Table 2 Strength of the evidence for the relationship between current smoking and the 36 health outcomes analyzed

From: Health effects associated with smoking: a Burden of Proof study

Risk–outcome pair

Risk unit

Mean risk at different exposure levels

85th percentile risk level

Mean risk at 85th percentile risk level

ROSs

Average BPRF

Average increased risk (%)

Star rating

Pub. bias

No. of studies

5

10

20

40

Laryngeal cancer

Pack-years

2.30 (1.88, 2.84)

3.77 (2.73, 5.30)

7.25 (4.48, 12.05)

14.62 (7.62, 29.11)

50.50

17.73 (8.82, 37.07)

1.56

4.75

374.95

5

0

5

Aortic aneurism (ref. age: 55–59 years)

Cigarettes per day

2.52 (1.79, 3.60)

3.78 (2.31, 6.33)

5.39 (2.89, 10.36)

6.22 (3.17, 12.64)

30.00

6.08 (3.13, 12.27)

0.92

2.50

149.73

5

0

14

Peripheral artery disease (ref. age: 60–64 years)

Cigarettes per day

2.52 (1.67, 3.90)

3.80 (2.10, 7.14)

5.69 (2.62, 12.94)

7.82 (3.13, 20.68)

31.25

7.16 (2.98, 18.16)

0.86

2.37

136.53

5

0

6

Lung cancer

Pack-years

1.58 (1.19, 2.15)

2.48 (1.40, 4.53)

5.11 (1.84, 14.99)

11.62 (2.49, 58.73)

50.88

13.42 (2.63, 74.59)

0.73

2.07

106.66

5

1

78

Other pharynx cancer

Pack-years

1.65 (1.30, 2.13)

2.20 (1.51, 3.30)

3.02 (1.77, 5.30)

3.89 (2.02, 7.78)

63.75

4.72 (2.24, 10.45)

0.65

1.92

92.26

5

0

8

COPD

Pack-years

1.61 (1.21, 2.17)

2.16 (1.37, 3.51)

3.17 (1.60, 6.55)

5.05 (1.94, 13.97)

49.75

6.01 (2.08, 18.58)

0.54

1.72

72.11

4

1

13

Lower respiratory infection

Cigarettes per day

1.46 (1.23, 1.76)

1.83 (1.38, 2.46)

2.63 (1.68, 4.23)

2.97 (1.79, 5.06)

31.25

2.97 (1.79, 5.06)

0.43

1.54

54.45

4

0

7

Pancreatic cancer

Pack-years

1.26 (1.22, 1.31)

1.47 (1.38, 1.57)

1.72 (1.57, 1.88)

1.80 (1.63, 1.98)

51.25

1.87 (1.69, 2.08)

0.42

1.52

51.66

4

0

19

Bladder cancer

Pack-years

1.21 (1.08, 1.36)

1.43 (1.16, 1.77)

1.90 (1.31, 2.81)

2.92 (1.57, 5.63)

50.65

3.29 (1.65, 6.83)

0.34

1.40

40.18

3

1

30

Tuberculosis

Cigarettes per day

1.46 (1.13, 1.92)

1.88 (1.22, 2.97)

2.71 (1.38, 5.56)

3.47 (1.49, 8.50)

26.56

3.24 (1.46, 7.56)

0.27

1.31

31.04

3

0

19

Esophageal cancer

Pack-years

1.24 (1.06, 1.46)

1.48 (1.11, 2.00)

1.96 (1.20, 3.32)

3.12 (1.36, 7.57)

50.00

4.79 (1.53, 16.26)

0.26

1.29

29.36

3

1

14

Cervical cancer

Pack-years

1.60 (1.12, 2.35)

1.99 (1.18, 3.48)

2.37 (1.23, 4.79)

2.62 (1.26, 5.72)

25.50

2.53 (1.25, 5.36)

0.21

1.24

23.53

3

0

4

Multiple sclerosis

Cigarettes per day

1.14 (1.10, 1.17)

1.31 (1.23, 1.40)

1.78 (1.55, 2.06)

