Peto-Lopez Method Research Articles

Estimating smoking-attributable lung cancer mortality in Chinese adults from 2000 to 2020: a comparison of three methods

BackgroundSmoking is a significant public health concern in China and a leading cause of lung cancer deaths among adults. This study aims to employ three methods to estimate smoking-attributable lung cancer mortality among Chinese adults from 2000 to 2020.MethodsPopulation attributable fractions (PAFs) of lung cancer deaths caused by smoking were estimated using lagged smoking prevalence, Peto-Lopez, and dose–response relationship methods, separately. Smoking exposure was obtained from national tobacco surveys in China, and relative risks (RR) were derived from a meta-analysis of state-of-the-art studies among the Chinese population. Finally, we estimated the sex- and age-stratified smoking-attributable lung cancer deaths in Chinese population in 2000, 2005, 2010, 2015, and 2020.ResultsThe PAFs estimated using 5- and 10-year lagged smoking prevalence method (45–47%) and Peto-Lopez method (46–47%) were similar, while PAFs calculated using the dose–response method were highest (47–58%). The PAFs were consistently higher in males than in females. Age-specific PAFs estimated by lagged smoking prevalence method (54–60%) and the Peto-Lopez method (57–61%) in males were similar and relatively stable, with slight decreases in older populations, while the dose–response relationship-based PAFs increased with age and fluctuated by year. By using the above methods, smoking-attributable lung cancer deaths were estimated to be 134,100, 134,600, 136,600, and 155,300 in 2000 increasing to 310,300, 301,100, 306,000, and 314,700 in 2020, respectively.ConclusionThe estimation from dose–response methods could better reflect the smoking effect, however, high-quality data and accurate estimation of parameters are necessary.

Trends in social inequality in mortality in Denmark 1995–2019: the contribution of smoking- and alcohol-related deaths

BackgroundDuring the past decades, social inequality in mortality has increased in several countries, including Denmark. Modifiable risk factors, such as smoking and harmful alcohol consumption, have been suggested to moderate...

Smoking-attributable mortality at an infra-national level: regional estimates in France in 2015

Abstract Background Tobacco smoking is a major leading preventable cause of mortality. The Peto-Lopez method and its variants are commonly used for estimating smoking-attributable mortality in population in high-income countries. The method assumes the average cumulative exposure of tobacco smoking in the population can be approximated using lung cancer death rates. However, providing estimates at an infra-national level is often much more challenging because the observed number of deaths for lung cancer are generally too low to use directly the method. The aim of this study was to estimate the number of deaths attributable to smoking at the regional level in France in 2015. Methods Population attributable fractions were computed using the Peto-Lopez method modified by Parkin which combines mortality statistics, lung cancer death rates and adjusted relative risks of deaths associated with smoking. To estimate the proxy for smoking prevalence in regional level by sex and age group, we pooled lung cancer mortality on several years according to the size of the regional populations and we smoothed the non-linear relationship of age with the estimates of the proxy. The attributable fractions were estimated for the 13 metropolitan regions and 4 French overseas regions. Results In whole France, we estimated that 19% of deaths among men and 7% among women were attributable to smoking in 2015. Deaths attributable to smoking ranged across metropolitan regions from 17% to 23% among men and from 5.5% to 8.7% among women. In overseas territories, estimates presented much more variability with a range from 6% to 18% for men and from 1.2% to 4.3% for women. Conclusions We highlighted disparities in regional mortality attributable to smoking. Producing estimates of the burden of smoking at an infra-national level is a tool offering many perspectives for better analyzing territorial inequalities and ultimately to further guide more effective localized interventions to reduce tobacco consumptions. Key messages We provide a straightforward solution to estimate the infra-national burden attributable to tobacco from a usual method. Our results highlight the disparities in mortality attributable to smoking across regions in France in 2015.

