title: Population attributable fraction of mortality associated with tobacco smoking in Japan: a pooled analysis of three large-scale cohort studies.
abstract: BACKGROUND
  Quantitative measures of the burden of tobacco smoking in Asian countries are limited. We estimated the population attributable fraction (PAF) of mortality associated with smoking in Japan, using pooled data from three large-scale cohort studies.
  
  
  METHODS
  In total, 296,836 participants (140,026 males and 156,810 females) aged 40-79 years underwent baseline surveys during the 1980s and early 1990s. The average follow-up period was 9.6 years. PAFs for all-cause mortality and individual tobacco-related diseases were estimated from smoking prevalence and relative risks.
  
  
  RESULTS
  The prevalence of current and former smokers was 54.4% and 25.1% for males, and 8.1% and 2.4% for females. The PAF of all-cause mortality was 27.8% [95% confidence interval (CI): 25.2-30.4] for males and 6.7% (95% CI: 5.9-7.5) for females. The PAF of all-cause mortality calculated by summing the disease-specific PAFs was 19.1% (95% CI: 16.0-22.2) for males and 3.6% (95% CI: 3.0-4.2) for females. The estimated number of deaths attributable to smoking in Japan in 2005 was 163,000 for males and 33,000 for females based on the former set of PAFs, and 112,000 for males and 19,000 for females based on the latter set. The leading causes of smoking-attributable deaths were cancer (61% for males and 31% for females), ischemic heart diseases and stroke (23% for males and 51% for females), and chronic obstructive pulmonary diseases and pneumonia (11% for males and 13% for females).
  
  
  CONCLUSIONS
  The health burden due to smoking remains heavy among Japanese males. Considering the high prevalence of male current smokers and increasing prevalence of young female current smokers, effective tobacco controls and quantitative assessments of the health burden of smoking need to be continuously implemented in Japan.
authors.affiliation: Cancer Information Services and Surveillance Division, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan. kkatanod@ncc.go.jp
authors.forename: Kota
authors.initials: K
authors.lastname: Katanoda
authors.forename: Tomomi
authors.initials: T
authors.lastname: Marugame
authors.forename: Kumiko
authors.initials: K
authors.lastname: Saika
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Satoh
authors.forename: Kazuo
authors.initials: K
authors.lastname: Tajima
authors.forename: Takaichiro
authors.initials: T
authors.lastname: Suzuki
authors.forename: Akiko
authors.initials: A
authors.lastname: Tamakoshi
authors.forename: Shoichiro
authors.initials: S
authors.lastname: Tsugane
authors.forename: Tomotaka
authors.initials: T
authors.lastname: Sobue
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology / Q000401:mortality*; D009369:Neoplasms / Q000209:etiology / Q000401:mortality*; D011014:Pneumonia / Q000209:etiology / Q000401:mortality*; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000209:etiology / Q000401:mortality*; D012306:Risk; D012907:Smoking / Q000009:adverse effects / Q000401:mortality*; D014041:Tokyo / Q000453:epidemiology