Study Estimates 14 Million US Medical Conditions Linked to Smoking

Enumerating the damage caused by smoking by how many persons are afflicted with serious smoking-attributable morbidities, a study published Oct. 13 in JAMA Internal Medicine  has estimated that approximately 14 million major medical conditions in U.S. adults were linked to smoking in 2009. To date, there are an estimated 480,000 annual deaths caused by tobacco use in the U.S. and approximately 5.7 million deaths each year globally, making smoking the most common cause of preventable death worldwide.

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Led by principal investigator Brian Rostron, PhD, MPH, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD, the study’s calculations derived from 2009 U.S. Census Bureau data and smoking prevalence, disease prevalence, and disease relative risk estimates taken from National Health Interview Survey data for survey adults from 2006-2012. National Health and Nutrition Examination Survey spirometry data was obtained from medical examination of surveyed adults from 2007 to 2010 was also used to adjust for underreporting of chronic obstructive pulmonary disease.

Using the collected data from the National Health Interview Survey, Rostron et al. estimated that 6.9 million (95 percent CI, 6.5-7.4 million) U.S. adults had a combined 10.9 million (95 percent CI, 10.3-11.5 million) self-reported smoking-attributable medical conditions. Meanwhile utilizing the chronic obstructive pulmonary disease prevalence estimates obtained from National Health and Nutrition Examination Survey self-reported and spirometry data, they estimated that U.S. adults had a combined 14.0 million (95 percent CI, 12.9-15.1 million) smoking-attributable conditions in 2009. Rostron and his co-authors argue that this figure is ultimately quite conservative due to the existence of other diseases and medical events that were not included in their estimates.

In a corresponding editorial comment, Steven Schroeder, MD, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, asks, “Does it make any difference that smoking is even riskier than previously assumed?” He adds that, “physician involvement has been inconsistent, even among the subspecialties that most encounter smokers with disease: cardiologists, oncologists and pulmonologists. The data from Rostron et al. should serve to keep tobacco control and its two-fold aims of preventing initiation and helping smokers quit as the most important clinical and public health priorities for the foreseeable future.”

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