Cigarette Smoking-Attributable Mortality and Years of Potential Life Lost -- United States, 1990

Cigarette smoking is the single most preventable cause of premature death in the United States (1). An estimated 390,000 smoking-attributable deaths in the United States occurred in 1985 (1), and more than 434,000 deaths occurred in 1988 (2); in 1988, an estimated 1,198,887 years of potential life lost (YPLL) before age 65 were attributed to smoking (2). To estimate the national impact of cigarette smoking on mortality and YPLL, calculations were performed using the Smoking-Attributable Mortality, Morbidity, and Economic Cost (SAMMEC) software (3). This report summarizes the results of this analysis.

SAMMEC uses attributable risk formulas to estimate the number of deaths from neoplastic, cardiovascular, respiratory, and pediatric diseases associated with cigarette smoking (3). Estimates for adults (aged greater than or equal to 35 years) and infants (aged less than 1 year) were based on 1990 mortality data, the 1990 prevalence of cigarette smoking among adults, and 1989 data on smoking prevalence among pregnant women from CDC's National Center for Health Statistics (4,5; CDC, unpublished data, 1993). The number of burn deaths was obtained from the National Fire Protection Association (6), and estimates of lung cancer deaths from environmental tobacco smoke (ETS) among nonsmokers were obtained from an Environmental Protection Agency report (7). The YPLL to age 65 years and to life expectancy were calculated using standard methodology (3), and smoking-attributable mortality (SAM) and YPLL rates were age-adjusted to the 1980 U.S. population to allow more accurate comparisons with 1988 SAM and YPLL.

During 1990, 418,690 U.S. deaths (approximately 20% of all deaths) were attributed to smoking (Table 1). Overall, approximately twice as many deaths occurred among males as among females. A total of 179,820 of these deaths resulted from cardiovascular diseases; 151,322*, neoplasms; 84,475, respiratory diseases; and 1711, diseases among infants. Lung cancer (119,920 deaths*), ischemic heart disease (98,921 deaths), and chronic airway obstruction (48,982 deaths) accounted for the most deaths; combined, these conditions were responsible for 64.0% of all SAM.

Cigarette smoking resulted in 1,152,635 YPLL before age 65 years and 5,048,740 YPLL to life expectancy (Table 2). Compared with SAM and YPLL during 1988 (2), SAM declined by 3.6% and YPLL to age 65 years by 3.9% during 1990. SAM rates, total YPLL, and YPLL rates were higher for males than for females.

Reported by: Public Health Practice Program Office; Epidemiology Br, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: The slight decline in SAM during 1990 compared with 1988 primarily reflects the 10.4% decline in deaths from cardiovascular disease. The rate of these deaths in the United States has decreased substantially since 1968 (8). In contrast, deaths from lung cancer increased by 4.4% and deaths from chronic obstructive pulmonary disease by 4.8%. SAM from these two conditions continue to increase because of the long latency period between the onset of smoking and the development of disease.

The higher SAM and larger number of YPLL among males is consistent with previous reports (1,2). Men in the United States are more likely to smoke and to smoke more cigarettes per day than women (1,4). However, the smoking prevalence among men has declined substantially since 1965 (1). The smoking prevalence among women, after increasing in the 1960s, also has declined since the late 1970s (1). Therefore, future estimates of SAM and YPLL will most likely indicate a smaller difference between men and women.

The SAM and YPLL described in this report may be underestimated for at least four reasons. First, these estimates are based on current smoking prevalence data, whereas most smoking-attributable deaths during 1990 resulted from the higher smoking prevalence during earlier decades (2). Second, the SAM estimate for infants may be substantially underestimated because previous research suggests that approximately 10% of the 38,351 infant deaths that occurred during 1990 may be attributable to smoking (1,9). Third, the SAM estimates do not include deaths from other conditions, such as leukemia (2) and peptic ulcer disease (1), that also may be associated with smoking. Finally, these estimates do not include mortality caused by cigar smoking, pipe smoking, or smokeless tobacco use. The SAM and YPLL estimates in this report are not adjusted for confounders (e.g., alcohol), which may lower the estimates for laryngeal and certain upper gastrointestinal cancers (1).

The decrease in the prevalence of cigarette smoking since the 1960s has contributed to the decline in SAM (1,4). Maintaining this decline will require continued reduction in the prevalence of smoking. The human and economic costs associated with smoking require continued vigorous efforts to prevent the initiation of smoking, to encourage smoking cessation, and to protect nonsmokers from the adverse effects of ETS. Because many factors influence both smoking initiation and smoking cessation, multiple approaches are necessary (1) including 1) school-based health education; 2) reducing minors' access to tobacco products; 3) more extensive counseling by health-care providers about smoking cessation; 4) developing and enacting strong, clean indoor air policies and laws; 5) restricting or eliminating advertising targeted toward persons aged less than 18 years (10); and 6) increasing tobacco excise taxes.

References

1. CDC. Reducing the health consequences of smoking: 25 years of progress -- a report of the Surgeon General, 1989. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1989; DHHS publication no. (CDC)89-8411.

2. CDC. Smoking-attributable mortality and years of potential life lost -- United States, 1988. MMWR 1991;40:62-3,69-71.

3. Shultz JM, Novotny TE, Rice DP. Smoking-Attributable Mortality, Morbidity, and Economic Cost (SAMMEC) version 2.1 {Software and documentation}. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, 1992.

4. CDC. Cigarette smoking among adults -- United States, 1990. MMWR 1992;41:354-5,361-2.

5. CDC. Pregnancy risks determined from birth certificate data -- United States, 1989. MMWR 1992;41:556-63.

6. Miller AL. The U.S. smoking-material fire problem through 1990: the role of lighted tobacco products in fire. Quincy, Massachusetts: National Fire Protection Association, 1993.

7. US Environmental Protection Agency. Respiratory health effects of passive smoking: lung cancer and other disorders. Washington, DC: US Environmental Protection Agency, Office of Health and Environmental Assessment, Office of Atmospheric and Indoor Air Programs, 1992; publication no. EPA-600/6-90/006F.

8. American Heart Association. 1993 Heart and stroke facts statistics. Dallas: American Heart Association, 1992.

9. NCHS. Advance report of final mortality statistics, 1990. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1993. (Monthly vital statistics report; vol 41, no. 7, suppl).

10. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

• Includes deaths from ETS.

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