Tips from Other Journals

Simple Charts Compare Health Risks for Adults



FREE PREVIEW Log in or buy this issue to read the full article. AAFP members and paid subscribers get free access to all articles. Subscribe now.


FREE PREVIEW Subscribe or buy this issue. AAFP members and paid subscribers get free access to all articles.

Am Fam Physician. 2009 Jul 1;80(1):86-91.

Background: Communicating health risk information to patients can be challenging. Information about the risk of death from specific medical conditions, such as cervical or prostate cancer, is often provided without context. In 2002, Woloshin and colleagues published a set of charts that used nationally representative mortality data to present comparative information on a patient's 10-year risk of death from various causes by age, sex, and smoking status. The authors subsequently updated and expanded these charts using improved methodology and more recent data sources. Tables 1 and 2 are the risk charts for men and women (current and never smokers).

Table 1.

Risk Chart for Men (Current and Never Smokers)*

Age Smoking status Vascular Disease Cancer Infection Lung disease
Heart disease Stroke Lung Colon Prostate Pneumonia Flu AIDS COPD Accidents All causes combined

35

Never smoker

1

1

<1

<1

<1

<1

<1

2

<1

5

15

Smoker

7

1

1

<1

<1

<1

<1

2

<1

5

42

40

Never smoker

3

1

1

1

<1

<1

<1

2

<1

6

24

Smoker

14

2

4

1

<1

<1

<1

2

1

6

62

45

Never smoker

6

1

1

1

<1

<1

<1

2

<1

6

35

Smoker

21

3

8

1

<1

1

<1

2

1

6

91

50

Never smoker

11

1

1

2

1

1

<1

1

<1

5

49

Smoker

29

5

18

2

1

1

<1

1

3

5

128

55

Never smoker

19

3

1

3

2

1

<1

1

1

5

71

Smoker

41

7

34

3

1

2

<1

1

7

4

178

60

Never smoker

32

5

2

5

3

2

<1

1

1

5

115

Smoker

56

11

59

5

3

3

<1

1

16

4

256

65

Never smoker

52

9

4

8

6

3

<1

<1

3

6

176

Smoker

74

16

89

7

6

5

<1

<1

26

5

365

70

Never smoker

87

18

6

10

12

6

<1

<1

5

7

291

Smoker

100

26

113

9

10

9

<1

<1

45

6

511

75

Never smoker

137

32

8

13

19

11

<1

<1

6

11

449

Smoker

140

39

109

11

15

16

<1

<1

60

9

667


note: Find the line closest to your smoking status. The numbers tell you how many of 1,000 men will die in the next 10 years from each cause. The numbers in each row do not add up to the chance of dying from all causes combined because there are many other causes of death besides the ones listed.

AIDS = acquired immunodeficiency syndrome; COPD = chronic obstructive pulmonary disease.

*— A never smoker has smoked fewer than 100 cigarettes in his life, and a current smoker has smoked 100 cigarettes or more in his life and smokes (any amount) now.

Adapted with permission from Woloshin S, Schwartz LM, Welch HG. The risk of death by age, sex, and smoking status in the United States: putting health risks in context [published correction appears in J Natl Cancer Inst. 2008;100(16):1133]. J Natl Cancer Inst. 2008;100(12):849.

Table 1.   Risk Chart for Men (Current and Never Smokers)*

View Table

Table 1.

Risk Chart for Men (Current and Never Smokers)*

Age Smoking status Vascular Disease Cancer Infection Lung disease
Heart disease Stroke Lung Colon Prostate Pneumonia Flu AIDS COPD Accidents All causes combined

