Cigarette smoking prevalence in US counties: 1996-2012.
Cigarette smoking prevalence in US counties: 1996-2012.
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DOI：
10.1186/1478-7954-12-5
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发表时间：
2014-03-24
影响因子：
3.3
通讯作者：
Murray CJ
中科院分区：
文献类型：
--
作者：
Dwyer-Lindgren L;Mokdad AH;Srebotnjak T;Flaxman AD;Hansen GM;Murray CJ
吸烟是美国发病率和过早死亡率的主要危险因素，但有关吸烟流行率和趋势的信息在州一级以下并不常见，这阻碍了地方一级的行动。我们使用了1996年至2012年行为风险因素监测系统（BRFSS）中470万18岁及以上成年人的数据。我们从BRFSS中的自我报告数据中推导出吸烟状况，并应用经验证的小区域估计方法来估计1996年至2012年期间每年3，127个县和县当量的当前总吸烟率和当前每日吸烟率。我们采用了一种新的方法来纠正2011年之前BRFSS中仅排除无线人群所产生的偏倚。总吸烟率在各县之间差异很大，甚至在州内，2012年男性从9.9%到41.5%，女性从5.8%到40.8%。南部的县，特别是肯塔基州、田纳西州和西弗吉尼亚州，以及那些有大量美洲原住民人口的县，吸烟率最高，而犹他州和其他西部州的县吸烟率最低。总体而言，1996年至2012年期间吸烟总流行率下降，各县男性平均每年下降0.9%，女性平均每年下降0.6%，一些县男性和女性的下降率超过每年3%。然而，在统计上显著下降的州相对较少，男性吸烟率（39.8%的州）比女性吸烟率（16.2%）有更多的州出现了统计上显著下降。下降率因收入水平而异：收入最高的五分之一的县的下降速度明显快于收入最低的五分之一的县。对州一级吸烟流行率的估计提供了一个独特的机会，可以评估哪里的流行率仍然很高，哪里的进展缓慢。这些估计提供了在地方和州一级更好地制定和实施战略所需的数据，以进一步减少吸烟造成的负担。
Cigarette smoking is a leading risk factor for morbidity and premature mortality in the United States, yet information about smoking prevalence and trends is not routinely available below the state level, impeding local-level action. We used data on 4.7 million adults age 18 and older from the Behavioral Risk Factor Surveillance System (BRFSS) from 1996 to 2012. We derived cigarette smoking status from self-reported data in the BRFSS and applied validated small area estimation methods to generate estimates of current total cigarette smoking prevalence and current daily cigarette smoking prevalence for 3,127 counties and county equivalents annually from 1996 to 2012. We applied a novel method to correct for bias resulting from the exclusion of the wireless-only population in the BRFSS prior to 2011. Total cigarette smoking prevalence varies dramatically between counties, even within states, ranging from 9.9% to 41.5% for males and from 5.8% to 40.8% for females in 2012. Counties in the South, particularly in Kentucky, Tennessee, and West Virginia, as well as those with large Native American populations, have the highest rates of total cigarette smoking, while counties in Utah and other Western states have the lowest. Overall, total cigarette smoking prevalence declined between 1996 and 2012 with a median decline across counties of 0.9% per year for males and 0.6% per year for females, and rates of decline for males and females in some counties exceeded 3% per year. Statistically significant declines were concentrated in a relatively small number of counties, however, and more counties saw statistically significant declines in male cigarette smoking prevalence (39.8% of counties) than in female cigarette smoking prevalence (16.2%). Rates of decline varied by income level: counties in the top quintile in terms of income experienced noticeably faster declines than those in the bottom quintile. County-level estimates of cigarette smoking prevalence provide a unique opportunity to assess where prevalence remains high and where progress has been slow. These estimates provide the data needed to better develop and implement strategies at a local and at a state level to further reduce the burden imposed by cigarette smoking.