Smoking-attributable Mortality by State in 2014, U.S.

Abstract

Contemporary state-specific estimates of mortality caused by cigarette smoking are important for tobacco control advocacy and healthcare planning in the U.S., but are currently lacking. The population-attributable fraction (i.e., proportion of deaths in the population caused by smoking), number of deaths, and number of years of potential life lost because of active cigarette smoking were estimated for each state based on state-specific smoking prevalence data from the 2014 Behavioral Risk Factor Surveillance System, recently updated relative risks of smoking, and numbers of deaths from smoking-attributable diseases. Analyses were performed in 2017. In 2014, active cigarette smoking caused an estimated 448,865 deaths (258,456 men and 190,409 women), representing 17.8% (95% CI=17.7%, 17.9%) of all deaths at age >35 years in the U.S. These deaths resulted in the premature loss of 6,387,021 years of life in 2014. Across states, population-attributable fractions ranged from 12.4% in Utah to 25.2% in Arkansas in men, and from 7.0% in Utah to 20.0% in Nevada in women. Cigarette smoking caused >20% of all deaths in seven states (Kentucky, Arkansas, Nevada, Tennessee, West Virginia, Oklahoma, and Missouri). California had the highest number of smoking-attributable deaths (n=38,182) and years of potential life lost (508,370 years), despite a relatively low population-attributable fraction (16.2%). Cigarette smoking continues to cause a substantial proportion of deaths in every state, with the highest population-attributable fractions in Nevada and the South. The continuing high burden in states with longstanding tobacco control, like California, highlights the need for enhanced tobacco control in all states.