Proportion of Cancer Deaths From Smoking Varies Across States and Is Highest in the South
Although smoking prevalence in the U.S. has declined by more than half since 1965, nearly 40 million adults still smoke cigarettes, resulting in about 167,133 cancer deaths in 2014, according to a study by the American Cancer Society. The study investigated cancer deaths among adults 35 and older due to smoking in each state and the District of Columbia and found that while cigarette use explained a high proportion of cancer deaths in all states, the proportion was highest in several Southern states, including Kentucky, Arkansas, Tennessee, West Virginia, and Louisiana.
The investigators concluded that increasing tobacco control funding, implementing innovative strategies, and strengthening tobacco control policies and programs at the federal, state, and local levels might further increase smoking cessation, decrease smoking initiation, and reduce mortality associated with smoking-related cancers. The study by Lortet-Tieulent et al was published in JAMA Internal Medicine.
Study Methodology
The researchers analyzed deidentified publicly available data and estimated the state-specific proportion of cigarette smoking–attributable cancer mortality using relative-risk methods similar to those in the 2014 Surgeon General’s report The Health Consequences of Smoking—50 Years of Progress for 12 smoking-related cancers, including acute myeloid leukemia and cancers of the oral cavity and pharynx; esophagus; stomach; colorectum; liver; pancreas; larynx; trachea, lung, and bronchus; cervix uteri; kidney and renal pelvis; and urinary bladder.
Age-, sex-, and state-specific smoking prevalence (never, former, or current) were calculated on the basis of data from the Centers for Disease Control and Prevention’s 2014 Behavioral Risk Factor Surveillance System Survey. Smoking prevalence estimates were based on 372,759 survey participants 35 years and older who provided information on their smoking status.
Study Results
The researchers estimated that at least 167,133 cancer deaths in the United States in 2014 (28.6% of all cancer deaths; 95% confidence interval [CI] = 28.2%–28.8%) were attributable to cigarette smoking. Among men, the proportion of cancer deaths attributable to smoking ranged from a low of 21.8% in Utah (95% CI = 19.9%–23.5%) to a high of 39.5% in Arkansas (95% CI, 36.9%-41.7%), but was at least 30% in every state except Utah. Among women, the proportion ranged from 11.1% in Utah (95% CI, 9.6%-12.3%) to 29.0% in Kentucky (95% CI, 27.2%-30.7%) and was at least 20% in all states except Utah, California, and Hawaii.
Nine of the top 10 ranked states for men and 6 of the top 10 ranked states for women were located in the South. In men, smoking explained nearly 40% of cancer deaths in the top 5 ranked states (Arkansas, Louisiana, Tennessee, West Virginia, and Kentucky). In women, smoking explained more than 26% of all cancer deaths in the top 5 ranked states, which included three Southern states (Kentucky, Arkansas, and Tennessee), and two Western states (Alaska and Nevada).
Conclusion
Although the proportion of cancer deaths attributable to cigarette smoking varies substantially across states and is highest in the South, where up to 40% of cancer deaths in men are caused by smoking, the human costs of cigarette smoking are high in all states. “Increasing tobacco control funding, implementing innovative new strategies, and strengthening tobacco control policies and programs, federally and in all states and localities, might further increase smoking cessation, decrease initiation, and reduce the future burden of smoking-related cancers,” concluded the study authors.
Funding for this study was provided by the American Cancer Society.
Joannie Lortet-Tieulent, MSc, of the American Cancer Society, is the corresponding author of this study.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
