Smoking-attributable Deaths Research Articles

Modeling the future effects of a menthol ban on smoking prevalence and smoking-attributable deaths in the United States.

We used a validated smoking simulation model and data from the 2003 Tobacco Use Supplement to the Current Population Survey to project the impact that a US menthol ban would have on smoking prevalence and smoking-attributable deaths. In a scenario in which 30% of menthol smokers quit and 30% of those who would have initiated as menthol smokers do not initiate, by 2050 the relative reduction in smoking prevalence would be 9.7% overall and 24.8% for Blacks; deaths averted would be 633,252 overall and 237,317 for Blacks.

Smoking-attributable Mortality in the United States

Various methods are used to estimate smoking-attributable mortality, but these methods often produce differing results. Most do not provide estimates for specific age groups or directly control for confounding factors. US smoking-attributable mortality by age is estimated here based on relative mortality hazards for smokers and observed death rates for never-smokers. Hazard ratios for smokers are estimated through survival analysis of data from adults in the 1997-2004 National Health Interview Survey, followed for mortality through the end of 2006. A variety of possible confounding risk factors are controlled for in the analysis. There were an estimated 291,000 smoking-attributable deaths among men and 229,000 such deaths among women annually in the United States from 2002 through 2006. These figures are generally consistent with, but somewhat higher than, published estimates from the Centers for Disease Control and Prevention, particularly for women. This method provides reasonable estimates of total and age-specific smoking-attributable mortality in the United States that include controls for potential confounding factors.

How many deaths are attributable to smoking in the United States? Comparison of methods for estimating smoking-attributable mortality when smoking prevalence changes

Background The number of smoking-attributable deaths is commonly estimated using current and former smoking prevalences or lung cancer mortality as an indirect metric of cumulative population smoking. Neither method accounts for differences in the timing with which relative risks (RRs) for different diseases change following smoking initiation and cessation. We aimed to develop a method to account for time-dependent RRs. Methods We used birth cohort lung cancer mortality and its change over time to characterize time-varying cumulative smoking exposure. We analyzed data from the American Cancer Society Cancer Prevention Study II to estimate RRs for disease-specific mortality associated with current and former smoking, and change in RRs over time after cessation. Results When lung cancer was used to measure cumulative smoking exposure, 254,700 male and 227,000 female deaths were attributed to smoking in the US in 2005. A modified method in which RRs for different diseases decreased at different rates after cessation yielded similar but slightly lower estimates [251,900 (male) and 221,100 (female)]. The lowest estimates resulted from the method based on smoking prevalence [225,800 (male) and 163,700 (female)]. Conclusions Although all methods estimated a large number of smoking attributable deaths, future efforts should account for temporal changes in smoking prevalence and in accumulation/reversibility of disease-specific risks.

Mortalidad atribuible al consumo de tabaco en España en 2006

This study estimates smoking-attributable mortality in Spain in 2006.Source data included 1) smoking prevalence in Spain; 2) deaths occurred in Spain; and 3) relative risks of mortality by tobacco-caused diseases drawn from the Cancer Prevention Study II. All data corresponded to individuals aged 35 years and older.In 2006, 53,155 smoking-attributable deaths were estimated (14.7% of all deaths occurred in individuals≥35 years; 25.1% in men and 3.4% in women). Almost 90% (47,174) of these attributable deaths corresponded to men, and 11.3% (5,981) to women. The most frequent attributable deaths were: cancer (24,058), specially lung cancer (16,482), cardiovascular disease (17,560), specially ischemic heart disease (6,263) and stroke (4,283), and respiratory disease (11,537), specially chronic obstructive lung disease (9,886). Since 2001, a decrease in smoking-attributable mortality was observed in men and an increase in women.About one out of 7 deaths occurring annually in individuals≥35 years in Spain is attributable to smoking (one in 4 in men and one in 29 in women). Despite a decreasing trend in the number of smoking-attributable deaths over time (except in women, where they increase), the toll of estimated attributable deaths is still very high.

Tobacco and the escalating global cancer burden.

The global burden of cancer is escalating as a result of dramatic increases in the use of tobacco in the developing world. The use of tobacco is linked to the development of a broad variety of cancers, mainly lung cancer, the single most common cancer in the world. Tobacco smoking-attributable deaths extends beyond cancer and include stroke, heart attack and COPD. Widening disparities in cancer-related mortality have shifted towards a more dramatic burden in the developing world. Appropriate interventions must be implemented to reduce tobacco use and prevent global mortality that has escalated to epidemic levels. Tobacco control policies, including public health advertisement campaigns, warning labels, adoption of smoke-free laws, comprehensive bans and tax policies are highly effective measures to control tobacco use. Clinicians and academic institutions have to be actively committed to support tobacco control initiatives. The reduction in cancer related morbidity and mortality should be viewed as a global crisis and definitive results will depend on a multilevel effort to effectively reduce the burden of cancer, particularly in underprivileged regions of the world.

