Background: The role of smoking in racial disparities in mortality and life expectancy in the United States has been examined previously, but up-to-date estimates are generally unavailable, even though smoking prevalence has declined in recent decades.
Objective: We estimate the contribution of smoking-attributable mortality to observed differences in mortality and life expectancy for US African-American and white adults from 2000-2019.
Methods: The indirect Preston-Glei-Wilmoth method was used with national vital statistics and population data and nationally representative never-smoker lung cancer death rates to estimate the smoking-attributable fraction (SAF) of deaths in the United States by sex-race group from 2000-2019. Mortality rates without smoking-attributable mortality were used to estimate life expectancy at age 50 (e 50) by group during the period.
Results: African-American men had the highest estimated SAF during the period, beginning at 26.4% (95% CI:25.0%-27.8%) in 2000 and ending at 12.1% (95% CI:11.4%-12.8%) in 2019. The proportion of the difference in e 50 for white and African-American men that was due to smoking decreased from 27.7% to 14.8%. For African-American and white women, the estimated differences in e 50 without smoking-attributable mortality were similar to observed differences.
Conclusions: Smoking continues to contribute to racial disparities in mortality and life expectancy among men in the United States.
Contribution: We present updated estimates of the contribution of smoking to mortality differences in the United States using nationally representative data sources.