Comparison of prevalence- and smoking impact ratio-based methods of estimating smoking-attributable fractions of deaths

Background: Smoking is a major modifiable risk factor for premature mortality. Estimating the smokingattributable burden is important for public health policy. Typically, prevalence- or smoking impact ratio (SIR)-based methods are used to derive estimates, but there is controversy over which method is more appropriate for countryspecific estimates. We compared smoking-attributable fractions (SAFs) of deaths estimated by these two methods. Methods: To estimate SAFs in 2012, we used several different prevalence-based approaches using no lag and 10- and 20-year lags. For the SIR-based method, we obtained lung cancer mortality rates from the Korean Cancer Prevention Study (KCPS) and from the United States-based Cancer Prevention Study-II (CPS-II). The relative risks for the diseases associated with smoking were also obtained from these cohort studies. Results: For males, SAFs obtained using KCPS-derived SIRs were similar to those obtained using prevalencebased methods. For females, SAFs obtained using KCPS-derived SIRs were markedly greater than all prevalencebased SAFs. Differences in prevalence-based SAFs by time-lag period were minimal among males, but SAFs obtained using longer-lagged prevalence periods were significantly larger among females. SAFs obtained using CPSII- based SIRs were lower than KCPS-based SAFs by >15 percentage points for most diseases, with the exceptions of lung cancer and chronic obstructive pulmonary disease. Conclusions: SAFs obtained using prevalence- and SIR-based methods were similar for males. However, neither prevalence-based nor SIR-based methods resulted in precise SAFs among females. The characteristics of the study population should be carefully considered when choosing a method to estimate SAF.