Journal of Epidemiology
Online ISSN : 1349-9092
Print ISSN : 0917-5040
ISSN-L : 0917-5040
Original Article
Comparison of Prevalence- and Smoking Impact Ratio-Based Methods of Estimating Smoking-Attributable Fractions of Deaths
Kyoung Ae KongKyung-Hee Jung-ChoiDohee LimHye Ah LeeWon Kyung LeeSun Jung BaikSu Hyun ParkHyesook Park
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2016 Volume 26 Issue 3 Pages 145-154


Background: Smoking is a major modifiable risk factor for premature mortality. Estimating the smoking-attributable burden is important for public health policy. Typically, prevalence- or smoking impact ratio (SIR)-based methods are used to derive estimates, but there is controversy over which method is more appropriate for country-specific estimates. We compared smoking-attributable fractions (SAFs) of deaths estimated by these two methods.
Methods: To estimate SAFs in 2012, we used several different prevalence-based approaches using no lag and 10- and 20-year lags. For the SIR-based method, we obtained lung cancer mortality rates from the Korean Cancer Prevention Study (KCPS) and from the United States-based Cancer Prevention Study-II (CPS-II). The relative risks for the diseases associated with smoking were also obtained from these cohort studies.
Results: For males, SAFs obtained using KCPS-derived SIRs were similar to those obtained using prevalence-based methods. For females, SAFs obtained using KCPS-derived SIRs were markedly greater than all prevalence-based SAFs. Differences in prevalence-based SAFs by time-lag period were minimal among males, but SAFs obtained using longer-lagged prevalence periods were significantly larger among females. SAFs obtained using CPS-II-based SIRs were lower than KCPS-based SAFs by >15 percentage points for most diseases, with the exceptions of lung cancer and chronic obstructive pulmonary disease.
Conclusions: SAFs obtained using prevalence- and SIR-based methods were similar for males. However, neither prevalence-based nor SIR-based methods resulted in precise SAFs among females. The characteristics of the study population should be carefully considered when choosing a method to estimate SAF.

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© 2015 Kyoung Ae Kong et al. This is an open access article distributed under the terms of Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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