Estimating Smoking-Attributable Mortality in the United States (original) (raw)
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50-Year Trends in Smoking-Related Mortality in the United States
New England Journal of Medicine, 2013
Background The disease risks from cigarette smoking increased in the United States over most of the 20th century, first among male smokers and later among female smokers. Whether these risks have continued to increase during the past 20 years is unclear. Methods
Adult mortality differentials associated with cigarette smoking in the USA
Population Research and Policy …, 1998
Although cigarette smoking has been extensively researched, surprising little knowledge has been produced by demographers using demographic perspectives and techniques. Thus, this paper contributes to the literature by extending a demographic framework to an important behavior for mortality research: cigarette smoking. In earlier works, the authors used nationally-representative data to show that cause of death patterns varied by smoking status and that multiple causes of death characterized smokers moreso than non-smokers. The present work extends previous analysis by estimating smoking status mortality differentials by underlying and multiple causes of death and by age and sex. Data from the 1986 National Mortality Foilowback Sur-vey are related to data from the 1985 and 1987 National Health Interview Survey supplements to assess the smoking-related mortality differentials. We lind that cigarette smoking is associated with higher mortality for all population categories studied, that the smoking mortality differentials vary across the different smoking status categodes and by demographic group, and that the mortality differentials vary according to whether underlying cause or multiple cause pattems of death are examined. Moreover, the multiple cause analysis highlights otherwise obscured smoking-mortality relations and points to the impoftance of respiratory diseases and cancers other than lung cancer for cigarette smoking research.
BMC Public Health, 2011
Background: Tobacco control policies at the state level have been a critical impetus for reduction in smoking prevalence. We examine the association between recent changes in smoking prevalence and state-specific tobacco control policies and activities in the entire U.S. Methods: We analyzed the 1992-93, 1998-99, and 2006-07 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) by state and two indices of state tobacco control policies or activities [initial outcome index (IOI) and the strength of tobacco control (SOTC) index] measured in 1998-1999. The IOI reflects cigarette excise taxes and indoor air legislation, whereas the SOTC reflects tobacco control program resources and capacity. Pearson Correlation coefficient between the proportionate change in smoking prevalence from 1992-93 to 2006-07 and indices of tobacco control activities or programs was the main outcome measure. Results: Smoking prevalence decreased from 1992-93 to 2006-07 in both men and women in all states except Wyoming, where no reduction was observed among men, and only a 6.9% relative reduction among women. The percentage reductions in smoking in men and women respectively were the largest in the West (average decrease of 28.5% and 33.3%) and the smallest in the Midwest (18.6% and 20.3%), although there were notable exceptions to this pattern. The decline in smoking prevalence by state was correlated with the state's IOI in both women and men (r = -0.49, p < 0.001; r = -0.31, p = 0.03; respectively) and with state's SOTC index in women(r = -0.30, p = 0.03 0), but not men (r = -0.21, p = 0.14). Conclusion: State level policies on cigarette excise taxes and indoor air legislation correlate strongly with reductions in smoking prevalence since 1992. Strengthening and systematically implementing these policies could greatly accelerate further reductions in smoking.
JAMA, 2014
IMPORTANCE January 2014 marks the 50th anniversary of the first surgeon general's report on smoking and health. This seminal document inspired efforts by governments, nongovernmental organizations, and the private sector to reduce the toll of cigarette smoking through reduced initiation and increased cessation. OBJECTIVE To model reductions in smoking-related mortality associated with implementation of tobacco control since 1964.
Risk analysis : an official publication of the Society for Risk Analysis, 2012
To better understand the contribution of cigarette smoking, and its changing role in lung cancer, this article provides an introduction to a special issue of Risk Analysis, which considers the relationship between smoking and lung cancer death rates during the period 1975-2000 for U.S. men and women aged 30-84 years. Six models are employed, which are part of a consortium of lung cancer modelers funded by National Cancer Institute's Cancer Intervention and Surveillance Modeling Network (CISNET). Starting with birth-cohort-specific smoking histories derived from National Health Interview Surveys, three scenarios are modeled: Actual Tobacco Control (observed trends in smoking), Complete Tobacco Control (a counterfactual lower bound on smoking rates that could have been achieved had all smoking ceased after the first Surgeon General's report in 1964), and No Tobacco Control (a counterfactual upper bound on smoking rates if smoking patterns that prevailed before the first studie...
