50-Year Trends in Smoking-Related Mortality in the United States
A partir de données de grandes cohortes américaines, cette étude analyse l'évolution de la mortalité associée au tabagisme depuis 1950, dont la mortalité par cancer du poumon
The disease risks from cigarette smoking increased over most of the 20th century in the United States as successive generations of first male and then female smokers began smoking at progressively earlier ages. American men began smoking manufactured cigarettes early in the 20th century; by the 1930s, the average age at initiation fell below 18 years. Relatively few women smoked regularly before World War II; their average age at initiation continued to decrease through the 1960s. Women were not included in the earliest prospective epidemiologic studies in the 1950s, since mortality from lung cancer among women was not yet increasing in the general population. The landmark 1964 U.S. Surgeon General's Report concluded only that “cigarette smoking is causally related to lung cancer in men.” Neither sex had yet experienced the full effects of smoking from adolescence throughout adulthood. The first large, prospective study of smoking and mortality involving both women and men was Cancer Prevention Study I (CPS I), initiated by the American Cancer Society (ACS) in 1959. The relative risk of death from lung cancer during the first 6 years of follow-up among current smokers, as compared with persons who had never smoked, was 2.69 (95% confidence interval [CI], 2.14 to 3.37) for women and 11.35 (95% CI, 9.10 to 14.15) for men. In 1982, the ACS initiated the second Cancer Prevention Study (CPS II), which included nearly 1.2 million men and women nationwide. During the intervening 20 to 25 years, the relative risk of death from lung cancer had increased to 11.94 (95% CI, 9.99 to 14.26) for female smokers and to 22.36 (95% CI, 17.77 to 28.13) for male smokers.10,12