Smoking-Related Cancer Mortality Highest in Southern States

In the United States, daily anti-smoking television ads play on repeat and in schools children are being taught that smoking kills. Despite this, there are still 40 million adults in the United States who smoke cigarettes, which accounts for an estimated 28.7% of all cancer deaths.

To get this number, Joannie Lortet-Tieulent, MSc from the American Cancer Society and coauthors, estimated the population-attributable fraction of cancer deaths caused by smoking cigarettes.

They used relative risks for 12 smoking-related cancers and state-specific smoking prevalence data from the Behavioral Risk Surveillance System. All US states and the District of Columbia were included in the study.

The results of the study showed that in 2014, there were 167,133 (28.6%) cancer deaths that were attributable to cigarette smoking. In men, it ranged from a low of 21.8% in Utah to a high of 39.5% in Arkansas, but was at least 30% in every state except Utah.

Furthermore, the estimated proportion of smoking-attributable deaths in men was nearly 40% in Arkansas, Tennessee, Louisiana, Kentucky, and West Virginia.

For women, the proportion ranged from 11.1% in Utah to 29% in Kentucky. Additionally, there was at least 20% in all states except Utah, California, and Hawaii.

A big chunk of states that had the highest proportion of smoking-attributable cancer deaths were found to be in the South. This included 9 of the top 10 ranked states for men, and 6 of the top 10 ranked states for women for proportion of smoking-related cancer deaths.

The study authors stated that the higher proportion in the South was most likely due to its higher historic smoking prevalence, which has continued in large amounts because of weaker tobacco control policies and programs. According to the study, most affordable cigarettes and some of the least restrictive public smoking policies are found down south as well.

The higher smoking-attributable cancer mortality in the Southern states could also be due to the disproportionately high levels of low socioeconomic status, which has been associated with a higher prevalence of cigarette smoking. Additionally, racial differences and population distribution may also account for some of the differences across the states.

Some limitations to the study were that deaths attributable to tobacco use was likely underestimated for a number of reasons, such as that only 12 cancers were included in the research. Also, self-reported data is known to underestimate smoking prevalence.

“Increasing tobacco control funding, implementing innovative new strategies, and strengthening tobacco control policies and programs, federally and in all states and localities, might further increasing smoking cessation, decrease initiation and reduce the future burden of smoking-related cancers,” study authors said.