Premature Death in the New Independent States (1997) / Chapter Skim
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Mortality from Tobacco in the New Independent States
Mortality from Tobacco in the New Independent States
Pages 262-274
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From page 262... ...
In the United States, however, the American Cancer Society (ACS) has conducted a large prospective study of more than a million adults aged 30 and over who 262
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From page 263... ...
The diseasespecific relative risks derived from this study, together with smoking prevalence data for the United States, have been used by the U.S. Surgeon General to estimate smoking-attributable deaths in the United States by applying the classic attributable risk formula (Levin, 1953~.
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From page 264... ...
Thus the validity of the estimates for the NIS based on this methodology depends entirely on the extent to which the nonsmoker lung cancer rates in these countries approximate those in the United States and elsewhere among the developed countries and the degree to which the cause-of-death data are reliable. On the former issue, data from other populations where smoking has been uncommon (e.g., Spanish females, Norwegian females)
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From page 265... ...
Since the procedure is based on the assumption that the smoothed U.S. nonsmoker lung cancer rates adequately describe the levels for nonsmokers in other countries, if the observed national rate at any age is less than the U.S.
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From page 266... ...
These estimates were prepared for the same age groups and under the same assumptions as for lung cancer, except that relative risks were assumed to be independent of age for nonrespiratory cancer and chronic obstructive pulmonary disease, as suggested by the ACS data (see Peto et al., 1992:1278~. On the basis of the comparative size of disease-specific relative risks suggested by epidemiological studies in different countries, six broad categories of causes of death in addition to lung cancer were constructed for the estimation of smoking-attributable mortality.
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From page 267... ...
For the Baltic states, as well as the Russian Federation, Belarus, and Ukraine, the estimated attributable fractions of mortality from smoking are comparable to those of neighboring countries including Poland (29 percent of all male deaths, 42 percent in middle age) and the Slovak Republic (26 and 38 percent, respectively)
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From page 268... ...
Lung cancer rates among middle-aged men in Kazakstan are substantially higher than in the United States, for example, and are comparable to those observed elsewhere in Eastern Europe. Death rates from the disease in Armenia are also high, similar to those in Belgium and The Netherlands (see Annex 9-1~.
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From page 269... ...
. Therefore, one would expect very low lung cancer rates among NIS women, comparable to those among nonsmoking American women in the ACS, and very low smoking-attributable mortality from other diseases as well.
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From page 270... ...
Thus they can only indicate what the likely mortality from smoking in the NIS may be if nonsmoker lung cancer rates in these states are low and comparable to those of the United States and if mortality data for these states are reliable (particularly lung cancer data)
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From page 271... ...
Given the strong dependence of the method on the assumption that nonsmoker lung cancer rates are low and comparable to those observed in the United States and the United Kingdom, the results presented here should be seen as merely suggestive of the probable impact of tobacco, pending confirmation based on direct evidence from these countries. A case-control study of lung cancer in Krakow, Poland, covering the period 1980-1985, found a significant effect of both air pollution and occupational exposures on lung cancer risk for men (Jedrychowski et al., 1990~.
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From page 272... ...
2. For example, the probability of death before age 70 of a man aged 35 years in 1985 was 34 percent for the United States as a whole, but only 13 percent and 32 percent for nonsmokers and smokers, respectively, in the ACS cohort.
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From page 273... ...
273 Countries All Ages Ages 35-69 Females USA 36.7 23.5 Denmark 34.3 23.6 Iceland 32.1 21.5 United Kingdom 30.7 18.5 Canada 30.3 19.4 Ireland 27.3 15.6 New Zealand 26.4 16.7 Hungary 22.6 13.9 Australia 18.4 11.1 Norway 15.2 10.3 Netherlands 14.7 10.2 Poland 14.2 9.2 Sweden 14.0 9.1 Kazakstan 13.6 8.9 Israel 13.3 6.2 Austria 12.8 7.4 Luxembourg 12.5 9.0 Czechoslovakia (former) 12.4 7.7 Japan 12.2 5.4 Germany 11.5 7.0 Belgium 11.2 7.2 Switzerland 11.1 6.8 Italy 10.9 6.0 Yugoslavia (former)
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From page 274... ...
70.6 France 67.9 Spain 67.6 Armenia 67.3 Austria 66.7 Switzerland 66.7 New Zealand 65.9 Moldova 64.3 Malta 62.8 Australia 62.5 Bulgaria 56.2 Romania 52.9 Kyrgyz 50.6 Japan 47.3 Iceland 45.4 Norway 44.4 Georgia 42.2 Israel 40.3 Portugal 40.2 Azerbaijan 38.0 Sweden 35.6 Turkmenistan 31.2 Uzbekistan 28.9 Tajikistan 21.1 Note: Countries in bold indicate the New Independent States.
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