State-Level Cancer Mortality Attributable to Cigarette Smoking in the United States
State-Level Cancer Mortality Attributable to Cigarette Smoking in the United States
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DOI：
10.1001/jamainternmed.2016.6530
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发表时间：
2016-12-01
影响因子：
39
通讯作者：
Jemal, Ahmedin
中科院分区：
文献类型：
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作者：
Lortet-Tieulent, Joannie;Sauer, Ann Goding;Jemal, Ahmedin
重要的是，关于吸烟健康负担的具体国家信息很有价值，因为国家一级的倡议处于烟草控制的最前列。目的计算2014年每个州和哥伦比亚区35岁及以上成年人中因吸烟而死亡的癌症的比例。设计、背景和参与者吸烟导致的癌症死亡的人群归因率(PAF)是根据12种与吸烟相关的癌症(急性髓性白血病、口腔和咽喉癌、食道癌、胃癌、结肠癌、肝脏、胰腺癌、喉癌、气管、肺和支气管癌、子宫颈和肾癌；肾癌；结果我们估计2014年美国至少有167 133例癌症死亡(占所有癌症死亡的28.6%；95%可信区间，28.2%-28.8%)可归因于吸烟。在男性中，可归因于吸烟的癌症死亡比例从犹他州的21.8%(95%可信区间，19.9%-23.5%)到阿肯色州的39.5%(95%可信区间，36.9%-41.7%)不等，但除犹他州外，每个州至少有30%。在女性中，这一比例从犹他州的11.1%(95%CI，9.6%-12.3%)到肯塔基州的29.0%(95%CI，27.2%-30.7%)不等，除犹他州、加利福尼亚州和夏威夷外，所有州的这一比例至少为20%。排名前十的男性州中有九个州和排名前十位的女性州中有六个位于南方。在男性中，在排名前五的州(阿肯色州、路易斯安那州、田纳西州、西弗吉尼亚州和肯塔基州)，吸烟导致了近40%的癌症死亡。在女性中，吸烟占前5个州所有癌症死亡的26%以上，其中包括3个南部州(肯塔基州、阿肯色州和田纳西州)和2个西部州(阿拉斯加州和内华达州)。结论和相关性吸烟导致的癌症死亡比例在各州有很大差异，在南部最高，那里高达40%的男性癌症死亡是由吸烟引起的。增加烟草控制资金，实施创新的新战略，并加强联邦以及所有州和地区的烟草控制政策和计划，可能会进一步增加戒烟，减少主动戒烟，并减少未来与吸烟相关的癌症的发病率和死亡率负担。
IMPORTANCE State-specific information about the health burden of smoking is valuable because state-level initiatives are at the forefront of tobacco control. Smoking-attributable cancer mortality estimates are currently available nationally and by cancer, but not by state.OBJECTIVE To calculate the proportion of cancer deaths among adults 35 years and older that were attributable to cigarette smoking in 2014 in each state and the District of Columbia.DESIGN, SETTING, AND PARTICIPANTS The population-attributable fraction (PAF) of cancer deaths due to cigarette smoking was computed using relative risks for 12 smoking-related cancers (acutemyeloid leukemia and cancers of the oral cavity and pharynx; esophagus; stomach; colorectum; liver; pancreas; larynx; trachea, lung, and bronchus; cervix uteri; kidney and renal pelvis; and urinary bladder) from large US prospective studies and state-specific smoking prevalence data from the Behavioral Risk Factor Surveillance System.MAIN OUTCOMES AND MEASURES The PAF of cancer deaths due to cigarette smoking in each US state and the District of Columbia.RESULTS We estimate that at least 167 133 cancer deaths in the United States in 2014 (28.6% of all cancer deaths; 95% CI, 28.2%-28.8%) were attributable to cigarette smoking. Among men, the proportion of cancer deaths attributable to smoking ranged from a low of 21.8% in Utah (95% CI, 19.9%-23.5%) to a high of 39.5% in Arkansas (95% CI, 36.9%-41.7%), but was at least 30% in every state except Utah. Among women, the proportion ranged from 11.1% in Utah (95% CI, 9.6%-12.3%) to 29.0% in Kentucky (95% CI, 27.2%-30.7%) and was at least 20% in all states except Utah, California, and Hawaii. Nine of the top 10 ranked states for men and 6 of the top 10 ranked states for women were located in the South. In men, smoking explained nearly 40% of cancer deaths in the top 5 ranked states (Arkansas, Louisiana, Tennessee, West Virginia, and Kentucky). In women, smoking explained more than 26% of all cancer deaths in the top 5 ranked states, which included 3 Southern states (Kentucky, Arkansas, and Tennessee), and 2 Western states (Alaska and Nevada).CONCLUSIONS AND RELEVANCE The proportion of cancer deaths attributable to cigarette smoking varies substantially across states and is highest in the South, where up to 40% of cancer deaths in men are caused by smoking. Increasing tobacco control funding, implementing innovative new strategies, and strengthening tobacco control policies and programs, federally and in all states and localities, might further increase smoking cessation, decrease initiation, and reduce the future burden of morbidity and mortality associated with smoking-related cancers.