35

Never smoker

1

1

<1

<1

<1

<1

<1

2

<1

5

15

Smoker

7

1

1

<1

<1

<1

<1

2

<1

5

42

40

Never smoker

3

1

1

1

<1

<1

<1

2

<1

6

24

Smoker

14

2

4

1

<1

<1

<1

2

1

6

62

45

Never smoker

6

1

1

1

<1

<1

<1

2

<1

6

35

Smoker

21

3

8

1

<1

1

<1

2

1

6

91

50

Never smoker

11

1

1

2

1

1

<1

1

<1

5

49

Smoker

29

5

18

2

1

1

<1

1

3

5

128

55

Never smoker

19

3

1

3

2

1

<1

1

1

5

71

Smoker

41

7

34

3

1

2

<1

1

7

4

178

60

Never smoker

32

5

2

5

3

2

<1

1

1

5

115

Smoker

56

11

59

5

3

3

<1

1

16

4

256

65

Never smoker

52

9

4

8

6

3

<1

<1

3

6

176

Smoker

74

16

89

7

6

5

<1

<1

26

5

365

70

Never smoker

87

18

6

10

12

6

<1

<1

5

7

291

Smoker

100

26

113

9

10

9

<1

<1

45

6

511

75

Never smoker

137

32

8

13

19

11

<1

<1

6

11

449

Smoker

140

39

109

11

15

16

<1

<1

60

9

667


note: Find the line closest to your smoking status. The numbers tell you how many of 1,000 men will die in the next 10 years from each cause. The numbers in each row do not add up to the chance of dying from all causes combined because there are many other causes of death besides the ones listed.

AIDS = acquired immunodeficiency syndrome; COPD = chronic obstructive pulmonary disease.

*— A never smoker has smoked fewer than 100 cigarettes in his life, and a current smoker has smoked 100 cigarettes or more in his life and smokes (any amount) now.

Adapted with permission from Woloshin S, Schwartz LM, Welch HG. The risk of death by age, sex, and smoking status in the United States: putting health risks in context [published correction appears in J Natl Cancer Inst. 2008;100(16):1133]. J Natl Cancer Inst. 2008;100(12):849.

Table 2.

Risk Chart for Women (Current and Never Smokers)*

Age Smoking status Vascular disease Cancer Infection Lung disease
Heart disease Stroke Lung Breast Colon Ovarian Cervical Pneumonia Flu AIDS COPD Accidents All causes combined

35

Never smoker

1

<1

<1

1

<1

<1

<1

<1

<1

1

<1

2

14

Smoker

1

1

1

1

<1

<1

<1

<1

<1

1

<1

2

14

40

Never smoker

1

<1

<1

2

1

<1

<1

<1

<1

1

<1

2

19

Smoker

4

2

4

2

<1

<1

<1

<1

<1

1

1

2

27

45

Never smoker

2

1

1

3

1

1

<1

<1

<1

1

<1

2

25

Smoker

9

3

7

3

1

1

<1

<1

<1

1

2

2

45

50

Never smoker

4

1

1

4

1

1

<1

<1

<1

<1

<1

2

37

Smoker

13

5

14

4

1

1

<1

<1

<1

<1

4

2

69

55

Never smoker

8

2

2

6

2

2

1

1

<1

<1

1

2

55

Smoker

20

6

26

5

2

2

1

1

<1

<1

9

2

110

60

Never smoker

14

4

3

7

3

3

1

1

<1

<1

2

2

84

Smoker

31

8

41

6

3

3

1

2

<1

<1

18

2

167

65

Never smoker

25

7

5

8

5

4

1

2

<1

<1

3

3

131

Smoker

45

15

55

7

5

3

1

4

<1

<1

31

3

241

70

Never smoker

46

14

7

9

7

4

1

4

<1

<1

5

4

207

Smoker

56

25

61

8

6

4

1

7

<1

<1

44

4

335

75

Never smoker

89

30

7

11

10

5

1

8

<1

<1

6

7

335

Smoker

99

34

58

10

9

4

<1

14

<1

<1

61

7

463


note: Find the line closest to your smoking status. The numbers tell you how many of 1,000 women will die in the next 10 years from each cause. The numbers in each row do not add up to the chance of dying from all causes combined because there are many other causes of death besides the ones listed.

AIDS = acquired immunodeficiency syndrome; COPD = chronic obstructive pulmonary disease.

*— A never smoker has smoked fewer than 100 cigarettes in her life, and a current smoker has smoked 100 cigarettes or more in her life and smokes (any amount) now.

Adapted with permission from Woloshin S, Schwartz LM, Welch HG. The risk of death by age, sex, and smoking status in the United States: putting health risks in context [published correction appears in J Natl Cancer Inst. 2008;100(16):1133]. J Natl Cancer Inst. 2008;100(12):850.

Table 2.   Risk Chart for Women (Current and Never Smokers)*

View Table

Table 2.

