Potentially preventable premature lung cancer deaths in the USA if overall population rates were reduced to those of educated whites in lower-risk states

Abstract

Purpose: Death rates for lung cancer, the leading cause of cancer death in the USA, vary substantially by the level of education at the national level, but this has not previously been analyzed by state.

Methods: We examined age-standardized lung cancer death rates by educational attainment, race/ethnicity, and state in men and women (aged 25-64 years) in the USA in 2008-2010 and estimated the proportion of potentially avoidable premature lung cancer deaths for each state if rates were reduced to those achieved among more educated non-Hispanic whites in five states with low lung cancer rates, using data on 134,869 lung cancer deaths.

Results: Age-standardized lung cancer mortality rates differed substantially by state and education level. Among non-Hispanic white men, for example, rates per 100,000 ranged from below 6 in more educated men (≥16 years of education) in Utah, Colorado, and Montana to >75 in less educated men (≤12 years of education) in Mississippi, Oklahoma, and Kentucky. An estimated 73 % of lung cancer deaths in the USA (32,700 deaths annually in 25- to 64-year-old individuals alone) would be prevented. This proportion was ≥85 % among men in Arkansas, Alabama, Kentucky, and Mississippi, and ≥80 % among women in West Virginia and Kentucky.

Conclusion: Most premature lung cancer deaths in the USA are potentially avoidable. As most of these deaths can be attributed to smoking, our findings underscore the importance of increasing tobacco control measures in high-risk states and targeting tobacco control interventions to less educated populations in all states.