Smoking-attributable mortality and years of potential life lost — United States, 1988

Putient Educution and Counseling.

Elsevier Scientific

Publishers

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Ireland

( 199 1) 75-83

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Ltd.

Facts and Trends Smoking-Attributable

Mortality and Years of Potential Life Lost - United States, 1988

Smoking is a leading cause of diseases associated with premature mortality in the United States; in 1985, these diseases accounted for an estimated 390,000 premature deaths [l]. In this report, mortality data and estimates of smoking prevalence for 1988 are used to calculate smokingattributable mortality (SAM), years of potential life lost (YPLL), and age-adjusted SAM and YPLL rates for the United States [2]. Calculations were performed using SmokingAttributable Mortality, Morbidity, and Economic Cost (SAMMEC II) software (21, which includes relative risk estimates for 22 adult (i.e., 2 35 years of age) smoking-related diseases and relative risk estimates for four perinatal (i.e., < 1 year of age) conditions (Table 1). Age-, sex-, and race-specific mortality data for I988 were obtained from CDC’s National Center for Health Statistics. Data on burn deaths caused by cigarettes were obtained from the Federal Emergency Management Agency [3]. The estimated number of deaths among nonsmokers from lung cancer attributable to passive smoking was obtained from a report of the National Academy of Sciences [4]. Age-, sex-, and and former smoking current race-specific prevalence rates in 1988 for adults aged 2 35 years and for women aged 18-44 years were estimated by linear extrapolation using National Health Interview Survey data for 1974- 1987 [ 1,5].

before age 65 (6,028,OOO before age 85) were attributable to cigarette smoking (Tables I and 2). Although SAM for blacks represented 11% of total SAM, the SAM rate for blacks was 12% higher than for whites. The SAM for men was 66% of total SAM, and the SAM rate for men was more than twice the rate for women (Tables 2 and 3). In addition, the rate of smoking-attributable Y.PLL before age 65 for blacks was twice that for whites, and the smoking-attributable YPLL rate for men was almost three times that for women. For YPLL before age 85, the rate for blacks was 52% higher than for whites, and for men, more than twice that for women (Table 3). Editorial Note: For 1988, total estimated smokingattributable deaths (434,000) were substantially higher than for 1985 (390,000) (I]. Although SAM from ischemic heart disease declined between I985 and 1988, SAM from lung cancer and chronic obstructive pulmonary disease was higher. Several heart disease categories (International Classification of Diseases, Ninth Revision [ICD-91 rubrics 390-398, 415-417,420-429) were included in the calculations for 1988 but not for 1985, contributing to the higher SAM estimate for 1988

YPLL before age 65 and before age 85 were calculated according to standard methods [2]. Age-adjusted SAM and YPLL rates were calculated by the direct method and standardized to the 1980 US population. YPLL estimates do not include deaths related to passive smoking.

The higher SAM rates for blacks underscore concerns about the higher burden of smokingrelated diseases among blacks than among whites. For example, the average lung cancer death rate from 1980 through 1987 for blacks was 2.3 times higher than for whites [6]. In addition, the larger racial disparity in smoking-attributable YPLL suggests that onset of smoking-attributable disease occurs at younger ages among blacks than among whites.

Based on these calculations, imately 434,000 deaths and

In this report, States represents

in 1988, approx1,199,OOO YPLL

the SAM estimate for the United a conservative estimate because it

Table 1. Relative risks’ (RR) for death attributed to smoking and smoking-attributable for current and former. smokers, by disease category and sex - United States, 1988. Disease category

(ICD-9)

Men

mortality (SAM)

Women

RR

SAM

Current smokers

Former smokers

21.5 7.6 2.1 10.5

8.8 5.8 1.1 5.2

22.4 NA 2.9 3.0

Total SAM

RR

SAM

Current smokers

Former smokers

4,942 5,418 2,715 2,401

5.6 10.3 2.3 17.8

2.9 3.2 1.8 11.9

1.460 1,609 3,345 589

6.402 7,087 6,120 2,990

9.4 NA 1.9 2.0

78,932 0 2,951 2,129

11.9 2.1 2.6 1.4

4.7 1.9 1.9 1.2

33,053 I.246 963 363

I I I.985

1.9

1.3

3,441

1.7

1.2

2,254

5,695

2.8 1.6

1.8 1.3

29,263 41,821

3.0 1.6

1.4 1.3

9,105 27,990

38,368 69.8 I I

1.9

1.3

27,503

1.7

1.2

14,638

42,141

4,644 5,798

4.8’ 1.5 3.0 3.0

1.4 I.0 1.3 1.3

4.504 5,134 3,612 1,435

9,625 16.688 8,256 7,233

1,874

3.0

1.3

1,111

2,985

Adult diseases ( ~35 years of age)

