Tobacco-related cancer deaths in the US disproportionately affects Southern states
1. Based on US prospective studies and state-specific smoking prevalence data, about 29% of all cancer deaths in 2014 were attributable to cigarette smoking.
2. Cancer deaths attributable to cigarette smoking disproportionately affected Southern states (particularly Kentucky, Arkansas, Tennessee, West Virginia, Louisiana) compared to the rest of the country, implying that additional action is necessary in those locations to curb smoking and its comorbidities.
Evidence Rating Level: 2 (Good)
Study Rundown: While there is much national data about tobacco-related cancers, there is limited state-level information. This is important as many tobacco control initiatives are managed by the states. This cross-sectional study aimed to calculate the proportion of cancer deaths among adults that were attributable to cigarette smoking in 2014 in each state and the District of Columbia (DC).
Just under 29% of all cancer deaths were attributable to cigarette smoking. Gender related differences were present: among men, the proportion was at least 30% across all states except Utah; among women, the proportion was at least 20% in all states except for Utah, California and Hawaii. Additionally, smoking-related cancer deaths disproportionately affected Southern states (particularly Kentucky, Arkansas, Tennessee, West Virginia, Louisiana) compared to the rest of the country. Limitations of the study included the likelihood of underestimation of deaths since only 12 types of cancers were examined, the information was self-reported in the databases, and the impact of other tobacco exposures (like second-hand smoke).
Click to read the study, published today JAMA Internal Medicine
Relevant Reading: What proportion of cancer deaths in the contemporary United States is attributable to cigarette smoking?
In-Depth [cross-sectional study]: This cross-sectional analysis used publicly available 2014 data from 2 large US prospective studies that included adults older than 35 years (Cancer Prevention study and Pooled contemporary cohort) to determine the relative risks for 12 smoking-related cancers (acute myeloid leukemia, cancers of the oral cavity and pharynx, esophagus, stomach, colorectal, liver, pancreas, larynx, trachea, lung and bronchus, cervix uteri, kidney and urinary bladder). The outcome of interest was the population-attributable factor (PAF) of cancer deaths due to cigarette smoking in each US state and in DC. State specific smoking prevalence data was gathered from Behavioural Risk Factor Surveillance System. The PAF was calculated using weighted sums method based on age, sex, race, education and marital status to adjust for nonresponse bias and ensure the sample is representative.
There was an estimated 167,133 cancer deaths in the USA in 2014 that were attributed to cigarette smoking. This translated to 28.6% of all cancer deaths (95%CI 28.2%-28.8%). In men, the proportion of cancer deaths ranged from 21.8% in Utah to 39.5% in Arkansas. In women, the proportion of cancer deaths ranged from 11.0% in Utah to 29.0% in Kentucky. For both sexes, the states with the highest proportions of cancer deaths attributed to cigarette smoking were found in the South, notably Kentucky, Arkansas, Tennessee, West Virginia, Louisiana.
Image: PD
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