Elsevier

Lung Cancer

Volume 31, Issues 2–3, March 2001, Pages 91-99
Lung Cancer

Lung cancer mortality rates in birth cohorts in the United States from 1960 to 1994

https://doi.org/10.1016/S0169-5002(00)00170-7Get rights and content

Abstract

We sought to describe the changing death rates from lung cancer in the US white population in sequential birth cohorts, adjusting for cohort smoking prevalence and duration. We searched the US mortality database (1960–1994) for all deaths among whites in which lung cancer was listed as the underlying cause of death. To determine the population at risk for lung cancer, we used the 1970, 1978–1980, and 1992 National Health Interview Surveys to estimate the annual number of current and recent smokers (those who had quit within 5 years) in 11 5-year birth cohorts, starting in 1901. We then determined annual lung cancer mortality rates for each birth cohort, stratified by sex and adjusting for the prevalence and duration of smoking. The population-based rates of lung cancer mortality were much higher among men than among women across all ages and birth cohorts, reflecting higher smoking rates among men. These differences decreased after we controlled for current and recent smoking within the cohorts and were slightly increased in women after we controlled for duration of smoking. Differences in lung cancer death rates across birth cohorts of US men and women primarily reflect differences in the prevalence and duration of smoking in these birth cohorts. Changes in cigarette design that have greatly reduced tar yields have a relatively small effect compared with that of people's smoking status and duration of smoking.

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.

Section snippets

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

References (18)

There are more references available in the full text version of this article.

Cited by (22)

  • An overview of the emergence of disparities in smoking prevalence, cessation, and adverse consequences among women

    2009, Drug and Alcohol Dependence
    Citation Excerpt :

    There was no evidence of an interaction of education and gender in these analyses. Tobacco exposure accounts for the vast majority of cases of lung cancer in the United States (U.S. Department of Health and Human Services, 2004) and it appears that trends in lung cancer mortality follow general trends in smoking prevalence (Jemal et al., 2001; Mannino et al., 2001). For example, Singh et al. (2002) linked an area-based index of SES to county level mortality data from 1950 to 1998 to test associations of SES with lung cancer.

  • Cough: Occupational and environmental considerations - ACCP evidenced-based clinical practice guidelines

    2006, Chest
    Citation Excerpt :

    Exposure to tobacco smoke should be assessed in all children and adults with cough. There is evidence of increased risk and severity of asthma in the children of parents who smoke,1–4 and the airway irritant effects of tobacco smoke will aggravate asthma, both from personal smoking and the inhalation of second-hand smoke, in addition to the other risks associated with tobacco smoking5–7 such as chronic obstructive lung disease, lung cancer, and cardiac disease, all of which commonly include cough as a symptom. Exposure to indoor biomass, which is widely used for cooking or heating in several developing countries, has also been shown to be a significant risk factor for childhood and adult asthma.8,9

View all citing articles on Scopus
View full text