped as the mainstream smoke that the smoker exhales after inhaling smoke that comes directly from the cigarette's tip. The sidestream smoke is further connected to about 80% of secondhand smoke. Sidestream smoke is further believed to have benzopyrene, which has been demonstrated to be a significant cause of skin cancer. The authors further argue that secondhand smoking is linked to the onset of cancer. Perveiousmet analyses have proved that non-smoking spouses have increased risks of developing lung cancer. Generally, cancer is among the leading cause of mortality rates across the globe.

Carter et al. (2015) argue that smokers who participated in the study had increased risks of death from each cause established and were linked to smoking-related diseases. In regards to the analysis of the diseases which are not currently determined as the leading cause of smoking. Additionally, male smokers were reported to have higher risks of death from prostate cancer, whereas female smokers were linked to increased risk rates of breast cancer (Carter et al., 2015)s. The relative risks for the other causes linked to smoking were the same for both men and women (Carter et al., 2015). The current smoking was further connected to a higher risk of death mainly triggered by infections caused by smoking cigarettes. The risks rise as the number of cigarettes smoked daily increases in case of mortality from contaminations. Based on the current smokers, the comparative risks for each disease except for the liver cirrhosis decreased with the years since cessation. The rates of death from renal failure were reported to be as high among the current smokers compared to the individuals who do not smoke. Smoking is an essential trigger of the cardiovascular risk factors for renal failure, which may openly damage the functioning of the kidney. Such aspects also applied to the patients without the underlying cardiovascular and urinary albumin. The current smoking was linked to increased mortality rates caused by hypertensive heart disease, the only group of the heart disease that is not formally recognized as being caused by smoking. The procedures for ascribing the death from heart disease to hypertensive heart disease have not yet been linked to smoking. Hypertensive heart disease can further be connected to a higher risk of death.

Impact of Secondhand Smoking on Health

Banks et al. (2015) showed that the death rates among the current smokers were three times more compared to individuals who did not smoke for both genders. Averagely, smokers mainly die ten years earlier as compared to those who never smoke. The mortality rates further increased significantly with the increase in the intensity of smoking, with the rates about bing double for those who smoke about 25 cigarettes on a daily basis. The researchers further argue that cessation of smoking had significant benefits compared to those who decided to continue smoking. Generally, the study demonstrated significant impacts of heavy and lengthy smoking of cigarettes. About 12% of participants aged 45 and over were approximated to be present smokers by the time they were 45 (Banks et al., 2015). The findings from the study were similar to those of the current risks of smoking in both the US and the UK, where RR smokers were more vulnerable to death rates. The revolution of the increased smoking that was attributed to smoking was effectively documented. The Relative Risk (RR) of all the causes of death in the existing versus the non-smokers was about 1.4 to 1.8 in the 1960s. The rates significantly increased over the years. Compared to the current studies estimates of both the UK and the US, such studies demonstrate that up to two-thirds of mortality among smokers in the 21st century are linked to smoking. The significant upsurge in RRs has been linked to the early beginning of smoking and better smoking strength among the consecutive birth associates, accompanied by a reduction in mortality rates among individuals who have never smoked (Amere et al., 2018). Among the participants, the mortality rates experienced during the follow-up era significantly upsurges with the increase in the number of smokes that one took on a daily basis. The mortality rates were further higher among women as compared to men. Besides, smokers have increased risks of myocardial infarction as compare to non-smokers as the odd ratios that comes out to be approximately 3.71 which is crucial. Additionally, smoking is considered to be harmful when it comes to illnesses like heart disease because of the constituents of the tobacco smoke. The chemicals in the cigarettes smoke often results in thickening of blood and form clots inside the arteries and veins. The blockage from a clot is responsible for heart attack and sudden deaths.

To identify the existing gap, the Sample, Phenomenon of Interest, Design, Evaluation, Research Type ( SPIDER) methodology will be used.  There is a need for more studies to be conducted in order to present the actual number of deaths caused by smoking. Based on the presented articles, the number of deaths is not identified. In the research presented by Banks et al. (2015), the number of deaths caused by smoking was not determined and presented. Therefore, to identify the actual impacts on the population, there is a need to present the actual data and the number of deaths. 


The increased risks of cardiovascular diseases, respiratory disease, and a wide variety of illnesses increased the number of tobacco smokers. With connected consequences, smokers are at a higher risk of dying prematurely. Smoking is associated with the cause of mortality and morbidity in each state across the globe. It is next to high blood pressure as a risk factor for the universal disease burden. The relative risks of the negative health impacts rise with the upsurge in smoking intensity, dignified by the amount of tobacco that individuals smoke daily. The deaths can be linked to the various diseases that smoking has on individuals' health. 


Amere, G. A., Nayak, P., Salindri, A. D., Narayan, K. M., & Magee, M. J. (2018). Contribution of smoking to tuberculosis incidence and mortality in high-tuberculosis-Burden countries. American Journal of Epidemiology, 187(9), 1846-1855.

Aungkulanon, S., Pitayarangsarit, S., Bundhamcharoen, K., Akaleephan, C., Chongsuvivatwong, V., Phoncharoen, R., & Tangcharoensathien, V. (2019). Smoking prevalence and attributable deaths in Thailand: Predicting outcomes of different tobacco control interventions. BMC Public Health, 19(1).

Banks, E., Joshy, G., Weber, M. F., Liu, B., Grenfell, R., Egger, S., Paige, E., Lopez, A. D., Sitas, F., & Beral, V. (2015). Tobacco smoking and all-cause mortality in a large Australian cohort study: Findings from a mature epidemic with current low smoking prevalence. BMC Medicine, 13(1).

Carter, B. D., Abnet, C. C., Feskanich, D., Freedman, N. D., Hartge, P., Lewis, C. E., Ockene, J. K., Prentice, R. L., Speizer, F. E., Thun, M. J., & Jacobs, E. J. (2015). Smoking and mortality — Beyond established causes. New England Journal of Medicine, 372(7), 631-640.

Drope, J., Liber, A. C., Cahn, Z., Stoklosa, M., Kennedy, R., Douglas, C. E., Henson, R., & Drope, J. (2018). Who's still smoking? Disparities in adult cigarette smoking prevalence in the United States. CA: A Cancer Journal for Clinicians, 68(2), 106-115.

Kim, A., Ko, H., Kwon, J., & Lee, J. (2018). Exposure to secondhand smoke and risk of cancer in never smokers: A meta-analysis of epidemiologic studies. International Journal of Environmental Research and Public Health, 15(9), 1981.

Teng, A., Blakely, T., Atkinson, J., Kal?dien?, R., Leinsalu, M., Martikainen, P. T., Rychta?íková, J., & Mackenbach, J. P. (2020). Changing social inequalities in smoking, obesity and cause-specific mortality: Cross-national comparisons using compass typology. PLOS ONE, 15(7), e0232971. 

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