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. …

Tabakattributable Mortalität in Deutschland und in den deutschen Bundesländern - Berechnungen mit Daten des Mikrozensus und der Todesursachenstatistik

Smoking is the single most important health risk, and annually about five million premature deaths worldwide are attributed to smoking. The aim of this study is to estimate the number of smoking attributable deaths for Germany and its 16 states (Länder) and to assess the regional differences of smoking prevalence and smoking-attributable mortality. The smoking-attributable mortality is estimated on the basis of (1) smoking and ex-smoking prevalence, (2) the number of deaths by ICD-10 for diseases for which smokers have an increased mortality risk, and (3) the relative mortality risks for smokers and ex-smokers for these diseases. According to the calculations, 106 623 deaths in Germany in 2007 are attributable to smoking, 77 588 deaths in men and 29 035 in women. This means that 13% of all deaths of people over 35 and of children under age 1 are attributable to smoking (20.2% in men, 6.7% in women). The state-specific differences of the smoking-attributable mortality rate indicate a north-south-gradient. This gradient is more significant in men, whereas in women there are also some eastern states with a low smoking-attributable mortality. Overall, there is still a high burden of tobacco-related deaths in Germany which leads to considerable costs for the German health system and economy.

Smoking-attributable cancer mortality in California, 1979–2005

BackgroundThe adult smoking prevalence has declined more in California than the rest of the US in the past 2 decades. Further, California has faster declines in cancer mortality, lung cancer...

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.

Clinical utility of varenicline for smokers with medical and psychiatric comorbidity

Chronic obstructive pulmonary disease (COPD) is a costly and deadly disease afflicting an estimated 210 million people and accounting for 5% of all global deaths. Exposure to cigarette smoke is the greatest risk factor for COPD in the developed world. Smoking cessation improves respiratory symptoms and lung function and reduces mortality among patients with COPD. Cigarette smokers with COPD and other co-morbid conditions such as cardiovascular disease and psychiatric illnesses should receive comprehensive tobacco treatment interventions incorporating efficacious pharmacotherapies. Varenicline, an alpha(4)beta(2) nicotinic acetylcholine receptor partial agonist, is the newest and most effective drug currently available to promote smoking cessation. In conjunction with behavioral interventions and clinical monitoring for potential side effects, varenicline offers great hope for reducing smoking-attributable death and disability.

Smoking-attributable deaths and potential years of life lost from a large, representative study in China

ObjectivesTo provide a more accurate estimate of early smoking-attributable mortality and potential years of life lost using data from a representative study of 103 study areas in China.MethodsTwo datasets were...

Issues in estimating smoking attributable mortality in Israel

The US Centres for Disease Control provides a widely used online user-friendly computational program, called SAMMEC (Smoking Attributable Mortality, Morbidity and Economic Costs) to produce estimates of tobacco-related mortality. However, the SAMMEC tool loses accuracy because it lacks flexibility in deciding which diseases enter into the calculations, has estimates of relative risk (RR) attributable to smoking based on old studies, and does not allow for the latency period that occurs between initial exposure and mortality. Smoking attributable mortality (SAM) due to active smoking in Israel was estimated with the approach used by SAMMEC taking into account past and present smoking prevalence (lag-times) as well as using new and expanded disease categories. Around 50.3% of the increase from the un-lagged SAM estimate of 3859 deaths to the final SAM estimate of 8664 deaths in 2003 is attributable to the introduction of lag times. More robust estimates of risk accounted for a further 29.6% of the increase. While 21.2% is attributable to the inclusion of additional disease categories, only 1.5% was attributable to the widening of existing diseases categories. This difference in estimates is attributable to expansion of the list of diseases included, updating the estimates of RR for smoking-attributable death, and the use of smoking prevalence from previous years to more accurately reflect the effect of tobacco use on disease occurrence. There is a need to establish an 'authority' to implement a multi-faceted intervention strategy to decrease the considerable burden from smoking in Israel.

