The Contribution of Smoking to Black-White Differences in U.S. Mortality

Abstract

Smoking has significantly impacted American mortality and remains a major cause of morbidity and mortality. No previous study has systematically examined the contribution of smoking-attributable deaths to mortality trends among blacks or to black-white mortality differences at older ages over time in the United States. In this article, we employ multiple methods and data sources to provide a comprehensive assessment of this contribution. We find that smoking has contributed to the black-white gap in life expectancy at age 50 for males, accounting for 20 % to 48 % of the gap between 1980 and 2005, but not for females. The fraction of deaths attributable to smoking at ages above 50 is greater for black males than for white males; and among men, current smoking status explains about 20 % of the black excess relative risk in all-cause mortality at ages above 50 without adjustment for socioeconomic characteristics. These findings advance our understanding of the contribution of smoking to contemporary mortality trends and differences and reinforce the need for interventions that better address the needs of all groups.

Age Differences in the Trends of Smoking Among California Adults: Results from the California Health Interview Survey 2001–2012

“…In addition, African Americans and Asians were more likely to be daily smokers than Whites regardless of age. Similar to our findings, one recent study showed that smoking contributed to BlackWhite mortality in the US [19]. The study found that smoking has contributed to the black-white life expectancy gap at age 50 for males but not for females.…”

“…The study found that smoking has contributed to the black-white life expectancy gap at age 50 for males but not for females. Smokingattributable mortality at age [50 is greater for black males than for white males and helps address the 20 % increase in relative risk for black all-cause mortality [19].…”

Social determinants and health behaviors: conceptual frames and empirical advances

“…First, human lives are shaped by historical times [88, 89]. For example, social acceptance of smoking in the U.S. has varied tremendously from decade to decade, influencing both people’s likelihood of smoking and the degree to which genetic susceptibility to smoking is associated with smoking behavior [90].…”

Contribution of smoking-attributable mortality to life-expectancy differences by marital status among Finnish men and women, 1971-2010

“…Moreover, adjustment for self-rated health and functional ability prior to smoking adjustment may partially mask the true effects of smoking on mortality differentials, since smoking-related illness may lead to lower self-rated health and impaired functional ability. Overall, by using the PGW method, we avoided the problems related to accurately capturing lifetime smoking exposure that survey-based methods may suffer from, including recall bias, misclassification of past and present smoking statuses, and difficulties in taking into account different smoking intensities or changes in smoking status during follow-up (Ho and Elo 2013). …”

“…In Finland, Joutsenniemi et al (2006) found that up to 33% of the differences in self-rated health was due to smoking, after controlling for education, in 1978–1980 and 2000–2001. Although previous population-based studies have made important contributions, studies based on self-reported smoking data from surveys are subject to problems related to accurately capturing lifetime smoking exposure in different marital states, due to factors such as misclassification of past and present smoking statuses, recall bias, and problems in taking into account different smoking intensities or changes in smoking status during follow-up (Ho and Elo 2013). …”