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Methodological issues in estimating smoking-attributable mortality in the United States
A M Malarcher1, J Schulman, L A Epstein
1Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. aym8@cdc.gov
American Journal of Epidemiology
|September 21, 2000
Summary
Estimating smoking-attributable mortality in the US revealed different results between cohort studies and national surveys. Adjusting for confounding factors like education and health conditions showed minimal residual impact on mortality estimates.
Area of Science:
- Epidemiology
- Public Health
- Biostatistics
Background:
- Accurate estimation of smoking-attributable mortality is crucial for public health policy.
- Methodological variations in data sources can influence mortality estimates.
- Confounding factors may affect the precision of smoking-attributable mortality calculations.
Purpose of the Study:
- To compare smoking-attributable mortality estimates derived from two distinct US data sources.
- To assess the impact of residual confounding on disease-specific mortality estimates.
- To evaluate the reliability of different epidemiological methods for quantifying smoking's health burden.
Main Methods:
- Comparison of smoking-attributable mortality estimates from the Cancer Prevention Study II (CPS II) cohort with data from the National Mortality Follow-back Survey (NMFS) and National Health Interview Survey (NHIS).
- Application of a model-based approach to address potential residual confounding in disease-specific mortality estimates.
- Adjustment for confounding factors including education, alcohol intake, hypertension, and diabetes status.
Main Results:
- The CPS II yielded a 19% higher smoking-attributable mortality estimate for four major diseases compared to the NMFS/NHIS.
- Both data sources produced similar smoking-attributable mortality estimates for lung cancer.
- After accounting for age and other confounders, residual confounding had minimal impact on mortality estimates.
Conclusions:
- Methodological differences between large cohort studies and national surveys can lead to variations in smoking-attributable mortality estimates.
- The NMFS/NHIS combined data provide a reliable estimate for smoking-attributable mortality, particularly for specific diseases like lung cancer.
- Age adjustment and control for common confounding factors effectively minimize bias in smoking-attributable mortality estimations.
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