Abstract
IntroductionDespite years of declining smoking prevalence, tobacco use is still the leading preventable contributor to illness and death in the United States, and the effect of past tobacco-use control efforts has not fully translated into improvements in health outcomes. The objective of this study was to use a life course model with multiple competing causes of death to elucidate the ongoing benefits of tobacco-use control efforts on US death rates.MethodsWe used a continuous-time life course simulation model for the US population. We modeled smoking initiation and cessation and 20 leading causes of death as competing risks over the life span, with the risk of death for each cause dependent on past and current smoking status. Risk parameters were estimated using data from the National Health Interview Survey that were linked to follow-up mortality data.ResultsUp to 14% (9% for men, 14% for women) of the total gain in life expectancy since 1960 was due to tobacco-use control efforts. Past efforts are expected to further increase life expectancy by 0.9 years for women and 1.3 years for men. Additional reduction in smoking prevalence may eventually yield an average 3.4-year increase in life expectancy in the United States. Coronary heart disease is expected to increase as a share of total deaths.ConclusionsA dynamic individual-level model with multiple causes of death supports assessment of the delayed benefits of improved tobacco-use control efforts. We show that past smoking reduction efforts will translate into further increases in life expectancy in the coming years. Smoking will remain a major contributor to preventable illness and death, worthy of continued interventions.
Highlights
Despite years of declining smoking prevalence, tobacco use is still the leading preventable contributor to illness and death in the United States, and the effect of past tobacco-use control efforts has not fully translated into improvements in health outcomes
We show that past smoking reduction efforts will translate into further increases in life expectancy in the coming years
The reductions in smoking prevalence that occurred over the last several decades have led to a substantial reduction in deaths from coronary heart disease attributed to smoking [10], lung cancer deaths have declined more slowly [7,11]
Summary
Despite years of declining smoking prevalence, tobacco use is still the leading preventable contributor to illness and death in the United States, and the effect of past tobacco-use control efforts has not fully translated into improvements in health outcomes. Despite significant reductions in smoking prevalence nationally and changes in social norms surrounding tobacco use, tobacco use persists as the leading cause of preventable illness and death in the United States [1,2]. From 2000 through 2004, one-fifth (45 million) of US adults smoked, resulting in an estimated 443,000 premature deaths and $193 billion in direct health care expenditures and productivity losses each year [1]. In the United States, smoking annually causes more than 30% of all cancer deaths and more than 80% of lung cancer deaths [1,7]. The reductions in smoking prevalence that occurred over the last several decades have led to a substantial reduction in deaths from coronary heart disease attributed to smoking [10], lung cancer deaths have declined more slowly [7,11]
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