The effect of smoking intensity on all-cause and cause-specific mortality: – a Mendelian randomisation analysis

Gunnhild Åberge Vie*, Robyn E. Wootton, Johan Håkon Bjørngaard, Bjørn Olav Åsvold, Amy E. Taylor, Maiken Elvestad Gabrielsen, George Davey Smith, Pål Richard Romundstad, Marcus R. Munafò

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

8 Citations (Scopus)
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Smoking is an important cause of mortality and recent studies have suggested that even low-intensity smoking might be associated with increased mortality. Still, smoking is associated with lower socio-economic status as well as other potential risk factors, and disease onset might motivate smoking cessation, thus residual confounding and reverse causality might bias results. We aimed to assess the evidence of a causal relationship between smoking intensity and cause-specific as well as all-cause-mortality using Mendelian randomization analyses.
MethodsWe included 56 019 participants from the Norwegian HUNT2 Study and 337 103 participants from UK Biobank, linked to national registry data on causes of death. We estimated associations of self-reported smoking as well as the genetic variant rs1051730 as an instrument for smoking intensity with all-cause and cause-specific mortality. We subsequently meta-analysed the results from the two cohorts.
ResultsEach effect allele of the rs1051730 was associated with a 9% increased hazard of all-cause mortality [95% confidence interval (CI) 6–11] among ever smokers. Effect alleles were also associated with death by neoplasms [hazard ratio (HR) 1.11, 95% CI 1.06–1.15], circulatory diseases (HR 1.06, 95% CI 1.01–1.11) and respiratory diseases (HR 1.15, 95% CI 1.05–1.26) among ever smokers. The association was stronger among ever than never smokers for all-cause mortality (p < 0.001), neoplasms (p = 0.001) and respiratory diseases (p = 0.038).
ConclusionsOur results indicate a causal effect of smoking intensity on all-cause mortality and death by neoplasms and respiratory diseases. There was weaker evidence of a causal effect of smoking intensity on death by circulatory diseases.
Original languageEnglish
Article numberdyz081
Pages (from-to)1438-1446
Number of pages9
JournalInternational Journal of Epidemiology
Issue number5
Publication statusPublished - 10 May 2019

Structured keywords

  • Brain and Behaviour
  • Tobacco and Alcohol
  • Physical and Mental Health


  • genetic variation
  • cigarette smoking
  • cause of death
  • epidemiology
  • alleles
  • Respiration disorders
  • genetics
  • mortality
  • neoplasms
  • self-report
  • biobanks
  • mendelian randomization analysis
  • smokers


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