The epidemiology of cigarette smoking and its impact on chronic obstructive pulmonary disease

Since the first Surgeon General's report on smoking and health was released in 1964, the United States has achieved substantial progress in curtailing smoking. Per capita cigarette sales for persons 18 yr of age or older have declined each year since 1973. Total cigarette sales have fallen an average of 1.8% each year since 1982, despite the increasing size of the population. National population-based surveys show that the prevalence of smoking has fallen steadily among adults during the past quarter century. Unfortunately, a parallel decrease in mortality from chronic obstructive pulmonary disease (COPD), one of the most important smoking-related diseases, has not occurred. To estimate the current impact of smoking on mortality from COPD, we used a modified formula for population attributable risk to calculate the mortality and years of potential life lost due to COPD caused by smoking. In 1984, an estimated 51,013 deaths occurred from COPD caused by smoking: 35,638 among men (85% of total COPD mortality) and 15,376 among women (69% of total COPD mortality) (sum does not equal total due to rounding). These deaths resulted in a total loss of 501,290 yr of life before the average life expectancy. We conclude that cigarette smoking continues to cause a heavy burden of premature death from COPD in the United States. This burden may increase in the coming years despite decreasing smoking rates because the residual risk of COPD mortality among former smokers persists for many years.