Explaining Divergent Levels of Longevity in High-Income Countries (2011) / Chapter Skim
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5 The Role of Smoking
5 The Role of Smoking
Pages 69-82
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From page 69... ...
In the United States, according to some estimates, smoking is the number one cause of preventable deaths, killing more than 440,000 Americans each year (American Heart Association, 2009; Centers for Disease Control and Prevention, 2004)
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From page 70... ...
Such prospective cohort studies, as they are called, have the advantage of allowing researchers to collect a great deal of information from participants and then use that information to determine the relationship between various medical and lifestyle factors -- smoking history or high blood pressure, for example -- and the various causes of death. Nonsmoking factors affecting mortality can be controlled in statistical analyses of the effects of smoking.
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From page 71... ...
One feature of that imprint is that the relative mortality levels of smokers have risen relative to nonsmokers, reflecting the heavy smoking histories of smokers today. Comparisons of the CPS-I and CPS-II data indicate that the age-adjusted death rate from lung cancer per 100,000 person-years increased among current smokers between the period covering the CPS-I (1959-1965)
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From page 72... ...
Then by applying these relative risks to the population of smokers in a given country -- estimated from the lung cancer mortality rates -- they could calculate what percentage of deaths from each disease was due to smoking. According to their estimates, 35 percent of the deaths attributable to smoking are from vascular diseases, 24 percent from lung cancer, and 16 percent from COPD.
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From page 73... ...
. There are probably many reasons for the higher level of smoking in the United States, including the fact that cigarettes were made freely available to many military and civilian groups during World War II; higher per capita income in the United States, which made cigarettes seem more affordable than in other countries; excellent growing conditions for tobacco in part of the United States; intense advertising campaigns in magazines, on billboards, and on the radio; the widespread smoking of popular movie stars on the silver screen; and the presence of a number of major tobacco companies (Brandt, 2007; Ravenholt, 1990)
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From page 74... ...
12 74 10 8 6 4 (number per adult per day) Manufactured Cigarette Consumption Denmark 2 Japan Netherlands United States 0 1935– 1940– 1945– 1950– 1955– 1960– 1965– 1970– 1975– 1980– 1985– 1990– 1995– 2000– 2005– 1939 1944 1949 1954 1959 1964 1969 1974 1979 1984 1989 1994 1999 2004 2006 Years FIGURE 5-1 Trends in per capita consumption of cigarettes for selected countries.
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From page 75... ...
to determine the numbers of deaths due to lung cancer by country, year, gender, and age group. Then, instead of assuming that relative mortality risks for smokers based on the CPS-II (in the United States)
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From page 76... ...
0.05* Belgium 0.09 0.30 0.00 0.01 Canada 0.07 0.22 0.24 0.01 0.06 0.19 Denmark 0.07 0.22 0.20 0.01 0.06 0.16 Finland 0.18 0.28 0.17 0.01 0.02 0.04 France 0.05 0.17 0.19 0.00 0.00 0.02 Hungary 0.07 0.22 0.30 0.01 0.05 0.13 Iceland 0.03 0.06 0.16 0.00 0.11 0.18 Ireland 0.04 0.17 0.19 0.02 0.07 0.14 Italy 0.04 0.20 0.23 0.00 0.01 0.04 Japan 0.01 0.11 0.20 0.00 0.03 0.09 Netherlands 0.10 0.32 0.26 0.00 0.01 0.09 New Zealand 0.08 0.21 0.17 0.00 0.06 0.12 Norway 0.02 0.09 0.16 0.00 0.01 0.07 Portugal 0.02 0.07 0.12 0.00 0.00 0.01 Spain 0.04 0.14 0.22 0.00 0.00 0.00 Sweden 0.03 0.10 0.09 0.00 0.02 0.06 Switzerland 0.09 0.19 0.16 0.00 0.01 0.04 United Kingdom 0.16 0.30 0.20 0.02 0.09 0.15 United States 0.08 0.23 0.22 0.01 0.08 0.20 *
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From page 77... ...
of the shortfall of U.S. female TABLE 5-2 Life Expectancy at Age 50 in 2003 Before and After Removal of Deaths Attributable to Smoking Males Females With Without With Without Country Smoking Smoking Difference Smoking Smoking Difference Australia 30.63 32.25 –1.63 34.59 35.61 –1.02 Canada 29.82 32.31 –2.49 33.85 35.91 –2.06 Denmark 27.77 29.89 –2.13 31.66 33.78 –2.12 France 28.83 31.01 –2.18 34.59 34.92 –0.33 Italy 29.46 31.88 –2.41 34.19 34.64 –0.45 Japan 30.47 32.52 –2.05 36.66 37.41 –0.75 Netherlands 28.34 30.92 –2.58 32.55 33.69 –1.15 Spain 29.00 31.39 –2.39 34.44 34.52 –0.08 United Kingdom 28.62 30.67 –2.05 32.21 33.87 –1.66 United States 28.46 30.98 –2.52 32.25 34.58 –2.33 Non-U.S.
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From page 78... ...
. 3 2.5 2 Years 1.5 1 0.5 0 Au a es ly s n m n lia k ce nd ai ar ad pa Ita do ra an at Sp m rla an Ja St st ng Fr en he C Ki d D te et d ni N te U ni U FIGURE 5-3 Gains in male life expectancy at age 50 from eliminating smoking in Fig 5-3.eps 2003.
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From page 79... ...
Part of the variation across countries reflects differences in the timing of the smoking epidemic: men in the United Kingdom and the United States adopted smoking earlier and have since exhibited declines, whereas the smoking epidemic hit other countries (e.g., Japan, Spain, Italy) much later (see Table 5-1)
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From page 80... ...
For women, on the other hand, the gap remained small until around 1975, when it began increasing rapidly, and by 2005 it had grown to 2.3 years -- nearly as large as the gap for men in that year. The gap for women is expected to level off and then begin declining, in concert with lung cancer mortality.
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From page 81... ...
By contrast, women in the United States, Denmark, and England and Wales had much higher smoking-related mortality during this period, and their life expectancy slowed significantly relative to the other cluster of countries. The Netherlands was something of an anomaly, with lung cancer mortality trends falling somewhere between those of the two clusters.
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From page 82... ...
In terms of the gap in life expectancy between the United States and other countries in 2003, Preston and colleagues find that differences in the estimated damage caused by smoking account for 78 percent of the 1.6-year gap for women and 41 percent of the 0.8-year gap for men. It appears that smoking has also caused significant reductions in life expectancy in Denmark and the Netherlands, two other countries with relatively poor life expectancy trends.
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