Smoking and Ischemic Heart Disease Disparities Between Studies, Genders, Times, and Socioeconomic Strata

Large, unexplained, but possibly related disparities exist between heart disease risks observed in differing genders, educational levels, times, and studies. Such heart disease disparities might be related to cumulative tobacco smoke damage (smoke load) disparities that are overlooked in standard assessments of point smoking status. So, I reviewed possible relationships between smoke load and heart disease levels across genders, educational strata, years, and leading studies. Smoker heart disease risk assessments in the Nurses Health Study (Nurses), Cancer Prevention Study-II (CPS-II), and British Doctors studies were compared and related to their likely selection and misclassification biases. Relationships between smoke loads and United States (US) education- and gender-related heart disease mortality disparities were qualitatively assessed using lung cancer rates as a smoke load proxy. The high heart disease mortality risks observed in smoking Nurses in 1980–2004 and in less educated US women in 2001 were qualitatively associated with their higher smoke loads and lower selection and exposure misclassification biases than in the CPS-II and Doctors studies. Smoking-attributable heart disease death tolls and disparities extrapolated from mortality ratios from the CPS-II and Doctors studies may be substantial underestimates. Such studies appear to have compared convenience samples of light smokers to lighter smokers instead of comparing representative smokers to the unexposed. Further efforts to minimize smoke exposures and better quantify cumulative smoking-attributable burdens are needed.

Smoking-attributable mortality and years of potential life lost in 16 Brazilian capitals, 2003: a prevalence-based study

BackgroundTo establish the impact of tobacco smoking on mortality is essential to define and monitor public health interventions in developing countries.MethodsThe Smoking-Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software was used to estimate the smoking attributable mortality (SAM) in 15 Brazilian State Capitals and the Federal District for the year 2003. Smoking prevalence and mortality data of people aged 35 years or older were obtained for each city from the Brazilian Household Survey on Non Communicable Diseases Risk Factors (2002–2003) and from the Brazilian Mortality System (2003), respectively.ResultsIn 2003, of the 177,543 deaths of persons aged 35 years and older 24,222 (13.64%) were attributable to cigarette smoking. This total represents 18.08% of all male deaths (n = 16,896) and 8.71% (n = 7,326) of all female deaths in these cities. The four leading causes of smoking-attributable death were chronic airways obstruction (4,419 deaths), ischemic heart disease (4,417 deaths), lung cancer (3,682 deaths), and cerebrovascular disease (3,202 deaths). Cigarette smoking accounted for 419,935 years of potential life lost (YPLL) (279,990 YPLL for men and 139,945 YPLL for women) in the same period.ConclusionTobacco use caused one out of five male deaths and one out of ten female deaths in the sixteen cities in 2003. Four leading causes of smoking attributable deaths (ischemic heart disease, chronic airways obstruction, lung cancer and cerebrovascular disease) accounted for 64.9% of SAM. Effective and comprehensive actions must be taken in order to slow this epidemic in Brazil.

Lung cancer mortality: Comparing Sweden with other countries in the European Union

To describe how snus use has reduced smoking among men in Sweden, and to estimate how smoking-attributable lung cancer mortality would decline in other European Union countries if they had the smoking prevalence of Sweden. Lung cancer mortality rates (LCMRs) and numbers of deaths among men and women age 45+ years in 25 EU countries in 2002 were obtained from the World Health Organization mortality database, and the number of lung cancer deaths expected in each country at the LCMR of Sweden was calculated. LCMRs for EU countries were obtained during the period 1950-2004, and per capita consumption of nicotine from cigarettes and snus was estimated for men in Sweden from 1931 to 2004. There were 172,000 lung cancer deaths among men in the EU in 2002. If all EU countries had the LCMR of men in Sweden, there would have been 92,000 (54%) fewer deaths. In contrast, the LCMR among Swedish women was the sixth highest in the EU; at the Swedish rate, deaths among EU women would have increased by 14,500 (26%). These LCMR patterns were in place for most of the last 50 years, and LCMRs among Swedish men can be correlated with snus and cigarette consumption. This study shows that snus use has had a profound effect on smoking prevalence and LCMRs among Swedish men. While it cannot be proven that snus would have the same effect in other EU countries, the potential reduction in smoking-attributable deaths is considerable.

The Role of Tobacco Control Policies in Reducing Smoking and Deaths Caused by Smoking in an Eastern European Nation: Results from the Albania SimSmoke Simulation Model

The Albania SimSmoke simulation model is used to examine the effects of tobacco control policies. The model is used to consider the projected trends in smoking prevalence and associated smoking-attributable deaths in the absence of new policies, and then to examine the effect of new policies that are consistent with the Framework Convention for Tobacco Control (FCTC) on these outcomes. The model shows that significant inroads to reducing smoking prevalence and premature mortality can be achieved through tax increases. Acomprehensive strategy to further reduce smoking rates should include a media campaign complete with programs to publicize and enforce clean air laws, a comprehensive cessation treatment program, strong health warnings, advertising bans, and youth access laws. Besides presenting the benefits of a comprehensive tobacco control strategy, the model helps to identify important information needed for both modeling and policymaking. The effectiveness of future tobacco control policy will require proper surveillance and evaluation schemes for Albania.

