The impact of cigarette smoking on mortality in developed countries: a population

描述（由申请人提供）：为了充分掌握吸烟对公共卫生的重要性，我们必须首先能够在社会层面衡量其对死亡率的影响。虽然在个人层面上，吸烟对死亡率的影响已得到充分证实，但研究人群层面的影响则面临更大的挑战。目前确定人群中吸烟死亡率负担的方法提供了信息，但存在一些不足之处，限制了我们对吸烟对不同社会死亡率经历差异的贡献的理解。这个项目将扩大我们对吸烟对人口健康的重要性的认识，并证明它有可能成为解释人口死亡率趋势的一个重要因素。这个项目有三个目标。首先，我们调查了吸烟率极低的墨西哥裔美国人吸烟对死亡率的影响。我们预计，与非西班牙裔白人相比，该人群的低卷烟消费量将转化为相对较低的吸烟相关死亡率。因此，吸烟可能为“西班牙悖论”提供了一个令人信服的答案。我们将建立全因死亡率模型，将其作为吸烟行为的函数，并估计吸烟对墨西哥裔美国人死亡率优势的贡献。第二个目标是确定预测发达国家肺癌死亡率国家趋势的最佳方法。在缺乏详细的队列吸烟史的情况下，研究人员经常被迫使用单年测量来测量人群吸烟行为。大多数研究使用人口中吸烟的流行程度，这是通过代表性调查中的自我报告来确定的。每年的香烟销售量较少被使用，但尚不清楚哪种是衡量人口吸烟行为的更好方法。我们将比较20个发达国家从1950年到2005年预测全国肺癌死亡率的各项指标的表现。第三个目标是开发一种估算发达国家因吸烟而死亡人数的新方法。我们的方法改进了以前的方法，因为它可以应用于更多的情况，并且它不严重依赖于关于吸烟与死亡率之间个人层面关系的假设。我们将调查肺癌死亡率与所有其他死因死亡率之间的宏观关系。这种方法将提高以前归因风险估计的准确性，并使我们能够在比以往更多的人群中计算归因风险。

DESCRIPTION (provided by applicant): To fully grasp the public health importance of cigarette smoking, we must first be able to measure its impact on mortality at the societal level. While the impact of smoking on mortality at the individual level is well- established, examining the population-level impact poses greater challenges. Current methods for determining the mortality burden of smoking in a population are informative, but suffer from several inadequacies that limit our understanding of the contribution of smoking to differences in mortality experiences across societies. This project will expand our knowledge of the importance of smoking for population health and demonstrate its potential to be an important factor explaining population-level trends in mortality. This project has three objectives. First, we investigate the impact of smoking on mortality in a population that exhibits extremely low rates of cigarette smoking - Mexican-Americans. We expect that low cigarette consumption in this population will translate into relatively low smoking-related mortality compared with non-Hispanic whites. Thus, smoking may provide a convincing answer to the "Hispanic Paradox". We will model all cause mortality as a function of smoking behavior and estimate the contribution of cigarette smoking to the mortality advantage of Mexican-Americans. The second objective is to identify the best method for predicting national trends in lung cancer mortality in developed countries. In the absence of detailed cohort smoking histories, researchers are often forced to measure population smoking behavior using single-year period measures. Most studies use the prevalence of cigarette smoking in the population, which is ascertained by self reports in representative surveys. Annual cigarette sales are used less often, but it is unknown which is the superior measure of population smoking behavior. We will compare the performance of each measure in predicting national lung cancer mortality from 1950 through 2005 in twenty developed countries. The third objective is to develop a new method for estimating the number of deaths attributable to smoking in developed countries. Our method improves upon previous methods in that it can be applied to a greater number of contexts and it does not rely heavily on assumptions about the individual-level relationship between smoking and mortality. We will investigate the macro-level relationship between lung cancer mortality and mortality from all other causes of death. This method will improve the accuracy of previous attributable risk estimates and will allow us to calculate attributable risk in a greater number of populations than ever before. PUBLIC HEALTH RELEVANCE: To fully grasp the public health importance of cigarette smoking, we must first be able to measure its impact on mortality at the societal level. This project seeks to improve our understanding of the significance of smoking for the health of populations and elucidate its potential to explain differences in life expectancy across places.