Risk Chart for Women (Current and Never Smokers)*

Age Smoking status Vascular disease Cancer Infection Lung disease
Heart disease Stroke Lung Breast Colon Ovarian Cervical Pneumonia Flu AIDS COPD Accidents All causes combined

35

Never smoker

1

<1

<1

1

<1

<1

<1

<1

<1

1

<1

2

14

Smoker

1

1

1

1

<1

<1

<1

<1

<1

1

<1

2

14

40

Never smoker

1

<1

<1

2

1

<1

<1

<1

<1

1

<1

2

19

Smoker

4

2

4

2

<1

<1

<1

<1

<1

1

1

2

27

45

Never smoker

2

1

1

3

1

1

<1

<1

<1

1

<1

2

25

Smoker

9

3

7

3

1

1

<1

<1

<1

1

2

2

45

50

Never smoker

4

1

1

4

1

1

<1

<1

<1

<1

<1

2

37

Smoker

13

5

14

4

1

1

<1

<1

<1

<1

4

2

69

55

Never smoker

8

2

2

6

2

2

1

1

<1

<1

1

2

55

Smoker

20

6

26

5

2

2

1

1

<1

<1

9

2

110

60

Never smoker

14

4

3

7

3

3

1

1

<1

<1

2

2

84

Smoker

31

8

41

6

3

3

1

2

<1

<1

18

2

167

65

Never smoker

25

7

5

8

5

4

1

2

<1

<1

3

3

131

Smoker

45

15

55

7

5

3

1

4

<1

<1

31

3

241

70

Never smoker

46

14

7

9

7

4

1

4

<1

<1

5

4

207

Smoker

56

25

61

8

6

4

1

7

<1

<1

44

4

335

75

Never smoker

89

30

7

11

10

5

1

8

<1

<1

6

7

335

Smoker

99

34

58

10

9

4

<1

14

<1

<1

61

7

463


note: Find the line closest to your smoking status. The numbers tell you how many of 1,000 women will die in the next 10 years from each cause. The numbers in each row do not add up to the chance of dying from all causes combined because there are many other causes of death besides the ones listed.

AIDS = acquired immunodeficiency syndrome; COPD = chronic obstructive pulmonary disease.

*— A never smoker has smoked fewer than 100 cigarettes in her life, and a current smoker has smoked 100 cigarettes or more in her life and smokes (any amount) now.

Adapted with permission from Woloshin S, Schwartz LM, Welch HG. The risk of death by age, sex, and smoking status in the United States: putting health risks in context [published correction appears in J Natl Cancer Inst. 2008;100(16):1133]. J Natl Cancer Inst. 2008;100(12):850.

The Study: Data sources for this study included the National Center for Health Statistics, the U.S. Census Bureau, and the American Cancer Society's Cancer Prevention Study II (a cohort study of 1.2 million adults that began in 1982). Risk charts were developed for common and less common causes of death in men and women (10 causes for men, 12 for women). The number of causes examined differed because of sex-specific causes of death (prostate, breast, cervical, and ovarian cancers). To calculate death rates, the authors divided the number of deaths in a particular age and sex group by the corresponding age and sex-specific population in the reference year (2004). Relative risks of death based on smoking status were obtained from the Cancer Prevention Study II. Higher death rates for current and former smokers were calculated by multiplying these relative risks by the baseline risk of never smokers. All death rates were presented as a number per 1,000 persons over 10 years.

Results: The risk charts illustrate several comparisons that may assist physicians in encouraging healthy behaviors and prioritizing preventive measures. Smoking dramatically increases the risk of death from vascular disease, cancer, and lung disease in men and women throughout the adult lifespan. At 75 years of age, a male smoker is more than 10 times as likely to die from lung cancer or chronic obstructive pulmonary disease (COPD) in the next 10 years than a never smoker. The strong association of smoking with death from certain causes leads to a statistical artifact in that smokers have lower death rates for a few conditions (colon cancer in men older than 65 years, breast cancer in women 55 to 70 years of age) than never smokers. However, the apparent “protective” effect from smoking actually results from more smokers dying earlier from competing causes of death (for example, a smoker who dies of COPD will not live long enough to die of colon cancer). Regardless of smoking status, the risk of death from vascular disease at any age far exceeds the risk of death from prostate or breast cancer.

Conclusion: The authors conclude that these risk charts provide reliable estimates of the magnitude of major health risks for adults in an understandable context. They caution that the death rates represent national averages and are not intended to provide more personalized risk estimates that account for the influence of individual genetic, behavioral, or environmental factors.

Source

Woloshin S, et al. The risk of death by age, sex, and smoking status in the United States: putting health risks in context [published correction appears in J Natl Cancer Inst. 2008;100(16):1133]. J Natl Cancer Inst. June 18, 2008;100(12):845–853.



Copyright © 2009 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions


Article Tools

  • Print page
  • Share this page
  • AFP CME Quiz

Information From Industry

Navigate this Article