Mixed evidence for the compression of morbidity hypothesis for smoking elimination-a systematic literature review

Charlotte M Dieteren*, Timor Faber, Job van Exel, Werner B F Brouwer, Johan P Mackenbach, Wilma J Nusselder

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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BACKGROUND: There is debate around the composition of life years gained from smoking elimination. The aim of this study was to conduct a systematic review of the literature to synthesize existing evidence on the effect of smoking status on health expectancy and to examine whether smoking elimination leads to compression of morbidity.

METHODS: Five databases were systematically searched for peer-reviewed articles. Studies that presented quantitative estimates of health expectancy for smokers and non-/never-smokers were eligible for inclusion. Studies were searched, selected and reviewed by two reviewers who extracted the relevant data and assessed the risk of bias of the included articles independently.

RESULTS: The search identified 2491 unique records, whereof 20 articles were eligible for inclusion (including 26 cohorts). The indicators used to measure health included disability/activity limitations (n=9), health-related quality of life (EQ-5D) (n=2), weighted disabilities (n=1), self-rated health (n=9), chronic diseases (n=6), cardiovascular diseases (n=4) and cognitive impairment (n=1). Available evidence showed consistently that non-/never-smokers experience more healthy life years throughout their lives than smokers. Findings were inconsistent on the effect of smoking on the absolute number of unhealthy life years. Findings concerning the time proportionally spent unhealthy were less heterogeneous: nearly all included articles reported that non-/never-smokers experience relatively less unhealthy life years (e.g. relative compression of morbidity).

CONCLUSIONS: Support for the relative compression of morbidity due to smoking elimination was evident. Further research is needed into the absolute compression of morbidity hypothesis since current evidence is mixed, and methodology of studies needs to be harmonized.

Original languageEnglish
Pages (from-to)409-417
Number of pages9
JournalEuropean Journal of Public Health
Issue number2
Early online date18 Dec 2020
Publication statusPublished - Apr 2021

Bibliographical note

Charlotte M Dieteren is employed and supported by the Erasmus University Rotterdam and Timor Faber by the Erasmus Medical Centre. Wilma J. Nusselder received funding as part of the project ‘Longer life, longer in good health, working longer? Implications of educational differences for the pension system’, which has received financial support from Netspar (Network for Studies on Pensions, Aging and Retirement).

© The Author(s) 2020. Published by Oxford University Press on behalf of the European Public Health Association.


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