Cancer death epidemics in United States Black males: evaluating courses, causation, and cures

Effect of cigarette smoking on plasma uric acid concentrations

OBJECTIVES

The purpose of this study was to examine the effect of cigarette smoking on plasma uric acid concentration and to determine the correlation between this parameter and the biological tobacco markers, plasma thiocyanate and urinary cotinine.

METHODS

The initial study was conducted on 300 subjects; 138 of them were nonsmokers (62 men and 76 women) aged 14-72 years and 162 were current smokers (145 men and 17 women) aged 16-85 years. Uric acid, creatinine, and urinary cotinine were determined by the enzymatic colorimetric method and plasma thiocyanate by selective electrode.

RESULTS

Plasma uric acid concentration was significantly lower in smokers than in nonsmokers. A statistically significant negative correlation was noted between the smoking status parameters, including both the number of cigarettes smoked/day (F (3-161) = 12.063; r = -0.9968; p = 0.0001) and the duration of smoking (F (3-161) = 1.305; r = -0.9406; p = 0.0274), and the plasma uric acid. Among smokers, we noted a negative correlation between uric acid and both plasma thiocyanates (r = -0.437; p < 0.05) and urinary cotinine (r = -0.580; p < 0.05).

CONCLUSION

After excluding the other factors affecting the uric acid levels, the significant low plasma uric acid in smokers was attributed to a reduction of the endogenous production as a result of the chronic exposure to cigarette smoke that is a significant source of oxidative stress. Therefore, it is recommended to stop or reduce smoking and to introduce plasma uric acid estimation as a routine test, since it is cheap and simple to reflect the antioxidant level.

Tobacco smoke load and non-lung cancer mortality associations in Austrian and German males

The millstone around the neck of tobacco control in Europe has been the influence of the tobacco industry on the governments of German speaking countries. This study attempts to estimate non-lung cancer mortality attributable to smoking in Austria during 1967-2006 and in Germany during 1973-2006. National estimates of the annual smoking-attributable fractions (SAF) were calculated for all ages in males, using lung cancer mortality rates as indicators of "tobacco smoke load" associated with cancer from active and passive smoking. In both countries non-lung cancer rates showed a nearly perfect linear correlation with lung cancer rates (R (2) = 0.95 in Austria and 0.94 in Germany) with a slope of 1.86 (95% confidence intervals [CI]: 1.71-1.99) in Austria and 1.77 (95% CI: 1.60-1.93) in Germany. In 2006 SAF of male cancer mortality for all ages were 61% in Austria (sensitivity range [SR]: 45%-70%) without autocorrelation and 61% in Germany (SR: 41-75%), if adjusted for possible autocorrelation. The similarity of the results is in line with the poor tobacco control measures in both countries until recently. Cancer prevention programs in Austria and Germany should focus on tobacco control, because 61% of male cancer mortality was associated with tobacco smoke load.

A new method for estimating smoking-attributable mortality in high-income countries

BACKGROUND

Cigarette smoking is responsible for a massive loss of life in both developed and developing countries. This article develops an alternative to the Peto-Lopez method for estimating the number or fraction of smoking-attributable deaths in high-income countries.

METHODS

We use lung cancer death rates as an indicator of the damage caused by smoking. Using administrative data for the population aged > or =50 years from 20 high-income countries in the period from 1950 to 2006, we estimate a negative binomial regression model that predicts mortality from causes other than lung cancer as a function of lung cancer mortality and other variables. Using this regression model, we estimate smoking-attributable deaths based on the difference between observed death rates from lung cancer and expected rates among non-smokers.

RESULTS

Combining the estimated number of excess deaths from lung cancer with those from other causes, we find that among males in 1955 the smoking-attributable fraction was highest in Finland (18%); among women, no country exceeded 1%. By 2003, Hungary had the highest fraction of smoking-attributable deaths among males (32%), whereas the USA held that position among women (24%). Our estimates are remarkably similar to those produced by the Peto-Lopez method, a result that supports the validity of each approach.

CONCLUSIONS

We provide a simple and straightforward method for estimating the proportion of deaths attributable to smoking in high-income countries. Our results demonstrate that smoking has played a central role in levels, trends and international differences in mortality over the past half century.

The role of tobacco in cancer health disparities

Although public health efforts have dramatically reduced the prevalence of smoking in the past several decades, smoking remains the leading cause of preventable morbidity and mortality in the United States. Moreover, tobacco use is becoming increasingly concentrated among individuals with the lowest levels of education, income, and occupational status. Profound racial/ethnic and socioeconomic status (SES) disparities exist for tobacco-related cancer incidence and mortality, and for access to and quality of cancer treatment. Furthermore, racial/ethnic minority and low SES smokers have greater difficulty quitting smoking, are less likely to use effective resources for quitting, and have limited access to evidence-based cessation treatments. Widespread implementation of population-based tobacco cessation approaches may have had the unintended effect of increasing tobacco-related cancer health disparities. It is crucial that vulnerable populations of smokers be provided with effective and accessible treatments for tobacco dependence, as this would have a profound impact on reducing tobacco-related cancer health disparities.

