Smoking behavior and lung cancer in a biracial cohort: the Atherosclerosis Risk in Communities study.
BACKGROUND
In the U.S., the incidence of lung cancer varies by race, with rates being highest among black men. There are marked differences in smoking behavior between blacks and whites, but little is known regarding how these differences contribute to the racial disparities in lung cancer.


OBJECTIVE
To compare the lung cancer risk associated with smoking in 14,610 blacks and whites in the prospective cohort Atherosclerosis Risk in Communities study.


METHODS
Smoking characteristics were ascertained at baseline and three follow-up visits in 1990-1992, 1993-1995, and 1996-1998 (response rates were 93%, 86%, and 80%, respectively), as well as from annual telephone interviews. Data were analyzed in the fall of 2012. Multivariable-adjusted proportional hazards models were used to calculate hazard ratios and 95% CIs for lung cancer.


RESULTS
Over 20 years of follow-up (1987-2006), 470 incident cases of lung cancer occurred. Lung cancer incident rates were highest in black men and lowest in black women. However, there was no evidence to support racial differences in the associations of smoking status, intensity, or age at initiation with lung cancer risk (all p(interaction)≥0.25). The hazard ratio for those who started smoking at age ≤12 versus >22 years was 3.03 (95% CI=1.62, 5.67). Prolonged smoking cessation (≥10 years) was associated with a decrease in lung cancer risk, with equivalent benefits in whites and blacks, 84% and 74%, respectively (p(interaction)=0.25).


CONCLUSIONS
Smoking confers similar lung cancer risk in blacks and whites.
Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota. Electronic address: prizm001@umn.edu.
Anna E
AE
Prizment
Department of Public Health, School of Medicine, Fujita Health University, Toyoake, Japan.
Hiroshi
H
Yatsuya
Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota.
Pamela L
PL
Lutsey
National Cancer Institute, Division of Cancer Epidemiology and Genetics, Bethesda, Maryland.
Jay H
JH
Lubin
The George Institute for Global Health, University of Sydney, Sydney.
Mark
M
Woodward
Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota.
Aaron R
AR
Folsom
School of Population Health, University of Queensland, Brisbane, Australia.
Rachel R
RR
Huxley
D001741:Black or African American / Q000706:statistics & numerical data*; D000367:Age Factors; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D054624:Health Status Disparities; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology* / Q000208:ethnology; D016540:Smoking Cessation / Q000706:statistics & numerical data; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*