Journal of the National Cancer Institute Advance Access originally published online on June 10, 2008
JNCI Journal of the National Cancer Institute 2008 100(12):845-853; doi:10.1093/jnci/djn124
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Published by Oxford University Press 2008.
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The Risk of Death by Age, Sex, and Smoking Status in the United States: Putting Health Risks in Context
Affiliations of authors: The Veterans Affairs Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT; Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH; and Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH
Correspondence to: Lisa M. Schwartz, MD, MS, Veterans Affairs Outcomes Group (111B), Department of Veterans Affairs Medical Center, White River Junction, VT 05009 (e-mail: lisa.schwartz{at}dartmouth.edu).
Background: To make sense of the disease risks they face, people need basic facts about the magnitude of a particular risk and how one risk compares with other risks. Unfortunately, this fundamental information is not readily available to patients or physicians. We created simple one-page charts that present the 10-year chance of dying from various causes according to age, sex, and smoking status.
Methods: We used the National Center for Health Statistics Multiple Cause of Death Public Use File for 2004 and data from the 2004 US Census to calculate age- and sex-specific death rates for various causes of death. We then combined data on smoking prevalence (from the National Health Interview Survey) and the relative risks of death from various causes for smokers vs never smokers (from the American Cancer Society’s Cancer Prevention Study-II) to determine age-, sex-, and smoking-specific death rates. Finally, we accumulated these risks for various starting ages in a series of 10-year life tables. The charts present the 10-year risks of dying from heart disease; stroke; lung, colon, breast, cervical, ovarian, and prostate cancer; pneumonia; influenza; AIDS; chronic obstructive pulmonary disease; accidents; and all causes.
Results: At all ages, the 10-year risk of death from all causes combined is higher for men than women. The effect of smoking on the chance of dying is similar to the effect of adding 5 to 10 years of age: for example, a 55-year-old man who smokes has about the same 10-year risk of death from all causes as a 65-year-old man who never smoked (ie, 178 vs 176 of 1000 men, respectively). For men who never smoked, heart disease death represents the single largest cause of death from age 50 on and the chance of dying from heart disease exceeds the chances of dying from lung, colon, and prostate cancers combined at every age. For men who currently smoke, the chance of dying from lung cancer is of the same order of magnitude as the chance dying from heart disease and after age 50 it is about 10 times greater than the chance of dying from prostate or colon cancer. For women who have never smoked, the magnitudes of the 10-year risks of death from breast cancer and heart disease are similar until age 60; from this age on, heart disease represents the single largest cause of death. For women who currently smoke, the chance of dying from heart disease or lung cancer exceeds the chance of dying from breast cancer from age 40 on (and does so by at least a factor of 5 after age 55).
Conclusion: The availability of simple charts with consistent data presentations of important causes of death may facilitate discussion about disease risk between physicians and their patients and help highlight the dangers of smoking.
| CONTEXT AND CAVEATS Prior knowledge The information that people receive about their risk of disease is often incomplete because it does not address the probability of dying from the specific disease over a defined time period, nor does it put the risk into the context of other important health risks. Study design National census and health data for 2004 were used to create simple one-page charts that present the 10-year chance of dying, according to age, sex, and smoking status, from heart disease; stroke; lung, colon, breast, cervical, ovarian, and prostate cancer; pneumonia; influenza; AIDS; chronic obstructive pulmonary disease; accidents; and all causes. Contribution At all ages, the 10-year risk of death from all causes combined is higher for men than women. The effect of smoking on the chance of dying is similar to the effect of adding 5 to 10 years of age. For men who never smoked, heart disease death represents the single largest cause of death from age 50 on. For men who currently smoke, the chance of dying from lung cancer is of the same order of magnitude as the chance of dying from heart disease from age 60 on, and after age 50, it is 10 times greater than the chance of dying from prostate or colon cancer. For women who never smoked, the 10-year risks of death from breast cancer and heart disease are similar until age 60; from this age on, heart disease represents the single largest cause of death. For women who currently smoke, the chance of dying from heart disease or lung cancer exceeds the chance of dying from breast cancer from age 40 on. Implications The availability of simple charts with consistent data presentations of important causes of death may facilitate discussion about disease risk between physicians and their patients and help highlight the dangers of smoking. Limitations The mortality data that were used to calculate cause-specific death rates were derived from death certificates and are only as good as the death certificates. Relative risks of death from various causes were from the American Cancer Society's Cancer Prevention Study-II, which represent a single—albeit very large—cohort study. Risk estimates were not personalized beyond age, sex, and smoking status.
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Manuscript received November 21, 2007; revised March 3, 2008; accepted March 20, 2008.
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