Tobacco-attributable burden of cancer according to socioeconomic position in France

Introduction Smoking is a major preventable cause of cancers and is increasingly concentrated among the most deprived individuals leading to increasing socioeconomic inequalities in the incidence of cancers linked to smoking. It has been shown that a higher level of tobacco smoking partly accounted for the higher incidence of tobacco related cancers in low socioeconomic groups. In addition to quantifying the relative contribution of risk factors to socioeconomic inequalities in cancer incidence, assessing the absolute number of cancer cases attributable to smoking by socioeconomic position (SEP) at a national level is important for policy makers to assess the population burden of smoking on social inequalities in cancer. We aimed to estimate the tobacco-attributable cancer burden according to socioeconomic position in France. Methods The analysis was restricted to cancer sites for which tobacco smoking was recognized as a risk factor. Cancer cases by sex, age group and European Deprivation Index (EDI) among people aged 30–74 between 2006 and 2009 were obtained from cancer registries covering approximately 20% of the French population. Socioeconomic position was assessed using the quintiles of the EDI. The tobacco-attributable burden of cancer according to EDI was estimated applying the population attributable fraction (PAF) computed with the Peto-Lopez method. We quantified the contribution of smoking to socioeconomic inequalities in cancer incidence at the national level by comparing the number of tobacco-related cancers that would be prevented if the four lower EDI quintiles smoked as the least deprived EDI quintile with the number of tobacco-related cancers that would be prevented if the four lower EDI quintiles had the same IRs as the least deprived EDI quintile Results The PAF increased from 56% in the least deprived EDI quintile to 70% in the most deprived EDI quintile among men and from 26% to 38% among women. Among men and women, the PAF was higher in the younger age groups i.e. 30–59 years. The age difference was pronounced in the more deprived EDI quintiles whereas the PAFs were almost identical in both age groups in the least deprived EDI quintile. In total, 28% of the excess cancer cases in the four most deprived EDI quintiles in men and 43% in women could be prevented if smoking in these four EDI quintiles was similar to that of the least deprived EDI quintile. The proportions did not differ by sex in the age group 60–74 (around 30%), but was much higher in women than in men in the age group 30–59 (48.1% versus 26.3%). Conclusion A substantial smoking-attributable burden of cancer by socioeconomic position was observed in France. The results highlight the need for policies reducing tobacco consumption. More comprehensive interventions integrating the various dimensions of health determinants and proportionate according to socioeconomic position may essentially contribute to the reduction of socioeconomic inequalities in cancer.

Tobacco-attributable burden of cancer according to socioeconomic position in France.

Smoking is a major preventable cause of cancers and is increasingly concentrated among the most deprived individuals leading to increasing socioeconomic inequalities in the incidence of cancers linked to smoking. We aimed to estimate the tobacco-attributable cancer burden according to socioeconomic position in France. The analysis was restricted to cancer sites for which tobacco smoking was recognized as a risk factor. Cancer cases by sex, age group and European Deprivation Index (EDI) among people aged 30-74 between 2006 and 2009 were obtained from cancer registries covering ∼20% of the French population. The tobacco-attributable burden of cancer according to EDI was estimated applying the population attributable fraction (PAF) computed with the Peto-Lopez method. The PAF increased from 56% in the least deprived EDI quintile to 70% in the most deprived EDI quintile among men and from 26% to 38% among women. In total, 28% of the excess cancer cases in the four most deprived EDI quintiles in men and 43% in women could be prevented if smoking in these 4 EDI quintiles was similar to that of the least deprived EDI quintile. A substantial smoking-attributable burden of cancer by socioeconomic position was observed in France. The results highlight the need for policies reducing tobacco consumption. More comprehensive interventions integrating the various dimensions of health determinants and proportionate according to socioeconomic position may essentially contribute to the reduction of socioeconomic inequalities in cancer.