2.77 (2.17, 3.60)

20.00

1.78 (1.55, 2.06)

0.21

1.23

23.36

3

0

6

Rheumatoid arthritis

Cigarettes per day

1.20 (1.10, 1.31)

1.40 (1.20, 1.66)

1.67 (1.31, 2.14)

1.73 (1.34, 2.26)

26.25

1.72 (1.34, 2.25)

0.21

1.23

23.32

3

1

6

Lower back pain

Cigarettes per day

1.58 (1.11, 2.28)

1.96 (1.16, 3.39)

2.26 (1.20, 4.40)

2.29 (1.21, 4.50)

26.25

2.29 (1.21, 4.49)

0.20

1.22

21.84

3

0

6

Ischemic heart disease

(ref. age: 55–59 years)

Cigarettes per day

1.66 (1.09, 2.57)

2.12 (1.14, 4.1)

2.43 (1.17, 5.27)

4.20 (1.28, 14.77)

31.25

3.13 (1.22, 8.50)

0.19

1.20

20.39

3

1

60

Peptic ulcer

Cigarettes per day

1.47 (1.11, 1.97)

1.79 (1.17, 2.80)

2.10 (1.22, 3.73)

2.16 (1.23, 3.92)

21.94

2.12 (1.22, 3.80)

0.18

1.20

19.84

3

0

7

Macular degeneration

Cigarettes per day

1.33 (1.07, 1.69)

1.67 (1.12, 2.54)

2.23 (1.20, 4.31)

2.42 (1.22, 5.01)

27.50

2.41 (1.22, 4.99)

0.18

1.19

19.44

3

0

2

Parkinson's disease

(protective risk)

Cigarettes per day

0.79 (0.66, 0.93)

0.65 (0.47, 0.88)

0.54 (0.34, 0.84)

0.49 (0.29, 0.81)

26.25

0.51 (0.31, 0.83)

0.16

0.85

−14.88

3

1

14

Stomach cancer

Pack-years

1.10 (1.06, 1.15)

1.18 (1.10, 1.27)

1.29 (1.16, 1.44)

1.39 (1.22, 1.60)

51.13

1.61 (1.32, 1.97)

0.16

1.17

17.39

3

1

13

Stroke

(ref. age: 55–59)

Cigarettes per day

1.40 (1.07, 1.88)

1.75 (1.11, 2.82)

2.23 (1.16, 4.45)

2.43 (1.18, 5.22)

29.50

2.42 (1.18, 5.19)

0.16

1.17

16.89

3

0

67

Type 2 diabetes

Cigarettes per day

1.23 (1.09, 1.39)

1.38 (1.15, 1.68)

1.49 (1.18, 1.90)

1.67 (1.24, 2.29)

26.25

1.54 (1.20, 2.01)

0.15

1.16

15.76

3

1

28

Cataracts

Cigarettes per day

1.10 (1.08, 1.12)

1.16 (1.13, 1.19)

1.29 (1.23, 1.35)

1.70 (1.54, 1.88)

25.00

1.43 (1.34, 1.53)

0.14

1.15

15.47

3

0

10

Nasopharyngeal cancer

Pack-years

1.16 (1.04, 1.31)

1.28 (1.06, 1.56)

1.39 (1.08, 1.83)

1.97 (1.17, 3.43)

50.00

2.67 (1.26, 5.94)

0.13

1.14

14.29

2

1

12

Alzheimer’s and other dementia

Cigarettes per day

1.16 (1.04, 1.30)

1.29 (1.06, 1.58)

1.46 (1.10, 1.96)

1.74 (1.14, 2.70)

30.00

1.54 (1.11, 2.18)

0.09

1.10

9.70

2

1

8

Gallbladder diseases

Cigarettes per day

1.15 (1.03, 1.30)

1.24 (1.05, 1.49)

1.29 (1.05, 1.61)

1.51 (1.09, 2.14)

27.93

1.41 (1.07, 1.88)

0.06

1.06

6.34

2

0

4

Atrial fibrillation and flutter

(ref. age: 55–59 years)

