The smoking epidemic in Australia is characterised by historic levels of prolonged smoking, heavy smoking, very high levels of long-term cessation, and low current smoking prevalence, with 13% of adults reporting that they smoked daily in 2013. Large-scale quantitative evidence on the relationship of tobacco smoking to mortality in Australia is not available despite the potential to provide independent international evidence about the contemporary risks of smoking. This is a prospective study of 204,953 individuals aged ≥45 years sampled from the general population of New South Wales, Australia, who joined the 45 and Up Study from 2006–2009, with linked questionnaire, hospitalisation, and mortality data to mid-2012 and with no history of cancer (other than melanoma and non-melanoma skin cancer), heart disease, stroke, or thrombosis. Hazard ratios (described here as relative risks, RRs) for all-cause mortality among current and past smokers compared to never-smokers were estimated, adjusting for age, education, income, region of residence, alcohol, and body mass index. Overall, 5,593 deaths accrued during follow-up (874,120 person-years; mean: 4.26 years); 7.7% of participants were current smokers and 34.1% past smokers at baseline. Compared to never-smokers, the adjusted RR (95% CI) of mortality was 2.96 (2.69–3.25) in current smokers and was similar in men (2.82 (2.49–3.19)) and women (3.08 (2.63–3.60)) and according to birth cohort. Mortality RRs increased with increasing smoking intensity, with around two- and four-fold increases in mortality in current smokers of ≤14 (mean 10/day) and ≥25 cigarettes/day, respectively, compared to never-smokers. Among past smokers, mortality diminished gradually with increasing time since cessation and did not differ significantly from never-smokers in those quitting prior to age 45. Current smokers are estimated to die an average of 10 years earlier than non-smokers. In Australia, up to two-thirds of deaths in current smokers can be attributed to smoking. Cessation reduces mortality compared with continuing to smoke, with cessation earlier in life resulting in greater reductions.

Data from the 45 and Up Study identify a range of modifiable risk factors for erectile dysfunction, suggesting that attention to lifestyle factors could help prevent this common problem

Limited evidence suggests that people from non-English speaking backgrounds in Australia have lower than average rates of participation in cancer screening programs. The objective of this study was to examine the distribution of bowel, breast and prostate cancer test use by place of birth and years since migration in a large population-based cohort study in Australia.

Objective: To compare the characteristics of people who utilize colorectal cancer screening tests with those who do not. Setting: Self-reported questionnaire data from 15,900 women and 14,953 men aged 50 or over who had never had colorectal cancer were taken from the 45 and Up Study cohort in Australia in 2006. Methods: A cross-sectional analysis of colorectal cancer test behaviour within the last five years by faecal occult blood test (FOBT), or by any test (FOBT, sigmoidoscopy or colonoscopy) was performed. Results: A total of 36.2% of participants reported colorectal cancer testing and 17.9% reported having a FOBT. Both FOBT and any testing were reduced significantly in groups with the following attributes compared with the remaining population; ages 50–59 and 80+; female; no family history of colorectal cancer; lower education; lower income; not speaking English at home; lack of private health insurance; not being retired; not living with a partner and not having other screening tests. Compared with other participants, test uptake was particularly low among current smokers (relative risk 0.76, 95% CI 0.71–0.80), sedentary participants (0.71, 95% CI 0.66–0.77), those without fruit (0.77, 95% CI 0.71–0.84) or vegetables (0.79, 95% CI 0.69–0.90) in their daily diet and those with a disability (0.91, 95% CI 0.85–0.97). Compared with participants from major cities, outer regional area participants were significantly more likely to report a FOBT (1.31, 95% CI 1.23–1.39) however participants in remote areas were significantly less likely to have had any colorectal cancer test (0.75, 95% CI 0.67–0.85). Conclusion: Subgroups of the Australian population may require targeted intervention to ensure equity in colorectal cancer screening.