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Current Trends Smoking-Related Mortality Decline among Physicians -- Rhode Island

Declines in smoking in the United States have contributed to declines in heart disease, stroke, and lung cancer among white men (1,2). In Rhode Island, where prevalence of smoking by physicians has been monitored since 1963, the proportion of physicians aged greater than or equal to 25 years who smoke declined by 73% from 1963 to 1983 (Table 1). To characterize smoking-related mortality trends among white male physicians and other white males in Rhode Island, the Rhode Island Department of Health examined vital statistics data from that state. This report summarizes the findings from that study.

For 1968-1987, death certificate information for deaths of resident Rhode Island white men aged greater than or equal to 25 years was sorted by age, cause of death, and occupation. The eighth and ninth revisions of the International Classification of Diseases (ICD) were used to group deaths by the following categories: all causes, major smoking-related cancers (oral, larynx, pharynx, esophagus, trachea, bronchus, lung, pancreas, and bladder) and heart disease and stroke (3,4). Definitions from the 1970 U.S. Census were used to group deaths by occupational categories, including physicians, other professionals (professional, technical, and kindred workers), and others (5). ICD-8 and ICD-9 rubrics were used to aggregate deaths for 1968-1978 and 1979-1987, respectively.

Census data for 1970 and 1980 were used to estimate the populations of physicians and "others"; the population of "other professionals" could not be estimated reliably from available census data. The 1970 U.S. population was used to standardize death rates by age. Rates were calculated for persons 25-64 years of age to ensure compatibility between the two sources of data; counts of deaths included retirees, and estimates of the populations at risk did not.

Proportionate mortality ratios (PMRs) (which do not require estimates of populations at risk) were used to compare the mortality of white male physicians aged greater than or equal to 25 years with that of white male nonphysicians aged greater than or equal to 25 years.

From 1968 through 1987, 89,593 white males died in Rhode Island, including 420 physicians and 10,640 other professionals. Smoking-related cancers accounted for 11% of deaths, and heart disease and stroke for 50%. Among persons aged 25-64 years, mortality from all causes declined substantially (among physicians, 38%; among nonphysicians, 19%) (Table 2). Among physicians, smoking-related cancer mortality decreased 38%, compared with a 3% decline among nonphysicians. Mortality from heart disease and stroke declined 57% among physicians and 32% among nonphysicians.

For both periods, PMRs for smoking-related cancers were less than 1.0 among physicians and other professionals and greater than 1.0 among other white males (Table 3). PMRs for smoking-related cancers declined moderately among physicians and remained relatively constant among other professionals and other men. PMRs for heart disease and stroke in the earlier period were greater than 1.0 among physicians and other professionals, decreasing over time among physicians but increasing over time among other professionals. Reported by: HD Scott, MD, JP Fulton, PhD, JS Buechner, PhD, WJ Waters, PhD, JT Tierney, MSW, Rhode Island Dept of Health.

Editorial Note

Editorial Note: These findings indicate that, for the two periods compared (1968-1978 and 1979-1987), white male physicians in Rhode Island experienced greater declines in overall mortality, smoking-related cancers, and cardiovascular diseases than did white males in other occupations. However, these findings are based on relatively small numbers of deaths and denominators and reflect moderate statistical variation. In addition, other risk factors for specific diseases are not considered in this analysis and may affect the results.

The Rhode Island data suggest a method for examining the population effects of smoking cessation on mortality trends among populations whose members have quit smoking in substantial numbers. Based on the study of physicians in Rhode Island, at least half the current cardiovascular and smoking-related cancer mortality of 25-64-year-old nonphysician white men in that state may be preventable. The Rhode Island Department of Health will use these data to strengthen support for antismoking programs in the state.


  1. CDC. Reducing the health consequences of smoking: 25 years of progress--a report of the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1989; DHHS publication no.(CDC)89-8411.

  2. National Cancer Institute. Cancer statistics review 1973-1986. Bethesda, Maryland: US Department of Health and Human Services, Public Health Service, National Institutes of Health, 1989; NIH publication no. 89-2789.

  3. Public Health Service. Eighth revision international classification of diseases, adapted for use in the United States. Washington, DC: US Department of Health, Education, and Welfare, Public Health Service, 1972; publication no. 1693.

  4. World Health Organization. Manual of the international statistical classification of diseases, injuries, and causes of death. Geneva: World Health Organization, 1977.

  5. Bureau of the Census. Census of population, 1970: detailed characteristics--final report. Washington, DC: US Department of Commerce, Bureau of the Census, 1972; PC(1)-D41.

  6. Keyfitz N. Sampling variance of standardized mortality rates. Hum Biol 1966;38:309-17.

  7. Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic research. Belmont, California: Lifetime Learning Publications, 1982.

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