Smoking as the main factor of preventable mortality in Serbia

The use of tobacco in Serbia has for many years been one of the most frequent risk factors affecting disease development. Although its impact is often neglected and the effects on health minimised, reviewing the existing literature and calculating the tobacco consumption impact on the mortality of the population in Serbia (using the Peto-Lopez method) show a clear link between smoking and health of the population. Serbian population is heavily burdened with the negative effects of tobacco on health, especially men. At the beginning of the second decade of the 21st century, mortality from the illness or cause of death associated with smoking was at about 17% of the total mortality. In men, it is estimated that even a quarter of the total mortality is associated with smoking. In the female population, the share of smokers is considerably lower, and consequently the mortality from this factor is lower, about 9% of the total mortality. Of all major disease groups, tumours are most affected by smoking. The share of tobaccorelated mortality in neoplasms is high and accounts for 30% (43% in men and 14% in women). In cardiovascular diseases, the impact of smoking is much smaller and about 6,000 deaths per year are associated with the use of tobacco. Since the early 1990s, the number of smoking-attributable death has been growing. Relatively, the share of men has not changed, but for 20 years of analysis the share of women has significantly increased from 5% to 9%. In all age groups, the share of smoking-related mortality has increased in the female population, especially in the 45-69 age range where mortality has been doubled. Surveys on the health of the Serbian population also confirm the trend of increasing the share of women smokers in the population, especially in the categories of young people. Men in Serbia (35-69 years of age) have the highest smoking-attributable death rate in Europe. As much as 44% of total deaths in that age are directly related to smoking. Besides Hungary, where mortality in men is also relatively high (42%), other countries have significantly lower shares. Observed at the level of the entire continent, countries of the Balkan Peninsula (and their neighbours) have the highest shares of smoking-attributable death. Women in Serbia have a moderately high share of 9% and are among the ten most vulnerable countries in Europe. The biggest difference in smoking-related mortality by gender is observed in the Pyrenees Peninsula and in the eastern and south-eastern parts of Europe. These are also the countries with the largest absolute difference in the mortality rate of men and women, thus confirming the hypothesis that tobacco smoke, as a single mortality factor, plays the most important role in establishing a different gender mortality pattern. A high percentage of smokers in the total population limits the growth of life expectancy and affects the difference in gender mortality rate. If a certain mortality factor potentially affects the life expectancy of up to three years for men in Serbia, as shown in the paper, then it is especially important to pay attention to measures of prevention and awareness of the population regarding this issue. Moreover, it is particularly important to recognise the consequences of passive smoking the youth and children are exposed to, since in Serbia there is a great deal of tolerance for smoking indoors.

The future of smoking-attributable mortality: the case of England & Wales, Denmark and the Netherlands.

We formally estimate future smoking-attributable mortality up to 2050 for the total national populations of England & Wales, Denmark and the Netherlands, providing an update and extension of the descriptive smoking-epidemic model. We used smoking prevalence and population-level lung cancer mortality data for England & Wales, Denmark and the Netherlands, covering the period 1950-2009. To estimate the future smoking-attributable mortality fraction (SAF) we: (i) project lung cancer mortality by extrapolating age-period-cohort trends, using the observed convergence of smoking prevalence and similarities in past lung cancer mortality between men and women as input; and (ii) add other causes of death attributable to smoking by applying a simplified version of the indirect Peto-Lopez method to the projected lung cancer mortality. The SAF for men in 2009 was 19% (44 872 deaths) in England & Wales, 22% (5861 deaths) in Denmark and 25% (16 385 deaths) in the Netherlands. In our projections, these fractions decline to 6, 12 and 14%, respectively, in 2050. The SAF for women peaked at 14% (38 883 deaths) in 2008 in England & Wales, and is expected to peak in 2028 in Denmark (22%) and in 2033 in the Netherlands (23%). By 2050, a decline to 9, 17 and 19%, respectively, is foreseen. Different indirect estimation methods of the SAF in 2050 yield a range of 1-8% (England & Wales), 8-13% (Denmark) and 11-16% (the Netherlands) for men, and 7-16, 12-26 and 13-31% for women. From northern European data we project that smoking-attributable mortality will remain important for the future, especially for women. Whereas substantial differences between countries remain, the age-specific evolution of smoking-attributable mortality remains similar across countries and between sexes.

