Quitting smoking, the earlier the better

On average, smokers live more than 10 years less than non-smokers. Quitting before age 40 eliminates roughly 90% of the extra death risk caused by continued smoking. The earlier you quit, the more years you gain. If you keep smoking after a fracture, the chance that the bone fails to heal is about 2.3 times that of a non-smoker, so don’t smoke until the bone has healed.

Cost

It costs nothing — in fact, it saves money. A pack-a-day habit costs roughly $3–$4, which you’ll no longer spend after quitting. The hard part is getting through the withdrawal period, which usually lasts a few weeks to several months.

Benefit

One U.S. study that tracked participants without assigning them to groups found that current smokers have a life expectancy more than 10 years shorter than those who never smoked. Quitting before age 40 removes about 90% of this excess mortality risk. Quitting between ages 25–34 adds roughly 10 years to life expectancy; between 35–44, about 9 years; and between 45–54, about 6 years (as reported in the original source). Similar Chinese research from the 2010s shows that urban male smokers have a 1.65 times higher death risk than non-smokers (RR 1.65), while rural male smokers have a 1.22 times higher risk. After 10 years of sustained abstinence, this smoking-related risk nearly disappears. The same holds after a fracture. Pooling 19 observational studies that only tracked people without assigning groups, smokers’ odds of non-union (the bone failing to knit) were about 2.3 times those of non-smokers (OR 2.32, 95% CI 1.76–3.06, adjusted for other factors). The excess was also seen in fractures of the tibia (shin bone) and in open fractures. In a Swedish randomized trial, 50 people who joined a 6-week smoking cessation program after emergency fracture surgery had at least one postoperative complication in 20% of cases, versus 38% among the 55 who did not join. For scheduled surgery, you can start quitting 4 to 8 weeks before the operation, with weekly coaching and nicotine replacement. That lowers postoperative complications by about 58% (RR 0.42, 95% CI 0.27–0.65, 2 trials, 210 people).

Notes

Secondhand smoke is deadly too: in 2004, an estimated 603,000 people worldwide died from exposure to it, accounting for roughly 1% of all global deaths that year. Even if you don’t smoke yourself, you must avoid secondhand smoke, especially to protect children. Specific quitting strategies are outlined in the following sections: Section 3 (smoking cessation medications), Section 4 (setting a quit date), Section 5 (visiting a smoking cessation clinic), and Section 6 (e-cigarettes). The non-union figure comes from observational studies that did not assign groups; smokers may differ from non-smokers in other ways, and these cannot all be removed. The post-fracture quitting trial had only 105 participants, and with a different method of calculation the difference is not significant.

Sources · 5

1. Jha P 等 (2013). 21st-century hazards of smoking and benefits of cessation in the United States. NEJM. doi.org/10.1056/NEJMsa1211128
2. Chen Z 等 (2015). Contrasting male and female trends in tobacco-attributed mortality in China: evidence from successive nationwide prospective cohort studies. Lancet. doi.org/10.1016/S0140-6736(15)00340-2
3. Oberg M 等 (2011). Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries. Lancet. doi.org/10.1016/S0140-6736(10)61388-8（二手烟那两个数字）；Scolaro JA 等 (2014). Cigarette smoking increases complications following fracture: a systematic review. J Bone Joint Surg Am. doi.org/10.2106/JBJS.M.00081
4. Nåsell H 等 (2010). Effect of smoking cessation intervention on results of acute fracture surgery: a randomized controlled trial. J Bone Joint Surg Am. doi.org/10.2106/JBJS.I.00627
5. Thomsen T 等 (2014). Interventions for preoperative smoking cessation. Cochrane Database Syst Rev. doi.org/10.1002/14651858.CD002294.pub4（骨折和手术那几个数字）