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Cancer deaths attributable to cigarette smoking in 152 U.S. metropolitan or micropolitan statistical areas, 2013–2017

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Abstract

Purpose

There are limited data on the burden of cancer attributable to cigarette smoking by metropolitan areas to inform local tobacco control policies in the USA. We estimated the proportion of cancer deaths attributable to cigarette smoking (or population attributable fraction [PAF]) in 152 U.S. metropolitan or micropolitan statistical areas (MMSAs).

Methods

Smoking-related PAFs for cancer mortality in ages ≥ 30 years in 2013–2017 were estimated using cross-sectional age-, sex-, and MMSA-specific cigarette smoking prevalence and cancer mortality data obtained from the Behavioral Risk Factor Surveillance System and the U.S. Cancer Statistics Database, respectively.

Results

Overall smoking-related PAFs of cancer ranged from 8.8% (95% CI, 6.3–11.9%) to 35.7% (33.3–37.9%); MMSAs with the highest PAFs were in the South region and Appalachia. PAFs also substantially varied across MMSAs within regions or states. In the Northeast, for example, the PAF ranged from 24.2% (23.7–24.7%) to 33.7% (31.3–36.2%).

Conclusion

The proportion of cancer deaths attributable to cigarette smoking is considerable in each MMSA, with as many as 4 in 10 cancer deaths attributable to smoking in the South region and Appalachia. Broad and equitable implementation and enforcement of proven tobacco control interventions at all government levels could avert many cancer deaths across the USA.

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Fig. 1

Data availability

The data that support the findings of this study are available from the Behavioral Risk Factor Surveillance System (reference number 10) and U.S. Cancer Statistics Public Use database (reference number 11).

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Funding

This work was supported by the Intramural Research Department of the American Cancer Society (no grant numbers apply).

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Authors and Affiliations

Authors

Contributions

JI: Study concept and design, BI: Acquisition of data, Islami: Statistical analysis and drafting of the manuscript, Sahar: Map compilation, All authors: Interpretation of data and critical revision of the manuscript for important intellectual content.

Corresponding author

Correspondence to Farhad Islami.

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Conflict of interest

All authors were employed by the American Cancer Society while this work was conducted. The American Cancer Society receives grants from private and corporate foundations, including foundations associated with companies in the health care sector for research outside of the submitted work. The authors were not funded by any of these grants and their salaries were solely funded through American Cancer Society funds. All authors have nothing else to declare.

Ethical approval

This study was based on government-issued, deidentified, public use data and did not require institutional review board approval.

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Islami, F., Bandi, P., Sahar, L. et al. Cancer deaths attributable to cigarette smoking in 152 U.S. metropolitan or micropolitan statistical areas, 2013–2017. Cancer Causes Control 32, 311–316 (2021). https://doi.org/10.1007/s10552-020-01385-y

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  • DOI: https://doi.org/10.1007/s10552-020-01385-y

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