title: Lung cancer mortality and years of potential life lost among males and females over six decades in a country with high smoking prevalence: an observational study.
abstract: BACKGROUND
  Little is known about sex-specific trends in lung cancer mortality and years of potential life lost (YPLL) attributable to lung cancer over more than five decades. The aim of the present study was to describe mortality and YPLL due to lung cancer over 61 years of observation in a country with a high smoking prevalence.
  
  
  METHODS
  We obtained data on trends in lung cancer mortality, population-level vital statistics, sales of taxed tobacco products, and survey data on smoking behavior among the German population. We then undertook joinpoint regression analyses to determine sex-specific trends in lung cancer mortality and YPLL.
  
  
  RESULTS
  Rates of lung cancer mortality and rates of lung cancer among all causes of death increased more among females than among males. Although YPLL among females increased from 6.6 in 1952 to 11.3 in 2012, this figure was found to have decreased from 7.3 to 4.4 among males in the same period. Sales of tobacco subject to tax increased from 1,509 cigarette equivalents per resident aged 15 or older in 1952 to 2,916 in 1976 - after which there was a decline. The prevalence of current smoking among females aged 35 years or older remained stable between 17.9 and 18.9 % in the period from 1989 to 2009. Among males in the same age group, however, prevalence decreased from 36.7 % in 1989 to 27.5 % in 2009.
  
  
  CONCLUSIONS
  Lung cancer mortality and YPLL among females increased over the six decades studied. Women should be more considered in smoking policies.
authors.affiliation: University Medicine Greifswald, Institute of Social Medicine and Prevention, Walther-Rathenau-Str. 48, D-17475, Greifswald, Germany. ujohn@uni-greifswald.de.
authors.forename: Ulrich
authors.initials: U
authors.lastname: John
authors.affiliation: University Medicine Greifswald, Institute of Social Medicine and Prevention, Walther-Rathenau-Str. 48, D-17475, Greifswald, Germany. hanke@uni-greifswald.de.
authors.forename: Monika
authors.initials: M
authors.lastname: Hanke
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005858:Germany; D006801:Humans; D008017:Life Expectancy; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects*