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WORKSHOP Life Expectwlcy at Age 30: Noilsmohig versus S111olClllg Men By G. H.114iller, Charles E. Cltittenden, and Robert J. Myers N A1OSFOl: TIIE It1iS1'"ARCH ON Atl?N'S SA1t1t:ING I1:1ti- its reported ot•cr the last fi>ur or tivc clccadcs, ttxrrtality rates were analyzed. While this approach is a},hrohri- atr for comparing the inihait uf smoking oil somtc smoking-rrlatett diseases, it tlocs not hrcwidc a clirrct estimate of the tiificrence in litc ea,ectancy as accurate as that dcrived 1i-um dctailed iilc tahle an:tlyscs. 'l6 mcasure thc iitll clkct oil smoking, tltc gr<wps that slurulcl hc compared are lifctimc smokers and lifetime tumsnxrkcr•s. l.ilctime smokers are tfefined here as those who have smoked all crf- thcir lives (ti•om hrctccns, tccns, or carlv adult J•t:ats onward), with the Iwssihlc mrptiun ut tltc last Nvar of- tilc. Nonsmokers include thcrsc who haNc snurkctl a maxinwm of rn•cnty packs crf ii};arcttcs cfurin}; thcir lilctimc, or tvhcr may have brrn ()ciasicmal cig,tr or hihe smokers. 1•hc best known of the carly hrospcrtivc invcstigaticrns on male cigarette smoking are the Rritish Physicians study,' the American (:anccr Society stm1};z atul the l I.S. Vctcrans stmlics.'•' Uh(latcs oil thcsc itwcstigaticros h.rvr hcrn iniluslrcf in c%•cry edition crf thc U.S. Sur};ccm (;rn- rral's reports on smoking and hcalth.s I fu~~rvcr, rsccf)t fc,r cmc article bv I larnmcmci,' which citcd an l1.3-yc.ir (fiflerence in lilc expectancy hetween male hea.•y snu~kers antt male n<msnuokcrs mcasurcd at age 35, the carh• rc- }uorts dealt with comparative mortality rates. In 1970 1'reston" reported on martality an:cm}; adult males. I Ic considcrcci many thcctrics, surh as l;rnrtii, sc~- ci:tl, and physical exhlanatitms, as well as tht: Iwssihlc G.H. Millet• is director a/'Stndics on Sutokintt, Eflinlnnm Reuusvhyn»itr; C;brrrles E. CGittenden is sellttlr critlstlltaUlt 11'Itll Ale.YfllNler Q'J-AlexlrN/ler C.onsAlllRlt (:rnttp, titbtuta, Gcorqut; and RuGcr•t J. ltlyevs is lbt7uer rhity'at-mur); Sui inl Serrrritv Adntlutstwrtiun, resirliurl iu Sili'e'r .S/1rn~et, .lfirl.r- land. 7his rrrtirle is based on rtpt•eseutrrticnr nurde at the Anrrrtrrl rileetinp of the Societi, of Aitturries, Nr,r UI'1CRNs, Loutsintrrr, UetuGcr 14, 19h.5. ('nntingeniirs h1aN./Jttnr 1990 Data derived from deaths in Erie County, Pennsylvania, reveal that the cost, in life expectancy, of a lifetime habit of smoking is dreadfully high- 17.9 years. Constructing the Life Tables "1'Irc lifc table ccrostructiun 1i)l. lables 2 and 3 uses thc fiilknwinK dcfinitions and forntulas: '1'Ite crntral clcath ratc, ti>r the pofiulaticitt fruttt age x to x + 5 is givcn by 'f _ I Actjusted Deaths .,.., ,~- 1'opnlr;tiott whct•r Adjttsted 1)caths are actual deaths, hltts adjust- nx:nt firr ncmrt•slwttdettts. 711c liVc-Vrar sttrVival rate , rSSR,,., from age x to.e + •S is eclual to: x fssll, = ( I +A1,.,a ,., )5 'I'hcn cfninyucnnial infurmation is obtaittcti fitr the liic tahlr hasctf oil these centt•al death and survival ratcs. •1'hc numhrr oI-li+,cs age x is ohtaincd h), setting the radix of the table (the nwiibrr at the }'oun};est age) cyual to 1(f0,UUt) antf obtaining lr , 5 from: 11 a.5 - r~.5S1Zs X 1,. -f-hcn thr numhcr crf ycars lived by the population from agc x tu .t• +5, T, - 7, ~;, is ctbtaincc.l fircmt: 1r - 1a.s + = 2 x S '1'hc 7', column is crhtained by sttmming the 7', ,; icilumn, hackwarefs, once the final Value, 7's.;, is detcrmined as lirlluws: ~,c5 = lxs 111es . '1-he cspectations of litc, ex, are ol>taincd from the li )rillul:t: 7; 1. Oncc again, thc results ctf' this approximation, ttficn trsteLl af ;tinst the dircrtly ccmiputcil liic tahlr V:ilurs (scr hle li), show a Small deviation (ncr morc than 0.3'%, in att), case). TIMN 0020615

cllccts c,f c,l,c•si1v; cxc•rcisc, ancl strc:ec. Rut Itr cimrlucleci that cigarcuc cmc,king «as the m:rjcu c,tu.cc 0 tltc in- crcasccl nu,rtalitt• anxml; .cnrc,king tnctt ttfic•n c„rnl,arcci n•itll nonsmclking nlcn. 1n his rclutrts, I'restcm al.ccr analt•zccl tile clifli•rc•ncc in liac expectancy hetlt•ecn mcn ancl w~nncn. Once ,rgain, lie imhlicatccl smuking as tile nuljnr cause fi,r thc tlifli•rc•ncc anJ provided cstcnsi+•c statistical supp „rt firr thi.c ccmclu- sicm, clcrivccl fiotll cc,tnharisun's c,f, malc Nrt:cu.c Ii•malc stltc,kittg Iiattcrns. ('restcm ttx,tccl "thc cltrhic,usncss uf tltc• hylx>thccis linking mc,rtality tlcrltlc tu f;c•ncric nr suci:tl factclrs." lit anc,thcr articlc," hr cc,rtcluclrcl th:lt, "1Lathcr than representing t•ictimizatic,n ht• Naturc c,r hostile sc,- cial fi~rccs, the ciillicultics c,f, ulclcr nlalcs apl,c:tr tu hc largclyscll=impc,sccl anci avnicl:thlc " I'rc.ctcm's .curmisc tlr:tt smc)king was the principal rcasc,n hchincl tile cliilcrcncc in Icmgcvitt• hcn\'c•cn ntcn and \Nc,tnc•n lr.ts cc,rrc,hur:uccl f1V Itct}lcr/i,rci,11z Whc, :tnalt'rccl cnu,king :tncl tlu• scx- rclatcd mortality ciiilcrcncc, lvicfcwltc>,nl, ancl sex ratic,s. Uthcr itnrstit;ators as N.rll haXr cliscuWcrccl l,,tttcrns ill tlle diflercncc in Icmgct•ityclfnu•n t•rt:cns «•cmu•n."'4-] lti.c cllscrChatlct• is Ill,t tile fixus c,f this articlc•, hut it is im- Iu,rtattt to realize that much c,f thc rcccttt inlirntaticm oil nlalc smclkcrs vctxut malc nc,n.cttutkcrs derives fi•cmt rc- scarch into the ciiflcrcnccs in lungcvity c,l men and Wcmlctl. ,Rco rcccnt U.S. rctreslicctivc stuclics ccnnl,arc•cl malc lilctimc smokers with tnalc lilctintc ncrosmukcrs. Onc «as a 1'cutlsvh•ania stuciv alluciccl tc, hcfinr;" the c,thc•r cun- ccrncd Ncw 1c7rk statc." 1'tcric,uclv; cmc c,fus ((-;.l I.nl.) rchvrtcd a cliflcrcncc c,f 12 yc:trs in lifc cxl,c•ct:tnc%• hc- t«•ccn malc lifitintc sntcrkcrs ancl nt-.tlc li(ctinte nun- smokcrc " while Rose and Cc,hcn" relx,rtccl a 10-w:tr ciiflercncc. Both clf these imrstigatiuns macic use c,f at•- cragc-agc-at-dcath statistics. '111e gah in (ifc cxhcct.itlct• hct«•c•ctt male smc,kct:c and nonsmctkccc was the sul,jcct ufrcl,urts liunt the Amc•rican (;anccr Sc,cict\' ancl tile Lt.S. \ctcrans /1clrrtinistraticrn.'" 1'hc fi,rntcr rclx,rtcd a 6.95-N•car clilicrcrtcc; tile lattcr, a 9-t•car dif7i•rcncc, hctwcen smukittl; :lttci nc,ttsmc,kirtg tncn. A 12-vc•ar clifli•rcrtcc• was citccl in a lili instrr.tncc stucly ccltlthlctc•d hy (;cwcll and 1 litst." 13ccausc there is a l,otcntial I,i:ts in usinl; ;IVc•ragc-:tgc•- at-clcatll statistics, one of tts ((;.) Lnl.) rc•calrul:ucci tile data from his 1976 report that conqparecl liktimc•.cnx,king men with lilctitttc nonsmoking ntcn by lik tat,lc :tttal}:cis. -I'hc life table analysis produced tile santc 12-ti-car cliflcr- ctlcc that was rc•lx,rtccl in tile lcl-h stnch;" and tritcr:lti•cl in 1986.'" Thcn, to acljust fi,r the lxncrlti:ll bias arisinf; lrclttl the ncmrespc,ncicnts in tile stucf.; tllc thinI atrthor pcrli,rntccl another recalculation uf'tltc clata cm lifrtimc smvkct:c versus ncrnsmnkc•t:c. Pc)n both statistics anci acttclri:,l .ccicncc•, it is intl,,,tt:ltrt to lirtcl c,ut tc•ft:tt kinds clf clilkrcncc.c ntig,ht atisc fic,m using axrragc-agc-at-cicatlt .ct:ltlstil5 .ts clhl,usccl tu lili• ta- blc analysis, witlt and li•ithc,ut Icljusttltrnt li,r nc,lncsl,c,n- clents. For this reason, the clata Iiunt tile sunn• ctf' tile smoking habits ctf the Iiving hul,ulaticm of liric (;cwttn; Pc•nnsylvani:t, ccrrc uscci fcn• this stuch:'li, clur kncctvlccl4',c, this is the crnhy cmc that ccrosiclcrs a ccmtl,lctc lilc table analt :ic, :uljn.ctccl fin- ncrnrccl,c,nclcnt.c, f,r cnnrl,aring thc• nWc•rall lilc npcctanct• uf lifctintc malc snx,kcrs with that c,f lilctitnc nunsnutkcr:c li/r a latgc l,crccrltagc of a total i,c,l,ttlaticm. Methods and Procedures 'l hc st:ttistic:tl tncth<,cl usccl in this stuciN• is the twc,-.cam- hIc cruss-sccticmal analysis intrvcluccci bkl I-Iacnszcl ct al."' 'I'his tcchnic1nc ccnnhincs data fircmt a cicccasccl hnpnla- tic,n (nunlcrator cl:lta) n•ith ciata liurlt a liVing lx,l,ulatic,tl (denominator data). C.(nllharccl with classic hroshcctkc ctuclics, this tnc•thcnl Icts investigators cieriVc• nlc,rt.llitV ratcs (ancl thcn lifc tahlcs) rahiclh,: Awcakncss c,f this tvpc c,f' stuch; of cc,ur:cc, is that it irucluclcs tWc, sc•ts 01' clata, instc•acl c,f ctnc; this can mcan less precise rchrescrltatic,rls if sl,ccial carc is ru,t takcn to makc the two hcthulaticm s:1ny,Ic•ti rcl,rescrttaticc ctf'thc.c:unc hc,hulatic,n. lLcins; this tcchniyuc, tile lifctitllc smoking hahits of aciult utrn and worltcn mdhu cliccl in Eric C;ounh: I'cttn- svlvani:l, in 1972-74 (data cicrivccl 1rum intcr.•ic~cs With close rclativrs clf tile cicccasc(.i) were inccrrlxlratcci with thc lilctintc sut•vcy, clata ott the smoking hahits of tltctt anci Wcmlc•n n•hct lit•cc1 in Eric Ccttultti' in 1972-74 (clata c,htainccf hy retrospective projection fi•cml a 1979 survcv). Iclcntic:tl items ct•crc used in both surl•cys to assure the validity c,( thc clucsticrtttl:lires. 7ilchhcmc intcrvicws wcrc usccl, hccausC result5 obtained this way scCtlt to lic more valicl th:ln thc,sc (i-um clucstivnnaires mailccl to scicctcci hart ii ihams.21 I):tt:t un clcccclcnts' smoking habits carcfirll~~ cc,llcctccl ficmt close rclati~•cs anci friends, it has bccn shrnwn, arc as valid as those ohtainc•c1 fi-cxlt the clc•ccasccl prior to clcath.'= z5 In support of this ccmclusicrn, a recent analcsis hy cmc c,f us (CT.1 Ln•i.) shcwccl tltat thc rchctrtirtg c,f thc clcccascci's cause ctf cicath hy close rclativcs provided close al,l,rnxitnatiuns to the causcs listed on death certificates (thcsc• findings arc now hcing :utal}•zccl ancl I,rcE,arccl fi,r I,uhlic:uicm). '1'his analt•sis agrccs with sitllilar reports on rctrc,Shc•cti\•c stuclics, which demonstrate f:lirll• clc,sc agrccnlcnt irt smc,king classificatiuns frcmt strrugatcs and ncst-c,(-kin, ancl also supports the hvIx,thcsis that thc• nunthc•r c,fcigarcttcs smukcci, as detailed in other stuclics, i.c l,rc,hahh• tuxlcrrcllurtt:cl.2`.z; Study Ilc>hulation. Eric, I'cnnsylvania, is a mcciicntl- sizccl citt• (thc third largrst in the state): its lu>hulaticm in 1970 cwas 129,341, while that of Lric L:c,unm, was 2(i3,(,54. 1listc,ricallti; the cc,untv has had a stable }x,hu- laticm, with an in-ctut ntigration of al,llruximatclt• 7°,6 during tile 20-ycan period, 1950-70. The llccllllcm-hv live in t;ric (antnn• are primarily nliclcilc-class Caucasians. Data on the deceased I/opulation. ln 1973 the Nc>rtlt- wc•uc•rn 1'cnnsYlt•ania Stucly un Smoking and I-icalth (N1'SSi l) was I,cgun to cictcrmirtc tile smoking habits of tllc clcccasccl resicicnts c,f Lric (.;outltv." ']*lle data ccrrc cc,llcctccl via telephone intct•vicws with relatives of tile clccc(.Ictlts. I)catll nc,t iccs fitr 1972-741,ro,ricicd the namcs of ncarh• cvcny l,crsun who died in F.ric (;ountv in these 1•cars, TIMN 0020616

1)ata filr this stutlt• arc hascti crn 1,879 nlalcs (ht)y present cigarcttc smokers; 394 iitrnlcr cil;arcttc sntcrkcr:a who arc nt,t cttrrcttth• snx>kct.; 2,}1 l,rescnt ci}'.ar ur l,il,c smokers tchtt ;u•c nctt currcntlt• cig,trt•ttc• stnukecs but nt;tt' h:n•c• l,ccn ill thc past; :,ncl 545 I,c•r:.cros %rhu ncv(:r snu ,krci cigarcttcs, cit;ars, or hiltcs). Life Table Atlalysis The tn•crall csut»atccl percentages (rf'stlutking mctl ;lnc1 ntmsmtlking tncn hv age (in liNc-t•c•ar ccthc,rts) in tllc• pop- ulation clf' l;ric• C;clunrt, are listed ill 'laitir 1. Thc~sc who ciictl during 1975-78 n•crc nc,t inclutlctt ill thc•sc c•stint;ucs, sin(:c the clata were nctt rc;xlilv availahlr. "1'his luss, Iluw- cvcr, should Itacr a ncglil;ihlc• inlpacr. I l;ul thc•sr Iy75-78 deaths been inchtclal, NVr Woulti expect that tllc snlc,kci-s' clc•atll rate ttrtulcl incrraer, sincc• srlu~kc•rx Ilatc a Itif;ltc•r nun-talitv ratc than ncrosm„krrs. I'opuLttictn statistics 101 the wtt:s 1t)7Z-74, pvcitlctl bt- thc Rtn-c•au tlfVital Statistics c~f the I'rnns•h•ania l)c•Ir,trt- mcm of I Ic•alth, ttirrc ccmlbinctl \%•itll tltc• hcrccnta~c fit;- ttres lioml thc strt•c•cy data cd the li\inl; puhulatiim to tlhtain the h;tsc hrrscm-w;lr:c li,r snlctking ;lntl ncrosnu,k- ing tllctt. 'I'hc cntttl'utatictn.e Itrocitlctl the tlcncmtin;ttcrrs nccclcti filr the c;llculaticm of ntc/rt;tlitv rates in c;tch fivr- yrar group. Actuarial ahhrclxinlatit,ns had tc/ hc clc%rlctpccl litr thc deaths that occurred Avithin thc l'c•ricul stutlictl, sincc• titc infilrnlatitm ()n ck•aths and hc,lmlatic,ns cxlutsc•tl to risk was nc~t availahlc in the fi~rnru th;u is nc~rntalh• used in mvrtalitv stutlics. (This hrct(ccltnr was also tuccssan• in makinl; tllc atljustmcnt litr ncmreshOrnlcntc.) Whcn the adjustctl nurllhcr t/f ticaths wae divided In' thc nurnhcr in the population exposed to risk, a unc-t•c;tr cctttral tlc;lth rate for the fic•c-1'car age ccthort vvas obtained. C)ttc ctf us (R.J.A1.) tlt•ric•cc1 fivc•-t•ru-.curvical r;uc-z lin• the exact akc at the beginning Ofcach lic•c-mar ;lgc };rctup, ill ordcr tcl make a projection ()l the cohujaticm fictn/ the hcginning ctl' thc age grc,uh to its crxi.'lltc pnolu/rticm uf the group stn•t•i.•ing is given ht• the formula, the litih howernfthccc>mhlcmcnt cll thc central tlcatll r:uc,lf, that is, (1-.lf)5 (scc fiultnotc h itl'lilNcs 2 ancl 3). The li/c tahlc• rcnlsu-ucticm Ior'litblcs 2 arxl 3 nscs the definitions and firrmuias shcncn in the acijarrnt box. 'Illc deaths recorded in the NPSSI I for the ttt•+l catc- gclrics, smoking and ncrosnuoking tnrn, adjusted as clc- scrilxd in the fxls, wcrc ttsctl as the numcrator tlata.'1-hc population and the reported deaths in each agc i;ttc•gc,rt, are shown in -Iable 2 fitr snutkct:c, and filr nt>nsnxlkcrs, in lable 3. These tablcs also Jishlat~ thc atljustc•ti tlctths and tit:ath rates, the fivr-trar survival rates and the survivors, and thc cvmyutcd Iitc csltcct;ln«~ The Iifc table cumhu- tations wcrc• mattlc according to stantlarcl ;lintari;tl and dcmograpIlic hrclcctlures,2' tising the atljustmcnts fin• ncmreslumtlcnts dcscrihccl ill thc• accunth;mt•int hos. The Results 7ahlt: Igivcs brclatl, general suhlutrt fitr thc argunlcnt that those «•Ilt/ quit snwking can expect grcat gains ill aun iral. Note also that, c,f thctsc aged 85 anci cx~c r,r, 474".~, ttcrc Ii witcr smokers, while ctrlh• ;i.3% were smokers. '1 Itc• fact tlrtt sct nr,ult• cd'thc• ntcn ill tltis age ~;rctul, %tirrc litrtncr, sm(,kct:c explains ~t~ltv it is vital to is<tl;ttc the data cm litrnlc•r snnrkct•s li•um hc,th thc "ntmsmc,king" and "smok- inf!" categories hcfi/rc attcnlpting to makc an arcuratc c.stimatc ctf thc mc~rtality cshcricncc clf lilctitllc smokers antl nc/n.ctlu,kcrs. 'laltlc 2 displays the lifc table attalYsis fitr male snlnkcrs in Eric Cctuntt: 'I:tblc 3 shows this anak•sis filr nctn- snu~kcrs. •Iahlc 4 crnnpares the lil•c cspectancics ff)r lilc- timc malc smokers a•ith tltusc clf lifctimc malc non- snutkcrs (litr ctmll•;lrativt: Inl rlulst:s, lilc cxpcctanrics titr all Lt.S. ntalcs, 1969-71, arc incluclc(lz")• TIIC lifc expectancy clf fifctinlc snluket:s was 179 %rars lc•ss th;in tllat tlf lifctimc ncnlsmttkcrs fitr males agrtl 3(1, ;lfict• hotlt trttmlatic tlcatlls and ncmrespcmcicnts wcre climinatctl. -I-hesc diftcrcnc,rs became snlallcr with itt- crrlsirlg agc. ('lahlc 5 shows the original data rcportrtl to thc St/cictt• uf Actuarics at its 1985 mmeeting. 'I'IIC ciillcr- cncc ill li/c expectancy reported at that timc v.-as 12 trars. ) 1:1bICs A;ltltl B represent tests lur the approximation nlcthculs used to tlcrivc ( I) the five-year survival ratc,; anci (2) thc lifc table populations at agcs v to x + 4, reshcc- tivclv, ill 'lahlcs 2 anti 3. -1'hcsc tests have, as a hasit, thc a1,Illicatitrn tlf the stated ahllrt~sinlatit/ns to a lilc table - Itopulatiun and the umlparisrm ofthc• results «ith a direct computaticm ctf-tltc elements involved, based cm t1;ua litr itltlividual years of life. The results in 'lablcs A antl 1; show that thc tcvu al•hrtlsinlatitms are satisfactcn-t: ' - I lliscttssion -laMc 4 shows tltat, wlicn tllc ta•o-.e;lntplc tl,lt,t fi0rn tltc IICCC1sCt1 and ItCltlg l,tlhulatitms are tratts(imntccl into lifc tablc data adjusted /itr ntmreslumticnts; ncrosrltukin.py, mcrt at age 30 cari, as a group, expect to cnjcrt• 179 mctrc rcar.S ctf lilc than tltcin cvcrs trhtt smoke (c•sclucling trautnatic eic;tths)• This hresctu stueh; ill ~vllich atljustntcnts were maclc fclr nt/nreslxontlc•nts, .ellcws ;m incrr;isc• of-;lplami- nlatcll~ Gycars ill thc tliflcrctucc ill lik cxltcctanc~• t~f malc• snulkcrs versus ncrosmokcrs. 'I'his nunlhcr is in a~rcc•tnrnt with the 1YCr8gC-71gc-1t-tIC1tI1 CSt11118tCS ill the fll:tt rCTOrt ctf the NI'StiI I and the filc itahlc analt:ais tlcmc six mlrs latcr,r` as 1t•CII as tI1C results of 1'rc•stcm; "Rcthcrforcl,', 12 ltclsc attci Gthcn,'l I lammorltl," anci (;cltrcll ancl 1-[irst.'.' I-Ic/wccct•, to our knowledge, the 1i.9-t•car tlillkrcncc citeci here is the I;rcatcst dilict•cncc rcllclrtctl tc/ clatc•. l'ut another way, the cl;lta from the present stutlv in- clicatc that a 30-year-old nlan whct srllukcs will rctiucr his lifc cxhcctanct; tltt at•cragc, In• ahcwt cmc-filurtlt. 'I Itis result, too, is well u•ithin tllc- experimental vatiatic~ns dc- tailctl in othcr uutlics. 1'c,r example, mclrtalitv ratcs tiiI- cussccl in thc comlrlt•isc/tl c,f snu>king-rc•latcti iiVICA~c~ ill the U.S. Surgccm General's rcpc,rt.es show nuiatmnc as high as 300c'4, (m;tlc smctkcrs t•cl:aus ncrosntctkrrt). TIaVIN 0020617

II•nrl,:rbnfl, cwNrmerd /infu pntir.3,3 Life-Table Computations for ntalc N otismukct:c, E ric (;twnty, 1'cnnsvI+•a nia, 1972-74 - I'ulutlati(m 1'ilhulatifrn Agc (:cnu.ll 5-tr,u at Agcs x Agcti x l:xpcrtaticm Cirotth A(I;tlstrtl Ucall, .5tirvi,al Suvivors t(1x4-4 and C)lcr of l.irc (x ttlA I'7 ) I'nhui;ttiun I)c•a)k I)t••ults.. - Rarc, 111 R:uc' I 30-34 8,241 2 2.9 .U(1(13 .9985 IO0,0(1(1 499,625 5,268,014 52.- 35-39 6,215 3 4.1 .11(1O7 .tJ9o5 9t),<450 498,374 4,768,389 4-.4 4O-44 5,790 3 4.1 .0007 .9965 99,5(l1 496,035 4,270,(111 42.9 45-49 5,545 11 15.1 .0(/27 .t))(0<i 99,153 492,442 3,473,376 35.(1 50-54 6,983 13 17.9 .(1()2C, .97i71 97,824 485,965 2,980,934 3U.5 55-59 5,4;1 ;() 41.3 .0076 .9626 96,562 473,782 2,494,969 25.8 60-64 3,576 4(1 55.0 .O153 .9258 92,y51 447,512 2,024,187 21.7 65-69 3, 121 41 56.4 .(11)11 .9127 86,054 411,488 1,573,Gi5 119.3 7O-74 2,648 39 53.h .tl2(12 .9O.30 78,541 373,660 1,162,187 14.8 75-79 2,(130 ht) 91(.9 .O4h7 .7873 7(1,923 316,902 788,527 11.1 80-84 1,(151 103 141.7 .13•1R .4848 55,838 2()7,27() 471,625 8.4 85 1 I,(14R 7R 1O7.3 .1O24 - 27,070 - 264,355 9.8 '1-tual 51,679 4,;2 594.2 -- - - - - - ascd rnl 72. "f I.ill dcaths IK•in~ Irh`u"l in cmcrr Ilclcl`hnnc n unlhc'IC n6taincJ lin RS!6 Ilf Jc'ctcllclcttts, tclrphunc crmtact madc in 90'%r /d cascs n'ith rclcphlmc routtht•r alailablc• and ensucrs ttl imluirc in (15% , l((aces \rlxrc mn} att maJcl. . '/ )- lt) tll tI1C St(1 IVn\'cr-tlllc IC :III 7ii11t:ItC al`I` II`C/II1:ItkN1 (IIIaCIlll llllt ('II'l/l' (ff I.cI'%)~ <t•l' IaI`Il' A. '112 (1, L 1- 1- thlc Ic:lll aC(Ilrltl' at`)`IfIlI111.1I11111 1111:1\Iltllltll ('tlrt ~. r (r Pi,); wt' tal .ll' 1;. 'I:rll .t'-R;. recila<xal Ilf .St rimcslxc. hn I,Ihct ag cc. ht tllllcald cmnnlati'ln. ' . :u Cemiparison of Fspectativns of l.ifc for Males Frir (awnt r Excess tlf U.S. I.ile (ailtu tin (2) over C;ol unut (3) Agc ']ahlc lin 1969-71 N(,nsnul kcr:c Snufkct:c Anwunt 1'crc•cnt 30 40.5 52.7 34.8 17.9 51 ?1o 35 36.() 47,8 3() (1 17.8 59 40 31.5 42.9 25.2 17.7 70 45 27.2 35.O 20.9 14.1 67 5O 23.1 ;(1.5 . 16.9 13.6 80 55 19.4 2 5.13 13.5 12.3 91 60 16.0 21 7 1(1.;( 10.y 101 65 13.(1 18.3 8.3 1(1.0 120 70 10.4 14.8 0. 7 8.1 121 75 11.1 I 1. I 5.7 5.4 95 80 6.3 8.4' 4. 3' 4.1' ' 95' 85 4.7 9.8" 2.7^ 7.1° 262' "I Ilt'cc calucc I+aln, ul:vlc arC rnrt crahlr .In`( .ur <u hi<, I t„ cubuanl6l rrlrnI hccvlcr " I Ihr cnl.dl :lmnumc u( dan nn 1ccFliJl Ihc'talc b.ICCJ Life Expectancies of Adult h9ales be Age and Smoking I Iabits front a'1'a'o-Sample Cross-Sectional Population Study in Erie Coun ty, I'ennsyh•ania,~1972-74' Dcatlu I. iving 1'tlpu latitm Lilc Esln•ctanr~- Age Snx,kcrs N(m smr/kcrs 5nu>kcts Nunsmnkrrs Snnokcrs Nonctnukc•rc 30-34 7 2 9,916 8,241 38.4 50.9 35-39 7 3 8,977 6,215 33.5 46.0 40-44 4(l 3 8,97(1 5,79() 28.6 41.0 45-49 73 11 9,299 5,545 24.2 3G.1 50-54 129 13 8,632 6,983 20.0 31.5 55-59 205 30 7,508 5,341 16.4 26.7 (i0-G4~ 252 4(/ 6,664 3,57G 13.5 22.4 65-69 234 41 ;,hh4 3,121 10.7 19.6 70-74 181 39 2,()()4 2,648 8.9 14.6 75-79 133 (79 1,330 2,O3(l 7.7 10.6 80-84 74 103 526 1,051 6.1 7.1 i 85 (- 40 78 150 . 1,048 5.0 5.0 Tntal 1,375 432 67,540 51,589 'D.lt.l fl'1N/ItCtI .lt Itll' .ltllltlal 1'f1r/It'll'/IC(' /I tllt' ti`N Il'I\' III AI'tlt:l/l,'c, Mq. -- TIMN 0020618

Table A 'Test of Method of Ahproxiniating 5-1'car Snrvival Ratcs Using U.S. "Ibtal Males Life Table for 1979-81 Age, xu,x+4 Central 1)catlt ltatc, Al Cnmhtucd From A1 Survival Itatc from Age x to Agex+5 Actual atio 30-34 929 474,355 .00196 .9902 .9902 1.000 35-39 1,156 469,76 1 .00246 .9878 .9873 1.001 4(1-44 1,696 462,778 .00366 .9818 .9810 1,001 45-49 2,642 452,131 .00584 .9711 .9735 .998 50-54 4,071 435,5(15 .00935 .9540 .9543 1.000 55-59 5,924 410,703 .01442 .9299 .9303 1.000 6(1-64 8,366 375,22F .022.;(1 .8934 .8941 .999 65-69 10,965 326,84(i .(L3355 .8431 .R448 .998 70-74 13,409 265,648 .05048 .7718 .7753 .995 7 5- 79 14,462 195,333 .074(l4 • .6807 .G875 .990 80-84 13,790 123,781 .11141 .5540 .5665 .978 Total 77,410 3,992,566 - - - - Table g '1'cst of Method of Approximating Poptdation at Ages x to x+4 Using U.S.'I'otal Males Life 1'able for 1979-81 Agc, x 5I2Y (1, -+ 1, . ~) T,-T, ,, Ratict 30 474,828 474,855 1.000 35 469,615 469,701 1.000 40 462,845 4G2,778 1.000 45 451,G4() 452,131 .999 50 434,1(58 435,505 .999 55 4()9,870 410,703 .998 hU 374,145 375,225 .997 65 325,818 320,846 .997 70 2(rt,883 2(i5,(i48 .997 75 195,205 195,333 .999 80 124,575 123,781 1.006 TIMN 0020619