Smoking and ischemic heart disease disparities between studies, genders, times, and socioeconomic strata

Large, unexplained, but possibly related disparities exist between heart disease risks observed in differing genders, educational levels, times, and studies. Such heart disease disparities might be related to cumulative tobacco smoke damage (smoke load) disparities that are overlooked in standard assessments of point smoking status. So, I reviewed possible relationships between smoke load and heart disease levels across genders, educational strata, years, and leading studies. Smoker heart disease risk assessments in the Nurses Health Study (Nurses), Cancer Prevention Study-II (CPS-II), and British Doctors studies were compared and related to their likely selection and misclassification biases. Relationships between smoke loads and United States (US) education- and gender-related heart disease mortality disparities were qualitatively assessed using lung cancer rates as a smoke load proxy. The high heart disease mortality risks observed in smoking Nurses in 1980–2004 and in less educated US women in 2001 were qualitatively associated with their higher smoke loads and lower selection and exposure misclassification biases than in the CPS-II and Doctors studies. Smoking-attributable heart disease death tolls and disparities extrapolated from mortality ratios from the CPS-II and Doctors studies may be substantial underestimates. Such studies appear to have compared convenience samples of light smokers to lighter smokers instead of comparing representative smokers to the unexposed. Further efforts to minimize smoke exposures and better quantify cumulative smoking-attributable burdens are needed.

Male tobacco smoke load and non-lung cancer mortality associations in Massachusetts

Background

Different methods exist to estimate smoking attributable cancer mortality rates (Peto and Ezzati methods, as examples). However, the smoking attributable estimates using these methods cannot be generalized to all population sub-groups. A simpler method has recently been developed that can be adapted and applied to different population sub-groups. This study assessed cumulative tobacco smoke damage (smoke load)/non-lung cancer mortality associations across time from 1979 to 2003 among all Massachusetts males and ages 30–74 years, using this novel methodology.

Methods

Annual lung cancer death rates were used as smoke load bio-indices, and age-adjusted lung/all other (non-lung) cancer death rates were analyzed with linear regression approach. Non-lung cancer death rates include all cancer deaths excluding lung. Smoking-attributable-fractions (SAFs) for the latest period (year 2003) were estimated as: 1-(estimated unexposed cancer death rate/observed rate).

Results

Male lung and non-lung cancer death rates have declined steadily since 1992. Lung and non-lung cancer death rates were tightly and steeply associated across years. The slopes of the associations analyzed were 1.69 (95% confidence interval (CI) 1.35–2.04, r = 0.90), and 1.36 (CI 1.14–1.58, r = 0.94) without detected autocorrelation (Durbin-Watson statistic = 1.8). The lung/non-lung cancer death rate associations suggest that all-sites cancer death rate SAFs in year 2003 were 73% (Sensitivity Range [SR] 61–82%) for all ages and 74% (SR 61–82%) for ages 30–74 years.

Conclusion

The strong lung/non-lung cancer death rate associations suggest that tobacco smoke load may be responsible for most prematurely fatal cancers at both lung and non-lung sites. The present method estimates are greater than the earlier estimates. Therefore, tobacco control may reduce cancer death rates more than previously noted.

Nativity and cigarette smoking among lower income blacks: results from the Healthy Directions Study

Blacks in the United States bear the greatest disease burden associated with cigarette smoking. Previous studies have shown that the rapidly increasing population of foreign-born Blacks has lower smoking rates compared to their native-born counterparts. However, less is known about whether cigarette smoking among Blacks varies by region of birth (US, Africa, or the Caribbean), generational status, or acculturation. We examined the association between nativity and cigarette smoking among 667 Black adult men and women enrolled in the Harvard Cancer Prevention Program project. In multi-variable analyses, US-born Blacks were more likely to be smokers compared to those born in the Caribbean (OR = 0.16, 95% CI 0.08, and 0.34) or in Africa (OR = 0.24, 95% CI 0.08, and 0.74). Language acculturation was positively associated with cigarette smoking (OR = 2.62, 95% CI 1.17, and 5.85). We found that US-born Blacks were more likely to be current cigarette smokers than those born in either Caribbean or African countries. Our findings highlight the importance of intervening early new Black immigrants to stem the uptake of cigarette smoking behaviors as individuals become acculturated.

Misestimation of peer tobacco use: understanding disparities in tobacco use

Blacks experience disproportionately elevated rates of tobacco-related morbidity and mortality. Blacks experience delayed smoking initiation relative to other racial/ethnic groups, highlighting the importance of examining smoking correlates occurring in late adolescence/early adulthood. The current study reports data collected as part of an ongoing collaborative effort to assess alcohol and drug use on the campuses of historically black colleges and universities (HBCUs). Two-thousand, two-hundred, seventy-seven African-American subjects, aged 20.3 +/- 3.9 (range 18-53), completed the CORE Alcohol and Drug survey and a brief demographic questionnaire. Results indicated that 90% of all subjects overestimated the rate of smoking among their peers. Overestimating was associated with a > 80% increase in the risk of smoking. These data highlight the need to correct misinformation regarding smoking norms among students at some HBCUs.