Neoplasms Lip, oral cavity, pharynx (140-149) Esophagus (150) Pancreas (157) Larynx (161) Trachea, lung, bronchus (162) Cervix uteri (180) Urinary Kidney,

bladder ( 188) other urinary (189)

I.246 3,914 3.092

Cardiovascular diseases Hypertension (401-404) Ischemic heart disease (410-414) Persons aged 35-64 years Persons aged 265 years Other heart diseases (390-398, 415-417 420-429) Cerebrovascular disease (430-438) Persons aged 35-64 years Persons aged 265 years Atherosclerosis (440) Aortic aneurysm (441) Other arterial disease (442-448) Respiratory diseases Pneumonia, influenza (480-487) Bronchitis, emphysema (491-492) Chronic airways obstruction (496) Other respiratory diseases (010-012, 493)

3.1 1.9 4.1 4.1 4.1

1.4 1.3 2.3 2.3 2.3

5,121

I 1,554

2.0

1.6

I 1,580

2.2

1.4

8,098

19,678

9.1

8.8

9,670

10.5

7.0

5,269

14.939

9.7

8.8

29,838

10.5

7.0

16,884

46.722

2.0

1.6

828

2.2

1.4

690

1,518

Pediatric diseases (< 1 year of age) Short gestation, low birth weight (765) Respiratory distress syndrome (769) Other respiratory conditions of newborn (770) Sudden infant death syndrome (798)

Burn deaths b Passive smoking deaths’ Total

261

605

1.8

233

584

384

1.8

277

661

422 850 1,330 286,824

1.5

280 453 2,495 147.351

1.8

344

1.8

351

1.8 1.5

1.8

“Relative to never smokers. bData from the Federal Emergency Management Agency, 1990 [3]. Deaths among nonsmokers from lung cancer attributable to passive smoking (National

702 1,303 3,825 434. I75

Academy of Sciences, 1986 [4]).

from

<

727.732

573.044 144.48 I IO.207

Men

and are not included

164.492

104.122 5X.057 2.313 1.19X.887

16.507

9 13.943 26X.437

Total h

before age 65

Pediatric

YPLL

4.093.602

3.440.682 606.297 46.673

Men

1.71x.747

I .444.X23 257.438 16.4X6

Women

Smoking-attributable

215.497

136.408 76.059 3,030

Pediatric

before age X5

in this table.

associated

6.027.846

66.13X

5.021.914 939.794

Total h

years of potential life lost (YPLL), by race, sex,

to passive smoking: estimates were available by sex but not by race [4]. The YPLL

306.662

236.776 65.X99 3.9X7

Women

Smoking-attributable

I year of age.

lung cancer attributable

years of age; pediatric.

with these deaths are unknown

‘Deaths among nonsmokers

235

378.657 47.692 3.997 3x5 434. I75

Total h

may not equal total because of rounding.

2.551

I.615 900 36

Pediatric

and women,

128.X0 I 14.011 994 2.495 146.301

Women

‘Sums

285.319

I.330

2.967

24X.24 I 32.7X I

Men

SAM

mortality (SAM) and smoking-attributable

‘Men

Other Unknown’ Total h

White Black

Race

Table 2. Estimated smoking-attributable and age’ - United States, 1988.

78

Table 3. Age-adjusted smoking-attributable mortality (SAM) rates’ and smoking-attributable life lost (YPLL) rates, by raceb and sex - United States, 1988. Race

White Black Other Total

Smoking-attributable YPLL (before age 65 yrs) rate

SAM

years of potential

Smoking-attributable YPLL (before age 85 yrs) rate

Men

Women

Both

Men

Women

Both

Men

Women

Both

555.8 702.9 186.8 558.6

244.2 231.5 54.0 240.7

389.3 437.3 115.0 387.8

1,773.g 3,776.4 843.1

699.1 1,397.8 290.8 761.0

I ,224.7 2.471.8 549.3 1,326.0

8152.0 13,152.O 3.177.0 8,436.4

3,063.8 4,443.0 968.4 3.140.5

5.472.8 8,31 I,6 1.981.5 5.63 I .O

1,926.9

‘Per 100,000 persons aged 235 years (adjusted to the 1980 US population). bRace-specific rates for SAM and all rates for smoking-attributable YPLL do not include passive smoking-related deaths.

is based on 1988 prevalence data, whereas smoking-attributable diseases in I988 actually are caused by higher rates of smoking in the 195Os, 196Os, and 1970s. For persons aged 155 years who smoked during those decades, lung cancer incidence and death rates and the chronic obstructive pulmonary disease death rate are increasing

ready begun to decline. Because smoking cessation is associated with a decreased risk for premature death at any age [9], efforts to support cessation must be further encouraged in the elderly and other groups (e.g., women and minorities) characterized by higher smoking prevalences or slower rates of decline

in smoking.