The Kentucky SimSmoke Tobacco Policy Simulation Model: Reaching Healthy People 2010 Goals Through Policy Change

Healthy People (HP) 2010 has a goal of reducing adult smoking prevalence to 12% by 2010. Kentucky, with the highest adult smoking rates (28.7% versus a US average of 20.9%) and weak tobacco control policies, has the potential to reduce smoking by implementing stricter policies. The SimSmoke tobacco control policy model is applied to Kentucky, validated over 1993 to 2003. Smoking prevalence evolves over time through initiation and cessation, as behaviors influenced by tobacco control policies. SimSmoke predicts well over the pre-2007 period, including larger annual decreases in latter years. With policies suggested by HP 2010 goals, smoking prevalence is projected to fall to about 19% by 2011 and 14% by 2026; more than 17,000 smoking-attributable deaths would be avoided by 2026. SimSmoke suggests policies can have a large impact on smoking rates and save lives in Kentucky. If HP 2010 goals will be met, states such as Kentucky need to implement strong tobacco control policies.

The role of tobacco control policies in reducing smoking and deaths in a middle income nation: results from the Thailand SimSmoke simulation model

Objectives:With the male smoking prevalence near 60% in 1991, Thailand was one of the first Asian nations to implement strict tobacco control policies. However, the success of their efforts has...

Population attributable fraction of mortality associated with tobacco smoking in Japan: a pooled analysis of three large-scale cohort studies.

BackgroundQuantitative measures of the burden of tobacco smoking in Asian countries are limited. We estimated the population attributable fraction (PAF) of mortality associated with smoking in Japan, using pooled data from three large-scale cohort studies.MethodsIn total, 296,836 participants (140,026 males and 156,810 females) aged 40-79 years underwent baseline surveys during the 1980s and early 1990s. The average follow-up period was 9.6 years. PAFs for all-cause mortality and individual tobacco-related diseases were estimated from smoking prevalence and relative risks.ResultsThe prevalence of current and former smokers was 54.4% and 25.1% for males, and 8.1% and 2.4% for females. The PAF of all-cause mortality was 27.8% [95% confidence interval (CI): 25.2-30.4] for males and 6.7% (95% CI: 5.9-7.5) for females. The PAF of all-cause mortality calculated by summing the disease-specific PAFs was 19.1% (95% CI: 16.0-22.2) for males and 3.6% (95% CI: 3.0-4.2) for females. The estimated number of deaths attributable to smoking in Japan in 2005 was 163,000 for males and 33,000 for females based on the former set of PAFs, and 112,000 for males and 19,000 for females based on the latter set. The leading causes of smoking-attributable deaths were cancer (61% for males and 31% for females), ischemic heart diseases and stroke (23% for males and 51% for females), and chronic obstructive pulmonary diseases and pneumonia (11% for males and 13% for females).ConclusionThe health burden due to smoking remains heavy among Japanese males. Considering the high prevalence of male current smokers and increasing prevalence of young female current smokers, effective tobacco controls and quantitative assessments of the health burden of smoking need to be continuously implemented in Japan.

Declining mortality from smoking in the United States

The proportion of Americans who smoke cigarettes has declined 50% since 1965. The effect on mortality of this considerable reduction has received little attention and is described in this study. U.S. national data were used to enumerate current, former, and never-smokers aged 35 years or older in 1987 and 2002. Mortality rate ratios were used to estimate smoking-attributable deaths among these groups, and corresponding age-adjusted smoking-attributable mortality rates (SAMRs) were calculated. There were 402,000 deaths attributable to smoking in 1987 and 322,000 in 2002. The SAMR for men aged 35 years or more was 556 deaths per 100,000 person-years in 1987, accounting for 24% of all male deaths. By 2002 the SAMR declined 41% to 329 and accounted for only 17% of deaths. The SAMR for women in 1987 was 175, accounting for 12% of deaths. By 2002 the SAMR among women had declined 30% to 122, representing 9% of deaths. The U.S. mortality rate attributable to smoking declined about 35% between 1987 and 2002. The impact of smoking on American society will diminish even further in the foreseeable future as smoking prevalence continues its decline among men and women.