Elsevier

Preventive Medicine

Volume 52, Issue 1, January 2011, Pages 60-65
Preventive Medicine

Population attributable numbers and fractions of deaths due to smoking: A pooled analysis of 180,000 Japanese

https://doi.org/10.1016/j.ypmed.2010.11.009Get rights and content

Abstract

Objective

Age- and sex-specific population attributable fraction (PAF) and premature deaths attributable to smoking were estimated from a pooled analysis of cohort studies in Japan.

Methods

A pooled analysis of individual participant data from 13 well-qualified cohort studies throughout Japan (a total of 183,251 Japanese aged 40–89, 69,502 men and 113,749 women; the baseline years between 1987 and 1995 with average 10 years of follow-up) was performed. Poison regression model was used to estimate age- and sex-specific hazard ratios, and their PAFs of all-cause deaths and number of annual premature deaths attributable to smoking were estimated.

Results

Overall PAF attributable to smoking was 24.6% in men and 6.0% in women. The estimated number of annual premature deaths due to smoking was 121,854 (men: 109,998; women: 11,856) in Japan. The age-specific PAF was largest in men aged 60–69 (47.7%) and in women aged 50–59 (12.2%). In the older group aged 70–79 and 80–89, PAF was 15.4% and 8.0% in men and 3.5% and 1.5% in women, respectively.

Conclusions

Age-specific PAFs attributable to smoking in Japanese men are much larger than that reported from other Asian countries.

Introduction

Cigarette smoking is one of the most important, established risk factors for diseases that threaten human life (Peto et al., 1999). A large volume of evidence on the harm of smoking has been published (Ezzati and Lopez, 2003, Lopez et al., 2006), with challenges and programs to stop smoking being common in Western countries. The mortality attributable to smoking showed the substantial impact that smoking may have on people's health and has been reported from various countries (Centers for Disease Control and Prevention (CDC), 2008, Gu et al., 2009, Hara et al., 2002, Honjo et al., 2010, Hozawa et al., 2004, Katanoda et al., 2008, Peto et al., 2006, Peto et al., 1992, Pham et al., 2007). However, smoking rates still remain high in Asian countries (Martiniuk et al., 2006) and incentive measures for smoking cessation are urgently required.

A recent study from China reported the number of deaths attributable to smoking (Gu et al., 2009). We expect that the impact of smoking on total mortality may be different in Japan; a more economically developed Asian country with the highest life expectancy in the world (World Health Organization, 2005) but with a high smoking rate in men. Moreover, few studies from Asia have performed age- and sex-specific investigations on the contribution of smoking to mortality, as such investigations need large-scale data from cohort studies.

In this pooled analysis of 180,000 Japanese men and women from 13 well-qualified cohort studies in Japan, we examined age- and sex-specific population attributable fraction (PAF) of mortality by smoking and the annual number of premature deaths attributable to smoking.

Section snippets

Study participants

The EPOCH-JAPAN (Evidences for Cardiovascular Prevention from Observational Cohorts in Japan) is the pooling project of a number of well-qualified cohort studies which investigates the relationship between health examination measures (laboratory measures and lifestyle factors) and mortality in the Japanese population. The EPOCH-JAPAN consists of 13 cohort studies in Japan and includes a total number of 188,321 participants followed up for an average of 10 years. The year range of baseline survey

Results

Table 1 shows the baseline characteristics of the participants in this study. The total number of participants in this analysis was 183,251 (69,502 men and 113,749 women) and the total number of all-cause deaths was 17,224 (9612 men and 7612 women) during follow-up. The mean age at study entry was 59.6 years for men and 58.4 years for women and the mean follow-up period was 9.6 years for men and 9.9 years for women. As reported previously, the distribution of baseline characteristics was not

Discussion

This large-scale pooled analysis of 180,000 Japanese from 13 well-qualified cohort studies showed that estimated annual premature deaths attributable to smoking habits were 110,000 for men and 12,000 for women in Japan. The proportion of premature all-cause deaths was 24.6% for men, with this proportion reaching 47.7% in men aged 60–69. This considerable loss of health attributable to smoking was confirmed in this analysis in Japan, a developed country with the greatest longevity in the world,

Conflict of interest statement

No conflict of interest.

Acknowledgments

This research was supported by a Grant-in-Aid from the Ministry of Health, Labor and Welfare, Health and Labor Sciences Research Grants, Japan (Research on Health Services: H17-Kenkou-007; Comprehensive Research on Cardiovascular and Life-Style Related Diseases: H18-Junkankitou [Seishuu]-Ippan-012; and Comprehensive Research on Cardiovascular and Life-Style Related Diseases: H20-Junkankitou [Seishuu]-Ippan-013). YM was supported by the Banyu Fellowship Program of Banyu Life Science Foundation

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    Chair-person: Hirotsugu Ueshima (Shiga University of Medical Science); Writing committee: Yoshitaka Murakami, Katuyuki Miura, Tomonori Okamura, Hirotsugu Ueshima; Statistical analysis: Yoshitaka Murakami; Secretariat: Yoshitaka Murakami; Executive committee: Hirotsugu Ueshima (Shiga University of Medical Science), Yutaka Imai (Tohoku University Graduate School of Medicine), Hiroyasu Iso (Osaka University Graduate School of Medicine), Yutaka Kiyohara (Kyushu University Graduate School of Medicine), Michiko Yamada (Radiation Effects Research Foundation), Hideaki Nakagawa (Kanazawa Medical University), Takeo Nakayama (Kyoto University School of Public Health), Tomonori Okamura (Keio University), Akira Okayama (Japan Anti-Tuberculosis Association), Shigeyuki Saitoh (Sapporo Medical University), Akiko Tamakoshi (Aichi Medical University), Ichiro Tsuji (Tohoku University Graduate School of Medicine), Fujiko Irie (Ibaraki Prefecture).

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