Methodological issues in estimating smoking-attributable mortality in the United States.
The authors explored two methodological issues in the estimation of smoking-attributable mortality for the United States. First, age-specific and age-adjusted relative risk, attributable fraction, and smoking-attributable mortality estimates obtained using data from the American Cancer Society's second Cancer Prevention Study (CPS II), a cohort study of 1.2 million participants (1982-1988), were compared with those obtained using a combination of data from the National Mortality Follow-back Survey (NMFS), a representative sample of US decedents in which information was collected from informants (1986), and the National Health Interview Survey (NHIS), a nationally representative household survey (1987). Second, the potential for residual confounding of the disease-specific age-adjusted smoking-attributable mortality estimates was addressed with a model-based approach. The estimated smoking-attributable mortality based on the CPS II for the four most common smoking-related diseases-lung cancer, chronic obstructive pulmonary disease, coronary heart disease, and cerebrovascular disease-was 19% larger than the estimated smoking-attributable mortality based on the NMFS/NHIS, yet the two data sources yielded essentially the same smoking-attributable mortality estimate for lung cancer alone. Further adjustment of smoking-attributable mortality for disease-appropriate confounding factors (education, alcohol intake, hypertension status, and diabetes status) indicated little residual confounding once age was taken into account.
Malarcher
A M
AM
Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. aym8@cdc.gov
Schulman
J
J
Epstein
L A
LA
Thun
M J
MJ
Mowery
P
P
Pierce
B
B
Escobedo
L
L
Giovino
G A
GA
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002423:Cause of Death; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000401:mortality; D003327:Coronary Disease / Q000209:etiology / Q000401:mortality; D003430:Cross-Sectional Studies; D003627:Data Interpretation, Statistical; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000209:etiology / Q000401:mortality; D008175:Lung Neoplasms / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000401:mortality*; D014481:United States / Q000453:epidemiology