Estimation of Cigarette Smoking–Attributable Morbidity in the United States | Journal Scan

Study Questions:

What is the burden of major medical conditions attributable to cigarette smoking in the United States?


The disease burden of smoking was estimated using population-attributable risk calculations, taking into account the uncertainty of estimates. Population estimates came from 2009 US Census Bureau data and smoking prevalence, disease prevalence, and disease relative risk estimates came from National Health Interview Survey data for surveyed adults from 2006 through 2012. National Health and Nutrition Examination Survey spirometry data obtained from medical examination of surveyed adults from 2007 through 2010 were used to adjust for underreporting of chronic obstructive pulmonary disease. Smoking status was assessed from self-reported National Health Interview Survey data. The main outcome measure was the number of adults 35 years and older who had a major smoking-attributable disease by sex and condition, and the total number of these conditions were estimated for the United States in 2009.


Using National Health Interview Survey data, they estimated that 6.9 million (95% confidence interval [CI], 6.5-7.4 million) US adults had a combined 10.9 million (95% CI, 10.3-11.5 million) self-reported smoking-attributable medical conditions. Using chronic obstructive pulmonary disease prevalence estimates obtained from National Health and Nutrition Examination Survey self-reported and spirometry data, they estimated that US adults had a combined 14.0 million (95% CI, 12.9-15.1 million) smoking-attributable conditions in 2009.


The authors concluded that US adults have had approximately 14 million major medical conditions that were attributable to smoking.


This analysis presents updated, nationally representative estimates of smoking-attributable morbidity for the United States that control for confounding risk factors and account for the statistical uncertainty of estimates. The study reports that US adults in 2009 had at least 14 million serious medical conditions that were attributable to cigarette smoking. These estimates demonstrate that smoking accounts for millions of serious medical conditions in the United States that could be avoided in the absence of cigarette use. The disease burden of cigarette smoking in the United States remains immense, demonstrating an urgent need for vigorous smoking prevention efforts.

Clinical Topics: Prevention, Smoking

Keywords: Smoking, Pulmonary Disease, Chronic Obstructive, Morbidity, Cost of Illness, Risk, Risk Factors, Censuses, Prevalence, Outcome Assessment (Health Care)

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