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Published on: October 22, 2020
The Risks of Mortality, Cardiovascular Events, and Pulmonary Complications in Cancer Patients Who Smoke Cigarettes
Danbee Kang1, Hea Lim Choi1, Hyunsoo Kim1
1Danbee Kang, Hea Lim Choi, Hong Kwan Kim, and Dong Wook Shin are with the Trend Sensing & Risk Modeling Center, Institution of Cancer Quality of Life, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Hyunsoo Kim and Juhee Cho are with the Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University, Seoul.
Abstract:
Objectives. To evaluate the risks of mortality, cardiovascular events, and pulmonary complications among cancer patients who quit, continued smoking, or switched to e-cigarettes after diagnosis. Methods. Using the Korean National Health Insurance Service database (2015-2022), we identified 46 834 cancer patients who were smoking at diagnosis. Patients were categorized as continued smokers (n = 17 418), quitters (n = 25 909), or e-cigarette users (n = 3507) after diagnosis. We used multivariable Cox proportional hazards models to assess associations. Results. During a median 4.2 years of follow-up, all-cause mortality was significantly lower in quitters (hazard ratio [HR] = 0.92; 95% confidence interval [CI] = 0.86, 0.98) and e-cigarette users (HR = 0.84; 95% CI = 0.72, 0.99) than continued smokers. Both groups also showed lower cardiovascular event risks (HR = 0.64; 95% CI = 0.57, 0.72 and HR = 0.72; 95% CI = 0.53, 0.97, respectively). Compared with quitters, e-cigarette users had increased pulmonary complication risk (HR = 1.26; 95% CI = 1.00, 1.58). Conclusions. E-cigarette use was associated with lower mortality and cardiovascular risks than continued smoking, though complete cessation conferred greater benefits. Elevated pulmonary complications in e-cigarette users warrant caution. (Am J Public Health. Published online ahead of print July 2, 2026:e1-e12. https://doi.org/10.2105/AJPH.2026.308512).
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