[6,71. The SAM described in this report also represents a conservative estimate because the calculations did not include deaths from cardiovascular disease that may have been attributable to passive smoking and deaths from cancers at unspecified sites [ 11, leukemia [8], and ulcers [9] all of which may also be associated with cigarette smoking. A recent analysis estimated that each year passive smoking is associated with 37,000 deaths from heart disease [lo]. Despite declines in the prevalence of smoking in the United States, the absolute numbers of deaths caused by smoking-related diseases may increase for several years. This trend is due partly to the increase in absolute numbers of smokers among the post-World War II generation (i.e., persons aged 25-44 years), who will soon attain the ages at which smoking-related diseases occur [5]. Persons in this age group and in older age groups will continue to develop chronic diseases associated with smoking unless widespread cessation efforts are successful. However, because of the declining prevalence of smoking in the United States, death rates of lung cancer [ 111and of coronary heart disease [ 121 among younger men and women have al-

References 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) 89-841 I. Shultz JM. Novotny TE. Rice DP: SAMMEC II: computer software and documentation. Rockville. Maryland: US Department of Health and Human Services. Public Health Service, CDC. April 1990. Federal Emergency Management Agency: Fire in the United States: 1983-1987 and Highlights for 1988. 7th edn. Emmitsburg. Maryland: US Fire Administration, Federal Emergency Management Agency. August 1990 (FA-94). National Research Council: Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects. Washington. DC: National Academy Press. 1986. Novotny TE. Fiore MC. Hatziandreu EJ. Giovino GA. Mills SL. Pierce JP: Trends in smoking by age and sex. United States. 1974-1987: the implications for disease impact. Prev Med 1990: 19: 552-561. CDC: Trends in lung cancer incidence United States. 1980-1987. MMWR 88 I-883.

and mortality 1990; 39: 875.

CDC: Chronic disease reports: chronic obstructive pulmonary disease mortality - United States. 1986. MMWR 1989; 38: 549-552. Garfinkel L. Boffetta

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JF: Declining

Perceptions About Sexual - United States, 1989

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KE, Selvin S, Merrill

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Behavior: Findings from a National

Sex Knowledge Survey

Perceptions of specific risk behaviors for sexually transmitted diseases (STDs) can influence socially accepted norms of sexual behavior and knowledge of STD risk among different demographic groups. This report summarizes tindings from a national survey (conducted by The Kinsey Institute for Research in Sex, Gender, and Reproduction at Indiana University) that addressed perceptions regarding the prevalence of highrisk sexual behaviors [ 11.

+3]) were more likely than men (21’%, [95X Cl = *3]) to believe the age at first intercourse was 5 13 years (P < 0.05). Persons who were younger, reported lower income, or claimed less formal education consistently estimated younger ages at first intercourse (Fig. 1, Table I). More black respondents (41%) [95’%, CI = +7]) than white respondents (23’% [95X Cl = *2]) estimated younger ages at first sexual intercourse ( 5 13 years; P < 0.05).

During October 14-20, 1989, a multistage, stratified, probability sample of 1974 US adults (persons 118 years of age) were interviewed in their homes by a private polling organization. Respondents were asked six questions in face-toface interviews and 12 questions by anonymous, self-administered questionnaires in the presence of the interviewers. In the face-to-face interview, participants were asked to estimate the age at which the “average or typical American” first has sexual intercourse and to estimate the proportion of married men who have had an “extramarital affair.” The self-administered questionnaire included items on the prevalence of heterosexual anal intercourse and male homosexual behavior. Refusal rates for the interview questions (Table 1, questions 1 and 2) were < 1X, and for the selfadministered questionnaire (Table 1, questions 3 and 4), l4’%,.

Half the respondents believed that ~50’%, of married men have had an “extramarital affair” (Table 1, question 2). Women (25’%, [95X CI = +3]) were more likely than men (17’%, [95X CI = f 21) and blacks (33’%1[95(X CI = f 61) were more likely than whites (19’%) [95’%) CI = *2]) to estimate that a high percentage of married men (170’%,) have had an “extramarital affair.” Respondents with lower income (26%) [95’%, CI = f 31 vs. 18’%,[95X CI = + 31) and with less formal education (26’%, [95’%, CI = &4] vs. 22’%) [95’%, CI = f 31 vs. lS’%l [95’%, CI = f 31) were more likely to estimate this behavior to be this prevalent. Separated and divorced respondents (34’%, [95’%~CI = *7]) were the most likely to estimate this high prevalence, followed by single (24’%, [95’%, CI = +4]) and married (18X [95’%, CI = ~21) respondents.

Most respondents. (62%) [95’% confidence interval (CI) = ~21) believed the “typical American” has first sexual intercourse at or before 15years of age (Table 1, question 1). Women (29’%, [95’%,CI =

More than one third (37%) [95X CI = &2]) estimated that I 20’%,of US women have ever had anal intercourse (Table I, question 3); 28’%, (95%) CI = *2) indicated “don’t know.” Respondents estimating that L 30’%,of US women have had anal