The largest US studies of smoking's risks are based on nurses, Cancer Society or MRFIT volunteers, and HMO members. Those groups exclude many poor Americans who have excesses of heavy and early age smoking, and other exposures which cause effects synergistic with smoking. So we estimated smoking's mortality risks in a representative sample of US households, without and with educational stratification.
Methods. We studied mortality in National Health Interview Survey (NHIS) interviewees from 1990-94, followed through 1995. We used Stata software, Cox proportional hazards modeling, primary sampling units, and final weights.
Results. The total mortality hazard ratios (HR) for current versus never smokers were 2.46 (95% CI 2.23-2.71), 2.23 (2.02-2.45) and 2.13 (1.93-2.36) if unadjusted, age-race-sex adjusted, or also education and marital status adjusted. The HR were 2.4 (1.8-3.3), 2.4 (1.8-3.1), 2.2 (1.9-2.6), and 1.8 (1.6-2.1) for strata with 0-11, 12, 13-15, and 16+ years of education, respectively, after adjustment for age, race, sex, and marital status.
Comment. These smoking-related mortality risks are similar to relative risks in Scandinavian cohorts which included the poor, but significantly higher than the risks seen in past US cohorts which largely excluded the poor. The higher smoking-related mortality risks seen in the less educated suggest that studies that exclude the poor or less-educated will underestimate the population risks from smoking. Reducing smoking may reduce health disparities between the more and less educated.
Learning Objectives: Quantify smoking's mortality risks. Quantify smoking's risks in different education strata
Keywords: Tobacco, Mortality
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
The 128th Annual Meeting of APHA