摘要：Objectives. We estimated annual mortality, years of potential life lost, and associated economic costs attributable to regular cigar smoking among US adults aged 35 years or older. Methods. We estimated cigar-attributable mortality for the United States in 2010 using the Centers for Disease Control and Prevention’s Smoking-Attributable Mortality, Morbidity, and Economic Costs methodology for smoking-related causes of death. We obtained cigar prevalence from the National Adult Tobacco Survey, relative risks from the Cancer Prevention Studies I and II, and annual US deaths from the National Vital Statistics System. We also estimated the economic cost of this premature mortality using the value of a statistical life-year. Results. Regular cigar smoking was responsible for approximately 9000 premature deaths and more than 140 000 years of potential life lost among US adults aged 35 years or older in 2010. These years of life had an economic value of approximately $23 billion. Conclusions. The health and economic burden of cigar smoking in the United States is large and may increase over time because of the increasing consumption of cigars in the United States. Cigar use and its accompanying health risks are a significant and growing public health problem in the United States. From 2000 to 2011, consumption of cigars more than doubled in the United States, from slightly less than 6.2 billion in 2000 to more than 13.7 billion in 2011. 1 By contrast, cigarette consumption decreased by 33%, from 435.6 billion to 292.8 billion during this period. The cigar category includes a variety of products, including little cigars, cigarillos, and large cigars. Small cigars such as little cigars and cigarillos are sold in a variety of packages and sizes, some of which resemble cigarettes. 2 Many small cigars also contain characterizing flavors, such as fruit, chocolate, and alcohol, 3 and are taxed at a lower rate than are cigarettes, which can increase their appeal to young people. Within the cigar category, some products are experiencing faster growth in use than are others. According to the Centers for Disease Control and Prevention (CDC), 1 consumption of small cigars increased almost 240% between 2003 and 2008, from 2.47 billion to 5.88 billion units. Sales of large cigars increased by 25% during this period, from 4.53 billion to 5.66 billion units. Cigar use is most common among young people. The CDC, on the basis of National Youth Tobacco Survey data, estimated that 12.6% of US high school students in 2012 had smoked a cigar in the past 30 days. 4 Among high school males, an estimated 16.7% had smoked a cigar in the past 30 days compared with 16.3% who had smoked cigarettes during this period. Cigars were also found to be the most commonly used tobacco product among African American high school students. Results from CDC’s National Adult Tobacco Survey (NATS) for 2009–2010 5 showed that cigar smoking prevalence among adults was highest among those aged 18 to 24 years (15.9%) and 25 to 44 years (7.2%). Cigars pose significant health risks to users. Cigar smoke contains many of the same toxic and carcinogenic compounds as does cigarette smoke and may have higher concentrations of some constituents, such as nitrogen oxide, ammonia, and tobacco-specific nitrosamines. 6 Research has found that cigar smoking increases the risk of dying from causes such as cardiovascular disease, lung cancer, and oral cancer. 7,8 In general, differences in risk between cigarettes and cigars are driven primarily by differences in smoking behavior such as frequency of use and depth of inhalation. The risks of upper aerodigestive tract cancers such as oral and esophageal cancer are particularly elevated for cigar smokers and comparable to risks for cigarette smokers. 7,8 The CDC has previously used its Smoking-Attributable Mortality, Morbidity, and Economic Costs methodology to estimate that cigarette smoking is responsible for approximately 480 000 deaths in the United States each year. 9,10 Similar estimates, however, are currently unavailable for cigar smoking. We employed an approach similar to the Smoking-Attributable Mortality, Morbidity, and Economic Costs methodology to quantify the population health burden of regular cigar smoking in the United States. In doing so, we have presented for the first time, to our knowledge, estimates of the overall mortality and economic costs owing to regular cigar smoking for the US population.
