Mortality Attributable To Smoking In American Indians: Findings From The Strong Heart Study
Background Smoking poses a risk for increased morbidity and mortality from many diseases. The ethnic group of American Indians has the highest prevalence of smokers compared to other racial/ethnic groups in the United States, and therefore may be at a greater risk of smoking-related death. This study aimed to estimate all-cause mortality attributable to smoking, and specifically to examine the association of smoking and mortalities from cardiovascular disease (CVD) and cancer in American Indians using data from the Strong Heart Study. Methods The Strong Heart Study is a large, community-based, prospective survey of CVD risk factors in American Indians from in three tribes residing in North and South Dakota, seven tribes in southwestern Oklahoma, and three tribes in central Arizona. A total of 4549 tribal members aged 45 to 74 years, representing 62% of total population in this age group, were recruited from all eligible individuals at the baseline survey between July 1989 and January 1992. The participation rates were 55% in the Dakota center, 62% in the Oklahoma Center, and 72% in the Arizona center. Baseline data were collected using personal interview and a physical examination. Mortality and causes of death were followed up from 1993 through the end of 2009. The numbers of deaths attributable to smoking until the end of 2009 were estimated using multivariable-adjusted relative risk analysis stratified according to gender and center. Results Overall, there was a significant association between smoking and death from any cause after adjustment for multiple risk factors. In 2009, a total number of 363 deaths were found attributable to smoking among American Indian population aged 45-74, of which 105 deaths were among men and 258 deaths among women. There is a significant association smoking and CVD mortality only in Dakota center. In cancer deaths, there was a significant association both in men and women: a total of 1462 deaths were attributable to smoking among American Indian population aged 45-74, of which 571in men, and 891in women. Conclusions Smoking was associated with increased risk of death among American Indians, especially with cancer deaths. There was no overall association between smoking and CVD deaths, but a significant association was observed in Dakota center. Reducing the prevalence of smoking might benefit in prevention of smoking related mortality among American Indians.