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The Contribution of Smoking to Black-White Differences in U.S. Mortality

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Demography

Abstract

Smoking has significantly impacted American mortality and remains a major cause of morbidity and mortality. No previous study has systematically examined the contribution of smoking-attributable deaths to mortality trends among blacks or to black-white mortality differences at older ages over time in the United States. In this article, we employ multiple methods and data sources to provide a comprehensive assessment of this contribution. We find that smoking has contributed to the black-white gap in life expectancy at age 50 for males, accounting for 20 % to 48 % of the gap between 1980 and 2005, but not for females. The fraction of deaths attributable to smoking at ages above 50 is greater for black males than for white males; and among men, current smoking status explains about 20 % of the black excess relative risk in all-cause mortality at ages above 50 without adjustment for socioeconomic characteristics. These findings advance our understanding of the contribution of smoking to contemporary mortality trends and differences and reinforce the need for interventions that better address the needs of all groups.

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Notes

  1. These sites are the kidney, larynx, liver, lung, bone marrow, nasal cavity and paranasal sinuses, nasopharynx, oro- and hypopharynx, esophagus, oral cavity, pancreas, stomach, ureter, urinary bladder, and uterine cervix (IARC 2004).

  2. Quit rates are calculated from a question asking respondents how long it had been since they last smoked regularly. The authors estimated a survival model using age at cessation as time of event and a base population of all ever-smokers in a given birth cohort/race/gender subgroup. Only respondents who had successfully quit at least two years prior to a survey were counted as having events in order to minimize the inclusion of failed quit attempts.

  3. “Never-smokers” are defined as those who reported smoking less than 100 cigarettes in their lifetimes.

  4. The median value in the open-ended category is estimated using the Pareto curve. The slope of this curve, v, is estimated as \( {{{\left[ {\log \left( {{n_t} + {n_{t - 1}}} \right) - \log \left( {{n_t}} \right)} \right]}} \left/ {{\left[ {\log \left( {{x_t}} \right) - \log \left( {{x_{t - 1}}} \right)} \right]}} \right.} \), where n t is the number of people in the open-ended (last) income category, n t – 1 is the number of people in the next-to-last income category, x t is the lower bound of the open-ended income category, and x t – 1 is the lower bound of the next-to-last income category. The median value for the open-ended category is then estimated as 10(0.301 / v) × x t .

  5. (1.49 – 1.39) / (1.49 – 1.00) = .20.

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Acknowledgments

This work was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development (R21HD060175) and the National Science Foundation Graduate Research Fellowship (Grant No. DGE-0822). We would like to thank Neil Mehta, Sam Preston, Hans-Peter Kohler, Mark Hayward, and three anonymous reviewers for comments on earlier drafts of this article.

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  1. Population Studies Center, University of Pennsylvania, 239 McNeil Building, 3718 Locust Walk, Philadelphia, PA, 19104-6298, USA

    Jessica Y. Ho & Irma T. Elo

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Ho, J.Y., Elo, I.T. The Contribution of Smoking to Black-White Differences in U.S. Mortality. Demography 50, 545–568 (2013). https://doi.org/10.1007/s13524-012-0159-z

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