Role of smoking in regional variation in mortality in Poland.

We assess the effect of smoking on regional disparities in mortality in Poland and its contribution to the change in regional disparities during the last two decades. We used population-level mortality data from the population registry for 379 Nomenclature of Territorial Units for Statistics (NUTS)-4 Polish regions for 1991-93 and 2008-10. The importance of smoking was assessed by smoking-attributable mortality (SAM) derived using a simplified indirect Peto-Lopez method. Regional differences in age-standardized all-cause, smoking- and non-smoking-attributable mortality (NSAM) rates at ages 35 years and over were mapped, and spatial clustering (Moran's I) and coefficients of variation (CV) were estimated. The contribution of SAM to variation in all-cause mortality was assessed by variance decomposition and compared over time. In 2008-10, all-cause and SAM rates were characterized by a similar pattern of spatial clustering (Moran's I > 0.44, P < 0.0001). For NSAM, a more random pattern with less regional clustering showed (Moran's I = 0.34, P < 0.0001). The contribution of smoking to regional variation was substantial [54%, 95% confidence interval (CI) = 44.9, 62.5 among men; 24.9%, 95% CI = 20.9, 29.1 among women], and compared with 1991-93, 27.5 percentage points lower for men and 6.3 percentage points higher for women. Smoking contributed to the divergence between the regions in all-cause mortality between 1991-93 and 2008-10 for men [increase in CV of SAM by 2% (0, 4%)], but not for women [decrease in CV of SAM by 15% (22, 10%)]. Differences in past smoking behaviour may largely explain the regional differences in all-cause mortality existing in 2008-10 in Poland, and its trends since 1991-1993.

Mortality attributable to smoking in Vietnamese men in 2008

ObjectiveSmoking prevalence among Vietnamese men is among the highest in the world. Our aim was to provide estimates of tobacco attributable mortality to support tobacco control policies. MethodWe used the Peto–Lopez method using lung cancer mortality to derive a Smoking Impact Ratio (SIR) as a marker of cumulative exposure to smoking. SIRs were applied to relative risks from the Cancer Prevention Study, Phase II. Prevalence-based and hybrid methods, using the SIR for cancers and chronic obstructive pulmonary disease and smoking prevalence for all other outcomes, were used in sensitivity analyses. ResultsWhen lung cancer was used to measure cumulative smoking exposure, 28% (95% uncertainty interval 24–31%) of all adult male deaths (>35years) in Vietnam in 2008 were attributable to smoking. Lower estimates resulted from prevalence-based methods [24% (95% uncertainty interval 21–26%)] with the hybrid method yielding intermediate estimates [26% (95% uncertainty interval 23–28%)]. ConclusionDespite uncertainty in these estimates of attributable mortality, tobacco smoking is already a major risk factor for death in Vietnamese men. Given the high current prevalence of smoking, this has important implications not only for preventing the uptake of tobacco but also for immediate action to adopt and enforce stronger tobacco control measures.

Application of the modified PGW method for determining the smoking attributable fraction of deaths in New Zealand Maori, Pacific and non-Maori non-Pacific populations

