Different dimensions of smoking behavior and their associations with accelerated composite biomarkers-based biological aging in Chinese older adults

Dec 1, 2025BMC geriatrics

How Various Smoking Habits Relate to Faster Biological Aging in Older Chinese Adults

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Abstract

Smoking characteristics are associated with an acceleration of biological age by up to 0.55 years in older adults.

Current smokers exhibit a acceleration of 0.33 years compared to never smokers.
Smoking since childhood is linked to a KDM-BA acceleration of 0.55 years.
Smoking more than 20 cigarettes per day results in a KDM-BA acceleration of 0.32 years.
Smokers with over 50 years of smoking experience show an acceleration of 0.35 years.
A higher years of smoking-to-age ratio correlates with a KDM-BA acceleration of 0.35 years.
Earlier initiation of smoking is associated with greater KDM-BA acceleration, plateauing after age 20.

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BACKGROUND: Smoking is a leading risk factor for numerous adverse health outcomes. However, in the context of a dramatically increasing aging population, evidence on how different dimensions of smoking characteristics is associated with biological aging remains limited and inconclusive.

METHODS: This cross-sectional study involved 143,955 participants aged ≥ 65 years from the Chinese National Basic Public Health Services Project in 2021. A composite biomarkers-based biological age (BA) was constructed using the Klemera-Doubal method (KDM). We estimated the associations of different dimensions of smoking (including smoking status, smoking initiation age, cigarettes smoked per day, smoking duration, years of smoking-to-age ratio, and cumulative smoking ) with the value, and the severity of acceleration using multiple linear regression and multinomial logistic regression, respectively. Restricted cubic splines (RCS) were used to examine their dose-response relationships.

RESULTS: All dimensions of smoking behavior were significantly associated with accelerated KDM-BA and elevated risk of severely accelerated aging (Δ ≥ 2 years). Compared with never smokers, participants who were current smokers, smoked since childhood, smoked more than 20 cigarettes per day, smoked for more than 50 years, smoked for more than 70% of their years of life, and smoked more than 40 pack-years, had an increased KDM-BA acceleration by 0.33 (95% CI: 0.30-0.36), 0.55 (95% CI: 0.29-0.81), 0.32 (95% CI: 0.29-0.35), 0.35 (95% CI: 0.31-0.38), 0.35 (95% CI: 0.32-0.39), and 0.33 (95% CI: 0.30-0.36) years, respectively. According to results of RCS, smoking duration and years of smoking-to-age ratio showed a linearly increasing dose-response relationship with KDM-BA acceleration, while the patterns for cigarettes smoked per day and cumulative smoking pack-years exhibited a rapid increase initially, but followed a slight decline after reaching a peak at approximately 15 cigarettes/day and 55 pack-years. Among participants ever smoked, earlier smoking initiation age was associated with greater KDM-BA acceleration, reaching a plateau after age 20.

CONCLUSIONS: Different dimensions of smoking show robust and dose-response relationships with composite biomarkers-based BA acceleration. Our findings confirm that there is no safe level of smoking and emphasize the public health significance of achieving small but population-wide shifts in biological age by strengthening tobacco control measures.

Key numbers

0.55 years

Increase in Biological Age from Early Smoking

Increase in for those who started smoking in childhood vs. never smokers.

0.32 years

Increase in Biological Age from High Smoking Intensity

Increase in for smoking more than 20 cigarettes per day vs. never smokers.

49.3%

Proportion of Participants with Accelerated Aging

Percentage of participants with accelerated in the study population.

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Different dimensions of smoking behavior and their associations with accelerated composite biomarkers-based biological aging in Chinese older adults

Abstract

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