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In sensitivity analyses adjusting for cumulative pack-years, results were similar (HR, 0.62 [95% CI, 0.50-0.77]

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The number of smokers is declining slightly in rich countries, but thats more than offset by the rise of vaping and the growing popularity of smoking in lower- and middle-income countries (where the tobacco industry has virtually free rein)

However, during that time period, overall tobacco consumption actually increased by 49%