.'Iu sc)tllr cxtcnt, thcsc cllscrclinncics in stu(Ir findings resttlt fronl lli/lcrencc•s in thc• wat• snutkcrs ancl n(rn- smclkcrs arr c la.esificci. Sl>ntc stu(lic•s incltulc /i,rnlrr snu,k" crs in the "ttnnsmOkin);., catcl;(tn; 11'llilc (,tllrrs i,lacc thclll ill the <`sn)(,king., rurl;(,rl'. 1-Icm•cl'cr, atlOhting cith(:r (ll'thcsc cl.)ssitic,ui(m sl'stcros W(wlcl rcducc thc diilcrrnccs irl rstinrltc•(i lifc cxpcctartc~' hctlvccn tilc sm(,king and nitnsmOkinl; C:ttcp,rics. Ivr example, the reslllts 111 I:111IC I sh(m' thc inaccuracics that c(tul(1 arisc in cstimating lilc czhcctanc}' for lifctimc smOk- crs ant.i nvnsnx>kcrs if fin-mcr snu)kcls-afiO tuul(ltlht- ccih' have Kt•catcr lifc expectancies tllan smOkcrs-arc in- cluclct.l in cithcr thc smoking (lr nonsmoking (:atcg(lrics. It is also possible that hrclshcctivc stullics On the cflccts OI-smoking, now undcr lray and cxhcctcci to hc comillctccl itl 30 to 40 vcars, \vill produce valucs similar to those rchc)rtc(1 hcrc. S(nnc ohscn'a-s had suK);cstccl that adjusting tilc clata for nunresh(mcicnts might llccrcnsc Otu' previously re- ported lifc cxpcctancl• clilkrcmial of 12 t'cal:s (iifi'timc snx)k(:rs 1•cr:5us lifctimc n(msnu,kcv's)-but iu fact, thc nhix)sitt: trc•ncl Was clhscrVcci. Sinct: this is tllc orth' stut.lr ilr «•hirli a(Ijustmcnts lvcrc nta(Ic li)r nlmresh(>txlcnts, it is possible that the other stuclics that did not do so may have also I,rut'iclc(.I unclcrestinlalcs. Thc final rclu/rts ctf })rOshcctivc sttlclies Can hc c(xlt- hlctct.l (ancl thcir results calt achievc nlaxintum acctiract) tmll' «'hc•n all the original particiltants in the sttcciy haVc died. Stuclic's cro smoking and hc:tlth sh(m• that nun- snxtkcl;a, as a>;r(tuh, live I(mf;cr tltatl sm(lkcrs.'I his mcans Iltat uttfillisltr(I ITn)sl,cllit'c tlu(iict «'ill tc'n(I t(1 1'icl(I untlc•rt'stinl:ltc•s Of, tllc nnnl.llitl (liltctcn(c-S bcllt(•<'n sm(rkcts anJ lu,nslrnlkcl:s. Sr,tiu• Krlg(tt I+f(ta,c(ti\'c•stutll; which sh(,\\r(I a 9-1•car (lifkfc'ru(• ill IVf,:, lu,lt' \ccll tnnl nut to (icnumstrttc• .1 ntucll Ilit;hcr clilli•Ic'ntc t\'l)cn tlu• fittal Ic•p(,rt fm tltc pt,jcct Is ctnnl,lcl(tl ir1 21)15. '11) is clillcre•IUc• nrtl• he Is f;trtt :te r,ln liIr I:Il+ic csrint.tfc r,l l-9 1'cars. (fltic nt:n' hold u'uc fin r,lll(-r ItlnSlt(•clic(. .ctutlics 1s S\'CIl. ) Gmtinnc(I rc.u•anlt an(I liflnlc rcl+t,fls \\'ill (Ictclfninc which Itlc•thl)l l,r(tl'i(Ics tlu• Itc•cI tstinrtlc. Bnt in am' c•\'cnt, thc obvious nwst nl>t I,(• tn'c'llr,r,kc(1 .;nu,kinl, is tlcl':utatinl; tn tlu' Ix•altlt (/1 tllr ~nt„kcr. (:unrc'fn fi,t Ilx• Itul>lic Ilc•altll rrtluir" an all tml c/G,lt to (unail .tilrn)k- iltl;. [U AckntlwIccl};rncnts - Sul,h(tf 1 lirr tllis \t•(nk a'as I,ft,\ itlt•ti I+c ,t 1~(:)nl lirnn rl,c Natir rnal Il)stinnc nn I lrtlf; Ahusc (rnluf ar. t rn+. ?; I?t; .;,tl 1 tt, th( ( t ntt ntittcc (,n .Suhstancc Ahusc anti I L/lritu•tl Rcltavit,r, N:uitm:ll Rcsc':ucit t:nnn( il, ulnlt r Ilrc tlnt (nr m ul 1)1.111 R. ( icl acin, antl ht' Ihc f•lir ('h,tlarr tt(thc Anlt•lit •In (:Intn ~tn irtc, thc Nt,lllt tcc•ctcln I<cnnct•Itania l.unk As,r,tiatir,(t, :,nrl Iltc Amt•li(an I Icatf Ascu(i:virm rd 1=.lit t.rnnuv l1i• t(ich tc, cxl+lrsc tt(n al,l,tt-t i,llir,n tu I\{:uvilt A. Sthttt'i ((clttnntl, )r,hn /1. htst, ancl Inltn t' I'irlrc• lin pntittilt); :Iritli litmal ctlitrni.tl rnlnnl(•nlc III :)str.l ilt Illr I+trl+.tt:llit,n r,l Illis atlicl(•, antl t,t I lrhtRah .Stllfi,:m Ir,r .ICeitl.lntc In tllc lili' tal+Ic cnrnl+ut,tt iun~ li+r c•at lic•I In:lnus+ l ll'I c. _ 7 liur,Ctice~t - - -- - - - I I,,,n. It md 11111 a It 1 f.,l,il-• , n, I,,,,....,,, rr, r„•r, ,; .,~,,,~„ 2 11 : I,,,rn I I r ..,\I,.~r.J" Gnrr,rrr, lr,r„•» rl rGr,lurrrrrnrr tr„n.rr,nl I„•.,,rrr.». I+.,,,,J.,, +.- 21,. I•+;'r. I, al \I,,,i.,fr, .,,n•,,,t• 1•rn,rrhr, rrNr, trrr.h „Jr Srn„r ,r,r,lf tr/,,, r 1.,,.,u, 1 b,,.,.,, Ic ni „I r.n ,. i hr.,n•u, Alrmnf,t.,l,h I'+ lS:,clntr~rr,n. Itl ` I I ti 1:,.,, inni,nr I'i,nnnl~'( tIL„1 I'>r.r,, f, I S Hrlvntc nf r(v Gnil;c„n (irncral fl I C I r.l,~rtnunr •d I Ir.,lth. IJn..un•n, +n,l tli~l/:nr irrrl I' C 11, ~l,utrnrnt n/ I 6r.,Irh I lu,,,.ul I'rn 1 „t (, I launnr,rtrl, IL.