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To the Editor:
Merchant et al. should be commended for their recent article in Neurology, which goes a long way in dispelling the notion that cigarette smoking is “protective” against AD.1 Moreover, their data provide a clear glimpse at the magnitude of differential survival, an under-recognized source of selection bias in epidemiologic studies.2–4 From table 2 of the report of Merchant et al.,1 the following table can be constructed (table 1). The percentage of individuals who never smoked increases from about 45% in the 65- to 74-year-old age group to about 65% in the 85+ year-old-age group. The most likely explanation for this 44% increase in the proportion of individuals who never smoked is the well-established fact that smokers experience higher mortality than nonsmokers. Because smokers die at a higher rate than nonsmokers, the proportion of nonsmokers will increase. Thus, the observed increasing proportion …
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