Background: Preston, Glei and Wilmoth recently proposed a new method for estimating smoking-attributable mortality in high income countries and an improvement to the method was proposed by Rostron. The method greatly simplifies estimation of smoking attributable fractions but additional testing has been recommended to validate the approach. Objective: We apply the Rostron (PGW-R) method to ethnic groups in New Zealand and compare the results with published estimates from other sources with the purpose of determining their consistency and exploring possible reasons for any divergence. Methods: Four different sources were identified with ethnic-specific estimates of smoking attributable mortality fractions (SAMF)for Maori, Pacific Island and European/Other ethnic groups in New Zealand for periods between 1995 and 1999. These employed a variety of direct and indirect estimation techniques. The results were compared with PGW-R method estimates for the same period and ethnic groups. Results: Although the PGW-R method produced SAMF estimates that were within 5% of those derived using the Peto-Lopez method for the European/other and total populations (in males and females), there were significant discrepancies between them in the Maori and Pacific SAMF estimates. Results using direct methods from a census linkage study were inconsistent with both the Peto-Lopez and the PGW-R method. Seven possible explanations for these discrepancies were considered and discussed but none could fully account for the differences. Conclusions: The results of this work raise questions not only about the validity of the PGW-R method, but also about the accuracy of the estimates derived from the Peto-Lopez and direct methods, at least in these populations. Further research should examine the applicability of the key assumptions of the PGW method. Other work to determine the effects of possible misclassification bias in the direct method estimates would also aid interpretation of these findings. Until then it would be prudent to use the PGW-R method cautiously when examining ethnic differences in SAMF. Comments: Accurate methods for determining the population health impact of smoking are vital for policy-makers to ensure that tobacco control is awarded the appropriate emphasis and resourcing.

Estimating the Effect of Smoking on Slowdowns in Mortality Declines in Developed Countries

Declines in mortality rates for females at older ages in some developed countries, including the United States, have slowed in recent decades even as decreases have steadily continued in some other countries. This study presents a modified version of the indirect Peto-Lopez method, which uses lung cancer mortality rates as a proxy for smoking exposure, to analyze this trend. The modified method estimates smoking-attributable mortality for more-specific age groups than does the Peto-Lopez method. An adjustment factor is also introduced to account for low mortality in the indirect method's study population. These modifications are shown to be useful specifically in the estimation of deaths attributable to smoking for females at older ages, and in the estimation of smoking-attributable mortality more generally. In a comparison made between the United States and France with the modified method, smoking is found to be responsible for approximately one-half the difference in life expectancy for females at age 65.

Explaining low mortality among US immigrants relative to native-born Americans: the role of smoking

In many developed countries, immigrants live longer-that is, have lower death rates at most or all ages-than native-born residents. This article tests whether different levels of smoking-related mortality can explain part of the 'healthy immigrant effect' in the USA, as well as part of the related 'Hispanic paradox': the tendency for US Hispanics to outlive non-Hispanic Whites. With data from vital statistics and the national census, we calculate lung cancer death rates in 2000 for four US subpopulations: foreign-born, native-born, Hispanic and non-Hispanic White. We then use three different methods-the Peto-Lopez method, the Preston-Glei-Wilmoth method and a novel method developed in this article-to generate three alternative estimates of smoking-related mortality for each of the four subpopulations, extrapolating from lung cancer death rates. We then measure the contribution of smoking-related mortality to disparities in all-cause mortality. Taking estimates from any of the three methods, we find that smoking explains >50% of the difference in life expectancy at 50 years between foreign- and native-born men, and >70% of the difference between foreign- and native-born women; smoking explains >75% of the difference in life expectancy at 50 years between US Hispanic and non-Hispanic White men, and close to 75% of the Hispanic advantage among women. Low smoking-related mortality was the main reason for immigrants' and Hispanics' longevity advantage in the USA in 2000.

A modified new method for estimating smoking-attributable mortality in high-income countries

