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Show Comparison of Smoking-Related Cancer Prevalence Between White Men in Utah and the United States Ray M. Merrill, Ph.D. M.P.H. Abstract: OBJECTIVE. Utah has historically experienced much lower cigarette smoking prevalence than the United States. Utah is currently the only state to achieve the national health objective for the year 2000 of cigarette smoking prevalence among adults of no more than 15%. In 1997, the Centers for Disease Control and Prevention reported that smoking prevalence in Utah was 13.8%. After more than two decades of decline, since the early 1990s cigarette smoking prevalence rates in the United States have leveled at about 26%. This paper assesses the impact of the differential cigarette smoking prevalence on cancer between white men in Utah and the United States. METHODS. Seven smoking-related cancer sites identified in the literature are considered. The prevalence of these cancers are derived and compared for white men between Utah and the United States, based on data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute. RESULTS. Smoking-related cancer prevalence rates are between two and three times higher in the United States than in Utah. The largest percent difference in rates is for lung cancer. In Utah in 1995, the number of lung cancer prevalent cases for patients alive from 0-1, 0-5, 0-10, and, 0-20 years of diagnosis was 197, 298, 362, and 428, respectively. If Utah had experienced the same lung cancer prevalence rates as in the United States, these numbers would have been 638, 1,032, 1,263, and 1,447. CONCLUSION. Lower levels of cigarette smoking in Utah than in the United States have resulted in substantially lower smoking-related cancer prevalence rates. United States smoking-related cancer prevalence rates will continue to fall, but will remain significantly higher than those in Utah for several years to come. Introduction An assessment of the overall impact of disease in a defined population requires consideration of different statistical measures. Disease incidence, mortality, and survival rates give information on the risk and lethality of the disease. Prevalence rates summarize the disease burden in the population (Freeman and Hutchison, 1980). Prevalence is a measure of primary interest in public health because it identifies disease burden in the population and on the health care system. Such information is useful in public policy debates when considering allocation of health resources and services. Prevalence is expected to increase if the number of new cases increase and/or the prognosis of the disease improves. In this paper, the prevalence of smoking-related cancers is estimated for both Utah and the United States. A comparison is made of the smoking-related cancer prevalence rates between white men in Utah and the United States in order to provide an estimate of the amount of cancer burden avoided in Utah because of the historically lower cigarette smoking rates (Table 1). Because treatment for cancer (e.g., surgery, radiation) may lead to long-term or permanent mental and physical impairment (Kazak et al., 1997; McCalla, 1985; Novakovic etal., 1996), as well as changes in one's socio-economic and cultural status, diagnosed cases are typically considered prevalent until death (Adami, Gunnarsson, Sparen, Eklund, 1989; Capocaccia et al., 1990; Enstrom and Austin, 1977; Feldman, Kessler, Myers, Naughton, 1986; Polednak, 1997). The prevalence estimates reported in this paper consist of all living diagnosed cases, including those cases considered to be cured. Prevalence estimates are reported for white men only. We focus on whites because of the small minority of nonwhites in Utah (i.e., less than 6%). We also select males because of their traditionally high cigarette smoking prevalence relative to females (National Health Interview Surveys: United States 1965-94; Centers for Disease Control and Prevention, 1996). 10 |
