Estimating benefits of past, current, and future reductions in smoking rates using a comprehensive model with competing causes of death.

Department of Health Services, University of California, Los Angeles School of Public Health, Los Angeles, CA 90095-1772, USA.
Preventing chronic disease (Impact Factor: 1.96). 07/2012; 9:E122. DOI: 10.5888/pcd9.110295
Source: PubMed

ABSTRACT Despite years of declining smoking prevalence, tobacco use is still the leading preventable contributor to illness and death in the United States, and the effect of past tobacco-use control efforts has not fully translated into improvements in health outcomes. The objective of this study was to use a life course model with multiple competing causes of death to elucidate the ongoing benefits of tobacco-use control efforts on US death rates.
We used a continuous-time life course simulation model for the US population. We modeled smoking initiation and cessation and 20 leading causes of death as competing risks over the life span, with the risk of death for each cause dependent on past and current smoking status. Risk parameters were estimated using data from the National Health Interview Survey that were linked to follow-up mortality data.
Up to 14% (9% for men, 14% for women) of the total gain in life expectancy since 1960 was due to tobacco-use control efforts. Past efforts are expected to further increase life expectancy by 0.9 years for women and 1.3 years for men. Additional reduction in smoking prevalence may eventually yield an average 3.4-year increase in life expectancy in the United States. Coronary heart disease is expected to increase as a share of total deaths.
A dynamic individual-level model with multiple causes of death supports assessment of the delayed benefits of improved tobacco-use control efforts. We show that past smoking reduction efforts will translate into further increases in life expectancy in the coming years. Smoking will remain a major contributor to preventable illness and death, worthy of continued interventions.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Answer questions and earn CME/CNE Esophageal adenocarcinoma (EAC) is characterized by 6 striking features: increasing incidence, male predominance, lack of preventive measures, opportunities for early detection, demanding surgical therapy and care, and poor prognosis. Reasons for its rapidly increasing incidence include the rising prevalence of gastroesophageal reflux and obesity, combined with the decreasing prevalence of Helicobacter pylori infection. The strong male predominance remains unexplained, but hormonal influence might play an important role. Future prevention might include the treatment of reflux or obesity or chemoprevention with nonsteroidal antiinflammatory drugs or statins, but no evidence-based preventive measures are currently available. Likely future developments include endoscopic screening of better defined high-risk groups for EAC. Individuals with Barrett esophagus might benefit from surveillance, at least those with dysplasia, but screening and surveillance strategies need careful evaluation to be feasible and cost-effective. The surgery for EAC is more extensive than virtually any other standard procedure, and postoperative survival, health-related quality of life, and nutrition need to be improved (eg, by improved treatment, better decision-making, and more individually tailored follow-up). Promising clinical developments include increased survival after preoperative chemoradiotherapy, the potentially reduced impact on health-related quality of life after minimally invasive surgery, and the new endoscopic therapies for dysplastic Barrett esophagus or early EAC. The overall survival rates are improving slightly, but poor prognosis remains a challenge. CA Cancer J Clin 2013;63:232-248. (©) 2013 American Cancer Society.
    CA A Cancer Journal for Clinicians 07/2013; 63(4):232-48. · 153.46 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Chronic inflammation is a prominent feature of aging and of common age-related diseases, including atherosclerosis, cancer and periodontitis. This volume examines modifiable risk factors for periodontitis and other chronic inflammatory diseases. Oral bacterial communities and viral infections, particularly with cytomegalovirus and other herpesviruses, elicit distinct immune responses and are central in the initiation of periodontal diseases. Risk of disease is dynamic and changes in response to complex interactions of genetic, environmental and stochastic factors over the lifespan. Many modifiable risk factors, such as smoking and excess caloric intake, contribute to increases in systemic markers of inflammation and can modify gene regulation through a variety of biologic mechanisms (e.g. epigenetic modifications). Periodontitis and other common chronic inflammatory diseases share multiple modifiable risk factors, such as tobacco smoking, psychological stress and depression, alcohol consumption, obesity, diabetes, metabolic syndrome and osteoporosis. Interventions that target modifiable risk factors have the potential to improve risk profiles for periodontitis as well as for other common chronic diseases.
    Periodontology 2000 02/2014; 64(1):7-19. · 4.01 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study is to analyse longitudinally, the annual effects of age group and birth cohort on smoking in the Swedish population during a 24-year period and to analyse the smoking trends for different levels of education. A random sample of adult, non-institutionalized persons aged 16-71 years was interviewed every 8 years by professional interviewers. In addition to three time-related variables-year of interview, age at the time of the interview, and year of birth-we included the following explanatory variables in the analyses: sex, educational level, and urbanization. We found significant decreases in smoking prevalence in all studied subgroups. The adjusted odds ratios for age were 0.89 (95 % CI 0.88-0.90) and 0.92 (95 % CI 0.91-0.93) for men and women, respectively. The decreases in smoking over time were significant in all levels of education, except for in women with low educational level. In Sweden, the prevalence of smoking has decreased in most age groups and cohorts, and in persons in most levels of education, albeit less so in women with low educational level.
    International Journal of Public Health 12/2013; · 1.99 Impact Factor

Full-text (2 Sources)

Available from
Jul 29, 2014