This study examines 50-year trends in smoking-related mortality in the United States, focusing on changes in relative and absolute risks of death from various causes among male and female smokers. Key findings include: 1. **Risks Among Female Smokers**: The relative risks of death from lung cancer, chronic obstructive pulmonary disease (COPD), ischemic heart disease, any type of stroke, and all causes are now nearly identical for female smokers compared to non-smokers. This convergence reflects the convergence of smoking patterns among men and women since the 1960s and the aging of birth cohorts with the heaviest lifetime smoking history. 2. **Risks Among Male Smokers**: The risk of death from lung cancer among male smokers appears to have stabilized since the 1980s, while it continues to increase among female smokers. The rate of death from COPD continues to rise among both male and female smokers, affecting those 55 years and older, despite improvements in diagnosis and treatment. 3. **Mortality Among Former Smokers**: Quitting smoking at any age significantly reduces mortality from all major smoking-related diseases. Former smokers who quit before 40 years of age avoid nearly all excess smoking-related deaths, and those who quit before 60 years of age have a lower relative risk compared to current smokers. 4. **Educational Level**: Educational level significantly modifies the association between smoking and mortality, with higher educational levels generally corresponding to lower relative risks. However, differences in the timing of smoking status information do not appreciably affect the results. 5. **Limitations**: The study primarily represents whites aged 50 years or older, born between 1870 and 1954, and most current smokers in the contemporary cohorts had smoked for at least 30 years. These limitations limit the ability to assess risks among younger smokers and the influence of smoking duration beyond 30 years. In conclusion, the study highlights persistent increases in smoking-related risks among female smokers over the past half century, with relative risks now equal to those for men. The risks among male smokers have plateaued, except for a continuing, unexplained increase in deaths from COPD.This study examines 50-year trends in smoking-related mortality in the United States, focusing on changes in relative and absolute risks of death from various causes among male and female smokers. Key findings include: 1. **Risks Among Female Smokers**: The relative risks of death from lung cancer, chronic obstructive pulmonary disease (COPD), ischemic heart disease, any type of stroke, and all causes are now nearly identical for female smokers compared to non-smokers. This convergence reflects the convergence of smoking patterns among men and women since the 1960s and the aging of birth cohorts with the heaviest lifetime smoking history. 2. **Risks Among Male Smokers**: The risk of death from lung cancer among male smokers appears to have stabilized since the 1980s, while it continues to increase among female smokers. The rate of death from COPD continues to rise among both male and female smokers, affecting those 55 years and older, despite improvements in diagnosis and treatment. 3. **Mortality Among Former Smokers**: Quitting smoking at any age significantly reduces mortality from all major smoking-related diseases. Former smokers who quit before 40 years of age avoid nearly all excess smoking-related deaths, and those who quit before 60 years of age have a lower relative risk compared to current smokers. 4. **Educational Level**: Educational level significantly modifies the association between smoking and mortality, with higher educational levels generally corresponding to lower relative risks. However, differences in the timing of smoking status information do not appreciably affect the results. 5. **Limitations**: The study primarily represents whites aged 50 years or older, born between 1870 and 1954, and most current smokers in the contemporary cohorts had smoked for at least 30 years. These limitations limit the ability to assess risks among younger smokers and the influence of smoking duration beyond 30 years. In conclusion, the study highlights persistent increases in smoking-related risks among female smokers over the past half century, with relative risks now equal to those for men. The risks among male smokers have plateaued, except for a continuing, unexplained increase in deaths from COPD.