Lung cancer mortality rates in birth cohorts in the United States from 1960 to 1994
Introduction
Lung cancer is the leading cause of cancer mortality among both men and women in the US [1], [2]. In the 1950s, evidence emerged that tobacco products were linked to the development of lung cancer [3], and multiple studies subsequently have confirmed this relationship [4], [7], including the observation that 85–90% of lung cancer cases are due to smoking. Age-specific lung cancer mortality rates have decreased in younger age groups in recent years [8]. It is not clear to what extent these changes are related to decreases in smoking prevalence among younger populations or to alterations in cigarettes [9].
We sought to determine whether the risk of dying from lung cancer in the US has changed between 1960 and 1994 across sequential birth cohorts, beginning with the cohort of men and women born in 1901–1905. We restricted the population at risk for developing lung cancer in each cohort to the estimated number of current smokers and those who had stopped smoking within the last 5 years. The purpose of this analysis was to determine if the pattern of first increasing and then decreasing lung cancer mortality across birth cohorts since 1900 disappears if we control for the prevalence and duration of smoking.
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Methods
Using the vital records from the individual states, the National Center for Health Statistics (NCHS) annually compiles data from all death certificates filed in the US. These data contain the International Classification of Diseases (ICD) codes for the underlying cause of death and demographic and geographic information on the decedents [10]. The study period bridged three ICD classifications: ICD-7 (1960–1967), ICD-8 (1968–1978), and ICD-9 (1979–1994) [10]. We searched the Underlying Cause of
Results
From 1960–1994, 2 044 981 men and 818 556 women died with lung cancer listed as the underlying cause of death. After subjects born prior to 1901 were excluded, 1 704 785 male decedents and 730 253 female decedents were included in the analysis (Table 1, Table 2). Men and women in more recent birth-cohorts tended to start smoking at an earlier age; this trend was especially pronounced among women (Table 1, Table 2). The prevalence of current and recent smoking at age 34.5 peaked in the 1936–1940
Discussion
When we restricted our estimates of lung cancer mortality to current and recent smokers and further controlled for the duration of smoking, differences in the age-specific death rates between men and women and across birth cohorts were eliminated. This suggests that the prevalence of smoking and the duration of smoking in each birth cohort is the major determinant of lung cancer risk, not factors related to cigarette design or factors unrelated to smoking [14].
Concerns about health effects of
Conclusion
While tar levels have decreased dramatically over the past 40 years, decreases in age-specific lung cancer mortality have been modest, have occurred on a linear scale and have not occurred in all age strata. At the same time, cohort-specific lung cancer mortality rates have increased on a logarithmic scale. We also found that women actually have a slightly higher rate of lung cancer mortality, after duration of smoking is controlled for. Thus we conclude that the decreases in machine-measured
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