Lung cancer mortality is elevated in coal-mining areas of Appalachia

Previous research has documented increased lung cancer incidence and mortality in Appalachia. The current study tests whether residence in coal-mining areas of Appalachia is a contributing factor. We conducted a national county-level analysis to identify contributions of smoking rates, socioeconomic variables, coal-mining intensity and other variables to age-adjusted lung cancer mortality. Results demonstrate that lung cancer mortality for the years 2000-2004 is higher in areas of heavy Appalachian coal mining after adjustments for smoking, poverty, education, age, sex, race and other covariates. Higher mortality may be the result of exposure to environmental contaminates associated with the coal-mining industry, although smoking and poverty are also contributing factors. The knowledge of the geographic areas within Appalachia where lung cancer mortality is higher can be used to target programmatic and policy interventions. The set of socioeconomic and health inequalities characteristic of coal-mining areas of Appalachia highlights the need to develop more diverse, alternative local economies.

Smoke load/cancer death rate associations in Korea females, 1985-2004

BACKGROUND

Korea female death rates from many cancers have risen rapidly since 1985. The sources of those cancer death epidemics are unclear but may be related to rising cumulative tobacco smoke damage (smoke load). We assessed Korea female smoke load/cancer death rate associations from 1985 to 2004.

METHODS

Lung cancer rates were used as a smoke load bio-index. Subtracting lung, stomach, and uterine corpus cancer death World age standard rates (rates) from all-sites rates gave us non-lung-stomach-uterine corpus (NLSUc) rates. Lung/NLSUc linear regressions were run, adjusted for autocorrelation. Estimated, lower, and upper bound smoking-attributable fractions (SAFs) were calculated using the formula SAF=1-{(unexposeds' cancer death rate)/(observed rate)}, based on the linear regression and respective best, upper, and lower bound estimated lung, stomach, and uterine cancer death rates in the unexposed.

RESULTS

Lung cancer death rates (smoke load) can explain 88% of the variance in NLSUc rates from 1985 to 2004 after adjusting for autocorrelation. The estimated Korea female all-sites cancer death rate SAF in 2004 was 43% (sensitivity range 29-56%).

CONCLUSIONS

Smoke load, probably from tobacco given the epidemic time course, may cause a large cancer death burden in Korea females despite their very low self-reported prevalence of smoking.

Disparities in smoking: data from the Nashville REACH 2010 project

The Nashville REACH 2010 project is funded by the Centers for Disease Control and Prevention to reduce health disparities in diabetes and heart disease among African Americans in Nashville, Tenn. While Tennessee has the third highest smoking rate (26.1%) in the United States, there are few appropriate local data useful for planning and evaluating local antismoking interventions. Data gathered for Nashville REACH 2010 from 4 large random telephone surveys were pooled to produce a database (n = 15,076) to define the extent of the local smoking disparity and the subgroups with the highest and lowest prevalence of smoking. African American women were least likely to smoke (21.3%) followed by white women (24.9%), and then African American and white men (27.3% and 27.9%, respectively). Among African American subgroups, smoking was lowest in students (10.8%) and retirees (17.1%) and highest in unemployed men (45.9%). In a logistic regression, smoking was highest among single men, the lowest educational level, the unemployed, the lowest income groups, and those between 40 and 50 years of age.

Tobacco smoke overload and ethnic, state, gender, and temporal cancer mortality disparities in Asian-Americans and Pacific Islander-Americans

BACKGROUND

Asians and Pacific Islanders (APIs) are important populations nationally and globally. So we assessed cumulative tobacco smoke overexposure (smoke overload)/cancer mortality associations across states, ethnicities, years, and genders among API-Americans.

METHODS

Death rates were adjusted to the 2000 United States age standard, lung cancer death rates used as a smoke overload bio-index, and lung/non-lung cancer death rate linear regressions run. Cancer death rate smoking-attributable fractions (SAFs) are equal to 1--estimated unexposed rate/observed rate.

RESULTS

The two lowest smoke overload and non-lung cancer death rates were in South Asian (Indo)-Californian females and males. The highest were in Korean-Californian males. Non-lung cancer death rates were tightly and steeply associated with smoke overload across ethnicity, state, year, or gender. Cancer death rate smoking-attributable fractions ranged from 0 in female and 6% in male Indo-Californians, to 39% in female and 57% in male API-Americans in 2002, to 71% in Korean-Californian and 69% in API Hawaiian males.

DISCUSSION

Many API American cancer death rate disparities across genders, ethnicities, states, or years can be explained by smoke overload disparities. Tobacco control may greatly reduce cancer death rates and disparities among API-Americans and, likely, others.