{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T13:00:14Z","timestamp":1790082014922,"version":"4.0.1"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":24,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["T32AG51108"],"award-info":[{"award-number":["T32AG51108"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000057","name":"National Institute of General Medical Sciences","doi-asserted-by":"publisher","award":["T32GM144273"],"award-info":[{"award-number":["T32GM144273"]}],"id":[{"id":"10.13039\/100000057","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000275","name":"Leverhulme Trust","doi-asserted-by":"publisher","award":["RC-2018-003"],"award-info":[{"award-number":["RC-2018-003"]}],"id":[{"id":"10.13039\/501100000275","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000781","name":"European Research Council","doi-asserted-by":"publisher","award":["ERC-2021-CoG-101002587"],"award-info":[{"award-number":["ERC-2021-CoG-101002587"]}],"id":[{"id":"10.13039\/501100000781","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The adverse association between smoking and mortality is well known, yet estimated risks for smokers have risen markedly in recent decades. Explanations range from physiological impacts of changes in smoking intensity to shifts in the social characteristics of smokers. However, these hypotheses have rarely been tested. Using National Health Interview Survey data linked to the National Death Index through 2018, we confirm the mortality penalty associated with smoking increased by nearly 50% from 1987\u20131990 to 2012\u20132013, controlling for age. We show that this growing gradient between smokers and nonsmokers is driven largely by changes in the age distribution of smokers. This occurs even as more recent cohorts of smokers exhibit lower education, worse health, and greater psychological distress. These findings illustrate how evolving population composition can shape estimated mortality risks for exposures such as smoking and hold implications for understanding temporal changes in other risk factors like obesity.<\/jats:p>","DOI":"10.1093\/pnasnexus\/pgag280","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T12:01:21Z","timestamp":1790078481000},"source":"Crossref","is-referenced-by-count":0,"title":["Why the mortality penalty of smoking is rising over time"],"prefix":"10.1093","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4640-5962","authenticated-orcid":false,"given":"Ralph","family":"Lawton","sequence":"first","affiliation":[{"name":"Interfaculty Initiative in Health Policy, Graduate School of Arts and Sciences, Harvard University , Cambridge, MA 02138, USA"},{"name":"Medical Scientist Training Program, Harvard Medical School , Boston, MA02115, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2006-5656","authenticated-orcid":false,"given":"Jennifer Beam","family":"Dowd","sequence":"additional","affiliation":[{"name":"Leverhulme Center for Demographic Science, Nuffield Department of Population Health, Nuffield College, University of Oxford , Oxford OX1 1JD ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4760-9396","authenticated-orcid":false,"given":"Jonathan","family":"Skinner","sequence":"additional","affiliation":[{"name":"Department of Economics, Dartmouth College , Hanover, NH 03755, USA"},{"name":"National Bureau of Economic Research , Cambridge, MA 02138, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0211-1970","authenticated-orcid":false,"given":"Ellen","family":"Meara","sequence":"additional","affiliation":[{"name":"National Bureau of Economic Research , Cambridge, MA 02138, USA"},{"name":"Department of Health Policy and Management, Harvard T.H. 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