Smoking-attributable mortality by cause in the United States: revising the CDC's data and estimates.

INTRODUCTION

Smoking is the leading cause of preventable mortality in the United States, but the methods and data used in the Centers for Disease Control and Prevention's (CDC) published estimates of adult smoking-attributable mortality have not been substantially revised since their introduction in the 1980s.

METHODS

We employed the CDC's general methodology for estimating smoking-attributable mortality but produced improved estimates by using recent, nationally representative relative risk data from the National Health Interview Survey-Linked Mortality Files and adjusting for confounding risk factors. We also produced estimates by smoking status and over time.

RESULTS

Our use of more recent and nationally representative relative risks tended to decrease estimates of smoking deaths for men and increased estimates for women compared with the CDC's estimates. Adjustment for confounding factors further refined the estimates, particularly by smoking status. We estimated 200,000 smoking-attributable deaths for men and 180,000 smoking-attributable deaths for women in the United States in 2004. Estimated smoking-attributable mortality has finally begun to decline for both U.S. men and women.

CONCLUSIONS

Our approach offers several substantive improvements in the estimation of smoking-attributable mortality by cause for the United States. Cigarette smoking remains a leading cause of preventable mortality in the United States, but we estimate that the number of smoking-attributable deaths has begun to decline.