(' •'Cmr,kinlj in It, larn,n n, r6,~ I.nh It.,n c„I ( tn,-,lfil6r,n \Ir n : and Nlin' R' I L,rnrrl, r,l , 1 f•nL nn.. l.f br, m rl.r tnr,~: ,•r r,urr. r ~ mrdflrlrrrt7nnrnr!)nrnv< f.lati,rttill.,n.,i Imntnrr~\L,nnl~i.,l,h I'r lS:rchingl<,n. ' It(:'. lt S Gr,«~tnmt~nr 1'tu,ru,l, (l/ri„~. 1?' I 7 14rcrnn, S If •'Iht• Ag,r Inci•hn„ „I I+,.,ih li„ni Sno,l.rnlL~ /,•ru,rnl rl Nv 1 ,Imrr,rmrllnrbl.r lrnrrvrn,irvor,rnnn h: i I'r'(/1 II?~ , R 1'tt•ch,r,, C f I ",Sn Int<rn.nr•,u.+l („r,q,un,,,r „f I........ ~ ,ldrdr \I~~,r,ln,.. I'/,rdrrnmr.Sbrda,)•I (f'l;1/) S, i 'J Ilr<r,m, ti I I nldr, ,Il,dr.u,•,rnl,rr,ru,/r 14ti+<-Iy nl (:ili/i,rnia 11r«, I'>-O I Irt Rrlt,t'tfind, It 1, "Ii,Dat,., Sul,~l:n,l• ~n•1 Ihr tir, ,llrn,.,lm I hllcrrnti.tl; 1'e I nmpurpln• 9 f 1It T 21 ?O3 II Rcrh,~rG•r,l. R It. "( ip.,rrn, Cnndmt. .nr,l (1h•„•,I rh, I'iunJ )1/minnnrr,Srrrr/r,~7i rI')7.if~ Nqt ~ 12 Itelhrrlrnil, !t I) "fi,h.ttrr, Cnu,4.nt1: ~~~~I Srt K.,rtr,< rn Iht 1'rlni,l ',r.,t, c; `' snrrnllloJrrrn' 21 t Pl~•1) 193 13. Alillcl, (i I I'•Sr„r,kirt)! antl I nn)p+irr:' J,unvnl „/ Itr,nrLnen (Illin,ae I unK Ac<r,tiatinn) ?t) 11'/.'(.)3 bt (',,,,,11. At 1, on,1 I lit<t. It I"Al.'Ih, •,I ic ,nd :<.,ncnu,t, r<;" li,an nrrrnn, n/ rlrr S,rr,,, nf ;lrnrrnrrr 3) ( 0 "11 W; IS f<ldlcr. (: I I, an,I (4~,ct,in, I) It '•I dr I\I,c,l.,nt, „1 N,•n<nAI•.n .n,d ISS,n+rn;' fSJ'Iv llrnl/h lir/.nrn')H ( I'1Rtl t 1.1 Ir, Ihrcr, ('.I„ aud t„It,n. AI 1"Itrftnl•rnlan. •-nf I nnl,a rit,;',Irurnl<n! rlv A'rm )~~rl,•;lradnnrnJ,Cnnvn 7nl i I'~--1 (+'1 I'- I hrntn•nul. f. ( I:.ulink, ,,n•I t„nrln~(itnrItnk< in Itt•lannn tr, ( Itcnntal (,artint,~;(nc<i<;• (rnr,••,rnrr,rrn! 1Lv,rr,h Ih 11'1-R): IS i IH It,•y:,,t, 1• anil Rcrd, It f, "tim„lan,l I.if. rtl•„t+rn+ znn,nK 1' S\ ,r.inc:';Imnr,rm/,nrnrlrln(1'rdrirr11rn1rl,nR (lv-R)~ 11122 I'+ 11dLr. t: II . tl,,,rIl. ,\I I. Al,rr<. It I,~t d u. t:.,r,J Sr< ,ll,•iul,t, I,itltrrrnrc;'lir,,,rd. .Swr,nnl:I,nII I19Rn)1C'/'7 ?n I Lnuv.L1S'. I r,,,i.,n<I. I1 It ,.inJ Itr-Lu„I tr, Itr<i,l,mr~ anJ tinn,Au,r. I hctr,rir< it, 11-(nlr ,tl.dc•." J.rn„nl N.r rnnr,rl (:nmrr lmrmm 2R I I'1t.1) 'li- ?I R,<t. /.lC Rrviu,h rrr 1:drnnrrnn, •Ilh t,l F.nl;lVurv„1 l lill-, I'rcn I,,,I1.,11, IvRf. " R.,I•„r. I~ ,.unl It,nl. I+ I1 " I hcS:dr,lit, <4 1 Ln.r Ir,,,u \, u„f F:m ,n t.udn~< ul dI„n:thtiva :,rre,np AIr):tant<;' 1Nrrnrrmnunl Innmal of Idr,rnnlna, 4 I I'/-; t l,7I ?i ,\1, f.ml},lin. I I: , I/trv, At C., Nlrl,l, P:.S • ci al "It, c r,l InGnm.nu,n nn ( ifnirnt• .Snu,kii,l: I,r lR lm t,f tnfarn,ant ".l,unrmrr /.•rmm/ nllyvdnmrdrlqr Ilo f It)Ril~ 111. : 1 l h.,rrtl•t,ttt I1'r, It , inrl Al.r<crt. lirnrlc in I'mn-.i Ct.vr< 171. ),6 1",r t:y,r tur,ac I nnt' and •Subl!rrm/•<;' n, lS-rrrrlnrq, nl rbr :Irrrrrtrnrr `.rnnarrnl ; I,vn rntran .krlmN nw ,Grrrn' Rnrrn,11,1Wbnrit. 19: R, I, 21 1 JS Ati, hlin• S It , klrinm.nt, I.( ~, anJ Ala<lin<. I 11 •'C.,L,Irn nl 11•'rr.,hr, ;Sn d c':n I:.rcnl nq !tr'In ra,n 1i,r .Cn,nl in1( InLqnnlinn. • Srnhnu. rn,l fnlrrrnr l u, /•n.•:I ?n Kull, I: ,S .\',tla,li.,n, I, Il1.1, rr al I+at.i: •; I,rrr nr.r,r /•....... l n/ 1 Sdrbr !lrnlrl, 79 ( I VR'1) 200 ?' I It S', I'all„nrn. 11 1' , Alnrr:n~, 1) AI , c, .,I ,6•hnr,f I- I•.Idn.,,,Cw„t< m A<v-inl; ( 11;.ut'HC .Cmnkin)t ir, liqrng Adultc;' .I,rrrr.rnn J.rr„r,d ,q I',r!•!rr JLrrAI,''t I P)R1'I )n) . IK 1k.v,,.k ILs ,:,ud5ivprl. 1 C. in-.1hrl.,,drmnl.Ilntrn,rLn11'n,manrf., lC,.h ur},rnn, Ii( . II S ld,arlnu,r-rrl I•iintinl:llflitc, 1975 7't It C I1,ut,un „I 11, .11111. P.ilut.ni„n, ar,J lllllnr ,:n,,,na (1„r 16 111 1 r/'r lnhlr, 1VI0 "1 1)111~15' IP..\I - I I~(t ll.,•.hinl;rr,n. I1( I.I 5 Gr„<.u,ruo~,n I•rinrniF l,lli,r. I'r"S TIMN 0020620