186471 Adult smoke load and mortality disparities across sex, racial/ethnic, and education strata in California

Tuesday, October 28, 2008

Helen Lee, PhD , Public Policy Institute of California, San Francisco, CA
Bruce Leistikow, MD, MS , Public Health Sciences, Univ California, Davis, Davis, CA
Background: California had recent ten fold lung cancer and three fold other deaths rate disparities across sex-education-race/ethnic strata. Recent data suggest that lung cancer rates may be a good proxy for cumulative tobacco smoke damage (smoke load) in populations. So we assessed smoke effects using lung cancer/other deaths rate associations across various sociodemographic strata in California.

Methods: Age-adjusted death rates(AADR) in California adults in 2000-2002 were used, stratified by Hispanic, Black, Asian, and White ethnicity, high school versus post high school education, and sex. We ran linear regressions of lung cancer/all other deaths rates, with and without excluding (subtracting out) homicide, HIV, and breast cancer deaths rates due to human intervention impacts on those death rates. Mortality smoking-attributable fractions (SAFs) were calculated.

Results: Tight lung cancer/other deaths rate disparities were observed, with and without exclusions for homicide, HIV, and breast cancer. Lung cancer AADRs per 100,000 and all cause mortality SAFs ranged from 17.5 and 10% (SR -37-54%) in Hispanic and 26.7 and 3% (SR -48%-50%) in Asian more educated females to lung cancer rates of 168 and 177 and SAFs of 81% (SR 71-90%) in White and Black less educated males, respectively.

Discussion: Tight lung cancer/other deaths associations suggest that smoking may cause about 90% of the mortality rate disparities studied and 40-80% of all cause mortality rates in all groups studied except educated Hispanic and Asian females. Further smoke exposure reductions seem merited. Further biological assessments of smoke load and population studies of smoke load disparities is needed.

Learning Objectives:
1. Assess how cumulative tobacco smoke exposure disparities as proxied by lung cancer death rates contributes to understanding overall mortality rate disparities, and for which particular population subgroups. 2. Articulate the impact of smoking and tobacco exposure on overall mortality and in explaining health disparities that exist across sociodemographic groups. 3. Identify population groups for whom further smoke exposure reduction are needed and develop further plans to assess smoke exposure reduction in population health studies.

Keywords: Mortality, Smoking

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I hold a PhD in Sociology, M.A. in Demography, and specialize in studying population health disparities and preventable and behavioral aspects of health status and mortality. I have published a policy report that examines racial/ethnic disparities in cause-specific mortality in the state of California, from which the proposed study is based.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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