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Estimating Smoking-Attributable Mortality in the United States

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Demography

Abstract

Tobacco use is the largest single cause of premature death in the developed world. Two methods of estimating the number of deaths attributable to smoking use mortality from lung cancer as an indicator of the damage from smoking. We reestimate the coefficients of one of these, the Preston/Glei/Wilmoth model, using recent data from U.S. states. We calculate smoking-attributable fractions for the 50 states and the United States as a whole in 2004, and estimate the contribution of smoking to the high adult mortality of the southern states. We estimate that 21% of deaths among men and 17% among women were attributable to smoking in 2004. Across states, attributable fractions range from 11% to 30% among men and from 7% to 23% among women. Smoking-related mortality also explains as much as 60% of the mortality disadvantage of southern states compared with other regions. At the national level, our estimates are in close agreement with those of the Centers for Disease Control and Prevention and Preston/Glei/Wilmoth, particularly for men, although we find greater variability by state than does CDC. We suggest that our coefficients are suitable for calculating smoking-attributable mortality in contexts with relatively mature epidemics of cigarette smoking.

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Notes

  1. 2004 is the latest year for which geographic identifiers below the national level are available in the public-use version of the MCD files.

  2. Retrieved online from the NCHS (http://www.cdc.gov/nchs/nvss/bridged_race.htm).

  3. Because the lung cancer death rate is the chief input for the calculation of the attributable fraction, the correlation between the age-adjusted lung cancer death rate and the attributable fraction across states is very high (0.97 among women, and 0.99 among men). The attributable fraction is a more meaningful measure of the burden of smoking than simple lung cancer mortality because it accounts for various other causes of death for which smoking is a risk factor (Preston et al 2010a).

  4. We elect to simply remove smoking deaths from the life table calculation as opposed to using cause-deleted life tables to preserve the simplicity of interpretation. The results do not change substantively.

  5. However, the CDC estimates used the current prevalence of smoking to make attributable-risk estimates, which does not accurately reflect the mortality burden of smoking. Depending on yearly changes in the prevalence of smoking, though, this may offset some of the downward bias from the use of baseline relative risks.

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Acknowledgements

This research was supported by National Institutes of Health fellowship 1-F31-AG-039188-01, and Grant from Social Security Administration and National Bureau of Economic Research. We are grateful to Andrew Noymer and Douglas Ewbank for comments and critiques. An earlier version of this paper was presented at the annual meeting of the Population Association of America in Dallas, TX, April 15–17, 2010.

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

    Andrew Fenelon

  2. Population Studies Center, University of Pennsylvania, Pennsylvania, USA

    Samuel H. Preston

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  1. Andrew Fenelon
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Correspondence to Andrew Fenelon.

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Fenelon, A., Preston, S.H. Estimating Smoking-Attributable Mortality in the United States. Demography 49, 797–818 (2012). https://doi.org/10.1007/s13524-012-0108-x

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