Increasing lung cancer death rates among young women in southern and midwestern States

Abstract

Purpose: Previous studies reported that declines in age-specific lung cancer death rates among women in the United States abruptly slowed in women younger than age 50 years (ie, women born after the 1950s). However, in view of substantial geographic differences in antitobacco measures and sociodemographic factors that affect smoking prevalence, it is unknown whether this change in the trend was similar across all states.

Methods: We examined female age-specific lung cancer death rates (1973 through 2007) by year of death and birth in each state by using age-period-cohort models. Cohort relative risks adjusted for age and period effects were used to compare the lung cancer death rate for a given birth cohort to a referent birth cohort (ie, the 1933 cohort herein).

Results: Age-specific lung cancer death rates declined continuously in white women in California, but the rates declined less quickly or even increased in the remaining states among women younger than age 50 years and women born after the 1950s, especially in several southern and midwestern states. For example, in some southern states (eg, Alabama), lung cancer death rates among women born in the 1960s were approximately double those of women born in the 1930s.

Conclusion: The unfavorable lung cancer trend in white women born after circa 1950 in southern and midwestern states underscores the need for additional interventions to promote smoking cessation in these high-risk populations, which could lead to more favorable future mortality trends for lung cancer and other smoking-related diseases.

Fig 1.

Trends in age-specific lung cancer death rates by year of death among white women for (A) California, (B) New York, and (C) Alabama. Dots denote the fitted lung cancer death rates, and shaded areas represent 95% point-wise CIs based on age-period-cohort modeling.

Fig 2.

Rate ratios of lung cancer death rates according to birth cohort among white women for (A) California, (B) New York, and (C) Alabama. The reference group is the 1933 birth cohort, and the shaded areas denote the 95% point-wise CIs of rate ratios.

Fig 3.

Rate ratios of lung cancer death rates according to birth cohort among white women for selected states. The reference group is the 1933 birth cohort, and the shaded areas denote the 95% point-wise CIs of rate ratios.

Fig A1.

Trends in age-specific lung cancer death rates by year of birth among white women for (A) California, (B) New York, and (C) Alabama. Dots denote the fitted lung cancer death rates, and shaded areas represent the 95% point-wise CIs based on age-period-cohort modeling. .