Quitting before age 35 puts your risk of death in line with never smoking

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Smokers who quit before the age of 35 have the same mortality rate over a period of time as those who have never smoked at all, a major study shows.

The study found that those who quit smoking at a later age still saw significant benefits, but their death rate exceeded that of those who quit before age 35. For example, former smokers who quit between the ages of 35 and 44 had a 21% higher all-cause mortality rate compared to those who had never smoked. And those who quit smoking between the ages of 45 and 54 had a 47% higher all-cause mortality rate than those who had never smoked.

“Among men and women of various racial and ethnic groups, current smoking was associated with at least twice the all-cause mortality compared with never smoking,” the study authors wrote in a new report published Monday (24 October) in the magazine JAMA Open Network (opens in a new tab). “Quitting smoking, particularly at a young age, was associated with a significant reduction in the relative excess mortality associated with continued smoking.”

This is the third large study to suggest that age 35 may be the optimal age to quit, especially for those who start smoking at a young age. John P. Pierce (opens in a new tab)professor emeritus of family medicine and public health at the University of California, San Diego, wrote in comment (opens in a new tab) research.

“It has long been known that the sooner you quit, the better,” wrote Pierce, who was not involved in the new study. “However, it is now possible to be more specific about the age at which one quits smoking.”

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The new study used data from the US National Health Survey, a questionnaire used to monitor the health of the US population, and the National Death Index, a national database of deaths. The analysis included survey data from more than 550,000 adults who completed questionnaires between January 1997 and December 2018 and were aged 25 to 84 at the time of recruitment. This includes current smokers, ex-smokers and so-called never smokers, meaning people who have smoked less than 100 cigarettes in their lifetime.

According to the National Death Index, nearly 75,000 of these study subjects had died by the end of 2019. Compared to never smokers, current smokers showed significantly higher all-cause mortality rates, as well as higher mortality rates from cancer, heart disease and easy disease, in particular.

Non-Hispanic white smokers had the highest all-cause mortality rate, which was three times that of never smokers. Nonwhite smokers, including both Hispanics and non-Hispanics, had a slightly lower death rate, about twice that of never smokers. This may be due to the fact that these participants reported smoking fewer cigarettes per day on average; starting smoking at an older age; and less likely to smoke daily compared to white subjects.

“These results remind us that reducing smoking intensity (cigarettes per day) should be one of the goals of tobacco control programs,” Price wrote in his commentary.

Importantly, while current smoking was associated with a higher risk of death in all racial and ethnic groups surveyed, “quitting was associated with a significant reduction in risk for all groups,” the study authors wrote.

Specifically, those who quit smoking by age 45 reduced their increased risk of death by up to 90%, and those who quit before age 35 showed a death rate very close to that of never smokers. Similarly, the study found that the longer a person quit smoking, the closer their death rate was to that of never smokers.

Having a 35-year timeframe is a potential motivator for young smokers trying to quit, Price wrote in his commentary. “Without an immediate goal, smokers are tempted to give up trying to quit with cognitions like, ‘I really don’t need to do it right now.’ The study … provides the data needed to set a motivating near-term goal of quitting by age 35,” he wrote. But of course, all is not lost after age 35 — as the study shows, quitting smoking at an older age is still reduces the risk of death, but not so significantly.

The study does have some limitations. For example, information on subjects’ smoking habits was collected at one point in time, so some subjects may have quit or started smoking after the survey. “Thus, both the true risk of smoking and the true benefit of smoking cessation may be underestimated in this study,” the authors warn.

However, research shows that quitting smoking significantly reduces the risk of early death – especially if you do it at a young age.

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