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      The effect of smoking cessation on work disability risk: a longitudinal study analysing observational data as non-randomized nested pseudo-trials

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          Smoking increases disability risk, but the extent to which smoking cessation reduces the risk of work disability is unclear. We used non-randomized nested pseudo-trials to estimate the benefits of smoking cessation for preventing work disability.


          We analysed longitudinal data on smoking status and work disability [long-term sickness absence (≥90 days) or disability pension] from two independent prospective cohort studies—the Finnish Public Sector study (FPS) ( n = 7393) and the Health and Social Support study (HeSSup) ( n = 2701)—as ‘nested pseudo-trials’. All the 10 094 participants were smokers at Time 1 and free of long-term work disability at Time 2. We compared the work disability risk after Time 2 of the participants who smoked at Time 1 and Time 2 with that of those who quit smoking between these times.


          Of the participants in pseudo-trials, 2964 quit smoking between Times 1 and 2. During the mean follow-up of 4.8 to 8.6 years after Time 2, there were 2197 incident cases of work disability across the trials. Quitting smoking was associated with a reduced risk of any work disability [summary hazard ratio = 0.89, 95% confidence interval (CI) 0.81–0.98]. The hazard ratio for the association between quitting smoking and permanent disability pension (928 cases) was of similar magnitude, but less precisely estimated (0.91, 95% CI 0.81–1.02). Among the participants with high scores on the work disability risk score (top third), smoking cessation reduced the risk of disability pension by three percentage points. Among those with a low risk score (bottom third), smoking cessation reduced the risk by half a percentage point.


          Our results suggest an approximately 10% hazard reduction of work disability as a result of quitting smoking.

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          Most cited references 10

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          Smoking cessation and lung function in mild-to-moderate chronic obstructive pulmonary disease. The Lung Health Study.

          Previous studies of lung function in relation to smoking cessation have not adequately quantified the long-term benefit of smoking cessation, nor established the predictive value of characteristics such as airway hyperresponsiveness. In a prospective randomized clinical trial at 10 North American medical centers, we studied 3, 926 smokers with mild-to-moderate airway obstruction (3,818 with analyzable results; mean age at entry, 48.5 yr; 36% women) randomized to one of two smoking cessation groups or to a nonintervention group. We measured lung function annually for 5 yr. Participants who stopped smoking experienced an improvement in FEV(1) in the year after quitting (an average of 47 ml or 2%). The subsequent rate of decline in FEV(1) among sustained quitters was half the rate among continuing smokers, 31 +/- 48 versus 62 +/- 55 ml (mean +/- SD), comparable to that of never-smokers. Predictors of change in lung function included responsiveness to beta-agonist, baseline FEV(1), methacholine reactivity, age, sex, race, and baseline smoking rate. Respiratory symptoms were not predictive of changes in lung function. Smokers with airflow obstruction benefit from quitting despite previous heavy smoking, advanced age, poor baseline lung function, or airway hyperresponsiveness.
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            Short-term economic and health benefits of smoking cessation: myocardial infarction and stroke.

            Most analyses of the economic benefits of smoking cessation consider long-term effects, which are often not of interest to public and private policy makers. These analyses fail to account for the time course of the short-run cost savings from the rapid decline in risk of acute myocardial infarction (AMI) and stroke. We estimate the time course of the fall in risk of AMI and stroke after smoking cessation and simulate the impact of a 1% absolute reduction in smoking prevalence on the number of and short-term direct medical costs associated with the prevented AMIs and strokes. In the first year, there would be 924+/-679 (mean+/-SD) fewer hospitalizations for AMI and 538+/-508 for stroke, resulting in an immediate savings of $44+/-26 million. A 7-year program that reduced smoking prevalence by 1% per year would result in a total of 63,840+/-15,521 fewer hospitalizations for AMI and 34,261+/-9133 fewer for stroke, resulting in a total savings of $3.20+/-0.59 billion in costs, and would prevent approximately 13,100 deaths resulting from AMI that occur before people reach the hospital. Creating a new nonsmoker reduces anticipated medical costs associated with AMI and stroke by $47 in the first year and by $853 during the next 7 years (discounting 2.5% per year). Although primary prevention of smoking among teenagers is important, reducing adult smoking pays more immediate dividends, both in terms of health improvements and cost savings.
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              Smoking: health effects and control (1).


                Author and article information

                Int J Epidemiol
                Int J Epidemiol
                International Journal of Epidemiology
                Oxford University Press
                April 2019
                27 February 2019
                27 February 2019
                : 48
                : 2
                : 415-422
                [1 ]Department of Psychology and Logopedics, Medicum, University of Helsinki, Helsinki, Finland
                [2 ]Department of Occupational Health, Finnish Institute of Occupational Health, Helsinki, Finland
                [3 ]Clinicum, University of Helsinki, Helsinki, Finland
                [4 ]Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
                [5 ]Institute of Public Health and Caring Sciences, University of Uppsala, Uppsala, Sweden
                [6 ]Department of Epidemiology and Public Health, University College London, London, UK
                Author notes
                Corresponding author. Department of Psychology and Logopedics, Medicum, University of Helsinki, Haartmaninkatu 3, PL 21, 00014 Helsingin Yliopisto, Finland. E-mail: jaakko.airaksinen@
                © The Author(s) 2019. Published by Oxford University Press on behalf of the International Epidemiological Association.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                Pages: 8
                Funded by: Finnish Work Environment Fund 10.13039/501100003128
                Award ID: 115421
                Funded by: NordForsk 10.13039/501100004785
                Funded by: Medical Research Council 10.13039/501100000265
                Award ID: K013351
                Award ID: S011676
                Award ID: MR/R/024227/1
                Funded by: NordForsk 10.13039/501100004785
                Funded by: Academy of Finland 10.13039/501100002341
                Award ID: 311492
                Funded by: Helsinki Institute of Life Science Fellowship
                Occupational Health

                Public health

                pseudo-trial, work disability, cessation, smoking


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