Cigarette smoking remains a leading cause of preventable medical problems

1. Based on data from the National Health Interview Survey and the National Health and Nutrition Examination Survey, there were 14 million cigarette smoking-attributable medical conditions in the US in 2009, with about 7.5 million of them being COPD.

Evidence Rating Level: 2 (Good)

Study Rundown: Smoking is the leading cause of preventable death in the US and the cause of the highest disease burden worldwide. The Centers for Disease Control and Prevention (CDC) last published smoking associated morbidity in 2000, when it found that there were 12.7 million smoking-attributable conditions. Since that time, there are have been even more diseases that have been linked to smoking. This study, which used data from the National Health Interview Survey (NHIS), was carried out to determine the smoking-attributed morbidity in the US in 2009. The results of the study suggest that there were 14 million cigarette smoking-attributable medical conditions in the US in 2009, with about 7.5 million of them being COPD.

The strengths of this study include the large number of respondents analyzed, and the broad scope of conditions included in the surveys that can be attributed to smoking. Additionally, the investigators used objective spirometry data to attempt to account for the cohort of people who are not diagnosed with COPD, but who do actually have obstructive features when measured via spirometry. While this does help with underreported COPD diagnoses, it does add a significant amount of uncertainty when results from one data set are applied to another. Lastly, as with all survey-based studies, there can be significant risk for reporting bias and volunteer bias.

Click to read the study, published today in JAMA Internal Medicine

Relevant Reading: Current cigarette smoking among adults – United States, 2005-2012.

In-Depth [survey-based outcomes]: The data for this study was obtained from the NHIS, a health survey collected annually by the National Center for Health Statistics. While most of the smoking-associated medical conditions were based on survey results, the investigators also used objective spirometry data collected by the National Health and Nutrition Examination Survey (NHANES) to account for the underreporting of the COPD in the population.

The NHIS collects smoking information from about 35,000 adults each year, which means that from 2006-2012, a total of 190,226 surveys were collected. The smoking-related medical problems included in the survey were COPD, heart attack, stroke, lung and numerous other smoking-related cancers, and diabetes (not included in the study from 2000). There were about 14 million lifetime major medical problems that can be attributed to smoking (95%CI 12.9-15.1 million). The majority of these were COPD (7.5 million; 95%CI 6.5-8.5 million).

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