The contribution of a history of heavy smoking to Scotland's mortality disadvantage

The Role of Smoking in Country Differences in Life Expectancy Across Europe, 1985-2014

INTRODUCTION

Smoking contributes substantially to mortality levels and trends. Its role in country differences in mortality has, however, hardly been quantified. The current study formally assesses the-so far unknown-changing contribution of smoking to country differences in life expectancy at birth (e0) across Europe.

METHODS

Using all-cause mortality data and indirectly estimated smoking-attributable mortality rates by age and sex for 30 European countries from 1985 to 2014, the differences in e0 between each individual European country and the weighted average were decomposed into a smoking- and a nonsmoking-related part.

RESULTS

In 2014, e0 ranged from 70.8 years in Russia to 83.1 years in Switzerland. Men exhibited larger country differences than women (variance of 21.9 and 7.0 years, respectively). Country differences in e0 increased up to 2005 and declined thereafter. Among men, the average contribution of smoking to the country differences in e0 was highest around 1990 (47%) and declined to 35% in 2014. Among women, the average relative contribution of smoking declined from 1991 to 2011, and smoking resulted in smaller differences with the average e0 level in the majority of European countries. For both sexes combined, the contribution of smoking to country differences in e0 was higher than 20% throughout the period.

CONCLUSIONS

Smoking contributed substantially to the country differences in e0 in Europe, their increases up to 1991, and their decreases since 2005, especially among men. Policies that discourage smoking can help to reduce inequalities in mortality levels across Europe in the long run.

IMPLICATIONS

Smoking contributes substantially to country differences in life expectancy at birth (e0) in Europe, particularly among men, for whom the contribution was highest around 1990 (47%) and declined to 35% in 2014. In line with the anticipated progression of the smoking epidemic, the differences between European countries in e0 due to smoking are expected to further decline among men, but to increase among women. The role of smoking in mortality convergence since 2005 illustrates that smoking policies can help to reduce inequalities in life expectancy levels across Europe, particularly when they target smoking in countries with low e0.

Trends in life expectancy and age-specific mortality in England and Wales, 1970-2016, in comparison with a set of 22 high-income countries: an analysis of vital statistics data

BACKGROUND

Since 2010, the rate of improvement in life expectancy in the UK has slowed. We aimed to put this trend in the context of changes over the long term and in relation to a group of other high-income countries.

METHODS

We compared sex-specific trends in life expectancy since 1970 and age-specific mortality in England and Wales with median values for 22 high-income countries (in western Europe, Australia, Canada, New Zealand, Japan, and the USA). We used annual mortality data (1970-2016) from the Human Mortality Database.

FINDINGS

Until 2011-16, male life expectancy in England and Wales followed the median life expectancy of the comparator group. By contrast, female life expectancy was below the median and is among the lowest of the countries considered. In 2011-16, the rate of improvement in life expectancy slowed sharply for both sexes in England and Wales, and slowed more moderately in the comparator group because of negative trends in all adult age groups. This deceleration resulted in a widening gap between England and Wales and the comparators from 2011 onwards. Since the mid-2000s, for the first time, mortality rates in England and Wales among people aged 25-50 years were appreciably higher than in the comparator group.

INTERPRETATION

Although many countries have seen slower increases in life expectancy since 2011, trends in England and Wales are among the worst. The poor performance of female life expectancy over the long-term is in part driven by the relative timing of the smoking epidemic across countries. The previously overlooked higher mortality among young working-age adults in England and Wales relative to other countries deserves urgent attention.

FUNDING

None.

Smoking-attributable mortality by cause of death in the United States: An indirect approach

More than 50 years after the U.S. Surgeon General's first report on cigarette smoking and mortality, smoking remains the leading cause of preventable death in the United States. The first report established a causal association between smoking and lung cancer, and subsequent reports expanded the list of smoking-attributable causes of death to include other cancers, cardiovascular diseases, stroke, and respiratory diseases. For a second level of causes of death, the current evidence is suggestive but not sufficient to infer a causal relationship with smoking. This study draws on 1980–2004 U.S. vital statistics data and applies a cause-specific version of the Preston-Glei-Wilmoth indirect method, which uses the association between lung cancer death rates and death rates for other causes of death to estimate the fraction and number of deaths attributable to smoking overall and by cause. Nearly all of the established and additional causes of death are positively associated with lung cancer mortality, suggesting that the additional causes are in fact attributable to smoking. I find 420,284 annual smoking-attributable deaths at ages 50+ for years 2000–2004, 14% of which are due to the additional causes. Results corroborate recent estimates of cause-specific smoking-attributable mortality using prospective cohort data that directly measure smoking status. The U.S. Surgeon General should reevaluate the evidence for the additional causes and consider reclassifying them as causally attributable to smoking.

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Examines association between mortality from lung cancer and specific causes of death.

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Evidence for some causes of death is not yet sufficient to infer causal link to smoking.

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420,284 annual deaths were due to smoking among U.S. adults ages 50+ in 2000–2004.

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A portion of deaths from breast and prostate cancer may be attributable to smoking.