Cigarettes per day

1.34 (1.03, 1.78)

1.40 (1.03, 1.93)

1.40 (1.03, 1.93)

1.40 (1.03, 1.93)

25.00

1.40 (1.03, 1.93)

0.06

1.06

5.67

2

0

5

Lip and oral cavity cancer

Pack-years

1.15 (1.00, 1.34)

1.37 (0.99, 1.94)

2.05 (0.98, 4.50)

3.50 (0.97, 13.93)

49.68

3.91 (0.96, 17.56)

0.05

1.05

4.81

2

0

10

Breast cancer

Pack-years

1.08 (1.02, 1.14)

1.13 (1.04, 1.24)

1.17 (1.04, 1.31)

1.17 (1.04, 1.31)

34.10

1.17 (1.04, 1.31)

0.04

1.04

4.46

2

0

23

Colon and rectum cancer

Pack-years

1.07 (0.99, 1.16)

1.12 (0.98, 1.29)

1.19 (0.97, 1.46)

1.20 (0.97,1.50)

50.00

1.20 (0.97, 1.50)

−0.01

0.99

N/A

1

0

16

Kidney cancer

Pack-years

1.01 (1.00, 1.02)

1.04 (0.99, 1.09)

1.15 (0.98, 1.36)

1.52 (0.94, 2.53)

45.86

1.59 (0.93, 2.79)

−0.01

0.99

N/A

1

1

18

Leukemia

Pack-years

1.04 (0.98, 1.11)

1.07 (0.97, 1.19)

1.10 (0.95, 1.29)

1.62 (0.79, 3.47)

37.50

1.50 (0.82, 2.80)

−0.04

0.96

N/A

1

0

7

Fracture

Binary

N/A

N/A

N/A

N/A

1 (binary)

1.34 (0.84, 1.97)

−0.05

0.95

N/A

1

0

59

Prostate cancer

Cigarettes per day

1.03 (0.98, 1.10)

1.07 (0.95, 1.21)

1.16 (0.89, 1.53)

1.30 (0.82, 2.10)

29.73

1.25 (0.85, 1.89)

−0.06

0.94

N/A

1

1

22

Liver cancer

Pack-years

1.15 (0.84, 1.59)

1.26 (0.75, 2.19)

1.39 (0.65, 3.10)

1.42 (0.64, 3.30)

62.50

1.42 (0.64, 3.30)

−0.32

0.72

N/A

1

0

11

Asthma

Cigarettes per day

1.41 (0.54, 3.96)

1.59 (0.43, 6.39)

1.61 (0.42, 6.74)

1.64 (0.41, 7.23)

26.25

1.63 (0.41, 7.04)

−0.64

0.53

N/A

1

0

7

  1. The ROS represents the signed value of the log(BPRF) averaged across the 15th–85th percentiles of exposure. The BPRF corresponds to the lower (if harmful) or higher (if protective) UI—inclusive of between-study heterogeneity—for each risk–outcome pair’s RR curve. ROSs are directly comparable across outcomes and each risk–outcome pair receives an ROS based on the final formulation of the risk curve. For Parkinson’s disease, the ROS reflects a protective effect of smoking, whereas for the other outcomes it reflects a harmful effect. Negative ROSs indicate that a conservative interpretation of the available evidence suggests that there may be no association between risk and outcome. For ease of interpretation, we have transformed the ROS and BPRF into a star rating (1–5), with a higher rating representing a larger effect and stronger evidence. Average BPRF, which is the exponential ROS for harmful effects (or exponential negative ROS for protective effects), is the conservative exposure-averaged RR consistent with all the available data. Average increased risk, which equates to (average BPRF − 1) × 100% for harmful effects or (1 − average BPRF) × 100% for protective effects, refers to the percentage increase in RR based on a conservative interpretation of the evidence. For harmful risks, this percentage is positive and, for protective risks, negative, indicating the percentage decrease in RR. The average increased risk is not applicable for pairs with negative ROSs. N/A, not available; Pub., Publication; ref., reference.
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