A new method for estimating smoking-attributable mortality in high-income countries.
BACKGROUND
Cigarette smoking is responsible for a massive loss of life in both developed and developing countries. This article develops an alternative to the Peto-Lopez method for estimating the number or fraction of smoking-attributable deaths in high-income countries.


METHODS
We use lung cancer death rates as an indicator of the damage caused by smoking. Using administrative data for the population aged > or =50 years from 20 high-income countries in the period from 1950 to 2006, we estimate a negative binomial regression model that predicts mortality from causes other than lung cancer as a function of lung cancer mortality and other variables. Using this regression model, we estimate smoking-attributable deaths based on the difference between observed death rates from lung cancer and expected rates among non-smokers.


RESULTS
Combining the estimated number of excess deaths from lung cancer with those from other causes, we find that among males in 1955 the smoking-attributable fraction was highest in Finland (18%); among women, no country exceeded 1%. By 2003, Hungary had the highest fraction of smoking-attributable deaths among males (32%), whereas the USA held that position among women (24%). Our estimates are remarkably similar to those produced by the Peto-Lopez method, a result that supports the validity of each approach.


CONCLUSIONS
We provide a simple and straightforward method for estimating the proportion of deaths attributable to smoking in high-income countries. Our results demonstrate that smoking has played a central role in levels, trends and international differences in mortality over the past half century.
Preston
Samuel H
SH
Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA.
Glei
Dana A
DA
Wilmoth
John R
JR
D000368:Aged; D000369:Aged, 80 and over; D016010:Binomial Distribution; D003627:Data Interpretation, Statistical; D019049:Developed Countries / Q000706:statistics & numerical data; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012306:Risk; D012907:Smoking / Q000401:mortality*; D012923:Social Class