Annals of Internal Medicine, 2018
Background: Tobacco control efforts implemented since the 1960s in the US have led to considerable reductions in smoking and smoking-related diseases including lung cancer. Objective: To project the reduction in tobacco use and lung cancer mortality due to existing tobacco control efforts from 2015 to 2065. Design: Comparative modeling approach using four lung cancer natural history simulation models that explicitly relate temporal smoking patterns to lung cancer rates.
Recent Trends and Geographic Patterns of the Burden of Disease Attributable to Smoking
Value in Health, 2010
Purpose: Quality-adjusted life-years (QALYs) use a single number to provide an assessment of the overall health burden of diseases associated both with mortality and morbidity. This study examined the trend and geographic variation of the burden of smoking by calculating smokingrelated QALYs lost from 1993 to 2008 for the US adults and individual states. Methods: Population health-related quality of life scores were estimated from the 1993 to 2008 Behavioral Risk Factor Surveillance System. The smoking-related QALYs lost are the sum of QALYs lost due to morbidity and future QALYs lost in expected life years due to premature deaths (mortality). Results: From 1993 to 2008, the percent of US adults who smoked declined from 22.7% to 18.5%, but the smoking-related QALYs lost were relatively stable at 0.0438 QALYs lost per population. Although smoking contributed more QALYs lost for men (0.0535) than for women (0.0339), smoking-related QALYs lost decreased by 2.5% for men but increased by 12.6% for women. Kentucky, Oklahoma, Mississippi, West Virginia, and Tennessee had the most smoking-related QALYs lost wheras Utah, California, Connecticut, Minnesota, and Hawaii had the least QALYs lost. The state tobacco tax rate was strongly and negatively associated with both the percent smoked (r =-0.60) and QALYs lost (r =-0.54), as well as the percentage change in both. Conclusions: This analysis quantified the overall burden of smoking for the nation and individual states from 1993 to 2008. Such data might assist in providing specified quantitative targets for the Healthy People 2020 smoking-related health objectives and for tracking changes on a yearly basis.
Reduced lung cancer deaths attributable to decreased tobacco use in Massachusetts
Cancer Causes & Control, 2007
Background Approximately 88% of the lung cancer deaths in men and 71% in women occurring in the US are attributable to cigarette smoking, with almost 3,700 annual lung cancer deaths in Massachusetts. In the state, male lung cancer death rates are showing a per year annual decline following a peak in the early 1990s. Such recent declines could be mostly attributed to tobacco control efforts over the past 40 years. Method This study predicts how many fewer lung cancer deaths have occurred in Massachusetts possibly attributable to tobacco control activities. The study employs the US National Cancer Institute's ''Joinpoint'' Regression Analysis Program (version 3.0) using statewide age-standardized (2000 US Standard Population) lung cancer death rates from 1931 to 2003 for each of the sexes. 95% confidence intervals (CI) were also calculated. Results Modeled male lung cancer death rates stabilized from the calendar year 1977 onwards but showed significant decline from 1992 onwards, while females showed a deceleration in rising lung cancer rates from 1993 onwards. Therefore, based on their corresponding beta-coefficients (slope) and standard error for each of the two calendar years 19,665 (95% CI: 18,655; 20,765) fewer lung cancer deaths in males and 3,855 (95% CI: 3,630; 4,055) fewer lung cancer deaths in females were estimated to have occurred from 1977 to 1993 onwards, respectively, largely because of the anti-smoking interventions in the past. Conclusions Reductions in tobacco smoking are a major factor in the decrease in lung cancer mortality rates. Sustained progress in tobacco control is essential.
Does the Impact of the Tobacco Epidemic Explain Structural Changes in the Decline of Mortality?
European Journal of Population
Since 1950, most developed countries have exhibited structural changes in mortality decline. This complicates extrapolative forecasts, such as the commonly used Lee-Carter model, that require the presence of a steady long-term trend. This study tests whether the impact of the tobacco epidemic explains the structural changes in mortality decline, as it is presumed in earlier studies. For this purpose, the time index of the Lee-Carter model in males was investigated in 20 developed countries between 1950 and 2011 for possible structural changes. It was found that removing the impact of smoking from mortality trends took away more than half of the 12 detected trend breaks. For the remaining trend breaks, adjusting for smoking attenuated the degree of change in mortality decline. Taking the tobacco epidemic into account should become standard procedure in mortality forecasts to avoid a misleading extrapolation of trends. Nevertheless, more research is needed to identify additional factors, such as health-care policies and innovations in medical treatment, to explain the remaining structural changes.