Abstract Preston, Glei, and Wilmoth (2010) recently proposed an innovative regression-based method for estimating smoking-attributable mortality in developed countries based on observed lung cancer death rates. Their estimates for females, however, differ appreciably from some published estimates. This article presents a modified version of the Preston, Glei, and Wilmoth method that includes an age-period interaction term in its model. This modified version produces improved estimates of smoking-attributable mortality that are consistent with results from a modified version of the Peto-Lopez indirect method. (ProQuest: ... denotes formulae omitted.) 1. Introduction and review of existing methods for estimating smoking-attributable mortality Attention has recently been directed to methods that estimate smoking-attributable mortality because of their usefulness in examining the role of smoking in mortality differences among developed countries. Several studies have shown a divergence in mortality trends at older ages among developed countries in recent decades, particularly for females. Mesle and Vallin (2006) observed that life expectancy at age 65 for females increased only slightly from 1984 to 2000 in the U.S. and the Netherlands, even as female e65 increased steadily in France and Japan during this period. Janssen, Kunst, and Mackenbach (2007) found similar differences in mortality declines at ages 80 and over in seven European countries, with declines steadily continuing in France, but stagnating in countries such as Denmark and the Netherlands. They concluded that these differences among countries were largely due to differences in smoking-related mortality. The effect of previous cigarette smoking on these mortality trends deserves particular attention. Decades of medical and epidemiological research have demonstrated that cigarette smoking is the leading cause of preventable mortality in the U.S. and most other developed countries (DHHS 2000; Ezzati et al. 2002). More specifically, Staetsky (2009) recently showed that smoking is a principal cause of observed mortality differences among selected developed countries. Staetsky also used the indirect Peto-Lopez method to estimate mortality in these countries in the absence of smoking-attributable deaths. Various methods have been proposed and used to measure smoking-attributable mortality in populations. Perez-Rios and Montes (2008) provided a useful systematic review of these methods. They found that two general types of methods were most commonly used in the research literature. Both types of methods generally calculate the fraction of deaths in a population that are attributable to smoking (smoking-attributable fraction or SAF). The first group of methods, which Perez-Rios and Montes called analysis, calculate SAF from data for current and former smoker prevalence, usually obtained from surveys, and relative risks for smoking, usually obtained from prospective cohort studies, such as the American Cancer Society's Cancer Prevention Study II (CPS II). Perez-Rios and Montes cited the method used by the U.S. Centers for Disease Control and Prevention (CDC) to estimate smoking-attributable mortality as an example of a prevalence-based analysis. The CDC method (2008) estimates adult smoking-attributable mortality using current and former smoker prevalence data from the National Health Interview Survey (NHIS), with relative risks for 19 causes obtained from the CPS-II. It estimates infant smoking-attributable mortality using maternal smoking prevalence from birth certificate data and relative risks for four causes for infants of mothers who smoke obtained from a meta-analysis of epidemiologic studies. Separate methods are used by the CDC to estimate smoking-attributable mortality due to secondhand smoke and burns. Perez-Rios and Montes identified the indirect method presented by Peto et al. (1992, 1994) as the other commonly used method for estimating smoking-attributable mortality. …

A new method for estimating smoking-attributable mortality in high-income countries

Cigarette smoking is responsible for a massive loss of life in both developed and developing countries. This article develops an alternative to the Peto-Lopez method for estimating the number or fraction of smoking-attributable deaths in high-income countries. We use lung cancer death rates as an indicator of the damage caused by smoking. Using administrative data for the population aged > or =50 years from 20 high-income countries in the period from 1950 to 2006, we estimate a negative binomial regression model that predicts mortality from causes other than lung cancer as a function of lung cancer mortality and other variables. Using this regression model, we estimate smoking-attributable deaths based on the difference between observed death rates from lung cancer and expected rates among non-smokers. Combining the estimated number of excess deaths from lung cancer with those from other causes, we find that among males in 1955 the smoking-attributable fraction was highest in Finland (18%); among women, no country exceeded 1%. By 2003, Hungary had the highest fraction of smoking-attributable deaths among males (32%), whereas the USA held that position among women (24%). Our estimates are remarkably similar to those produced by the Peto-Lopez method, a result that supports the validity of each approach. We provide a simple and straightforward method for estimating the proportion of deaths attributable to smoking in high-income countries. Our results demonstrate that smoking has played a central role in levels, trends and international differences in mortality over the past half century.