Lung cancer deaths in the United States from 1979 through 1992: an analysis using multiple-cause mortality data

Background We sought to describe trends in the presence of lung cancer at the time of death in the United States from 1979 to 1992. Methods We analysed death certificate reports in the Multiple-Cause Mortality Files compiled by the National Center for Health Statistics, searching for any mention of lung cancer, lung cancer as the underlying cause of death, and comorbid conditions. Results Of the 29 042 213 decedents in the study period, 1 892 129 (6.5%) had a diagnosis of lung cancer listed on their death certificates; of these 1 892 129 decedents, 1 734 767 (91.7%) had lung cancer listed as the underlying cause of death. Decedents with lung cancer listed as being present but not the underlying cause of death were more likely to be male (relative risk [RR] 1.16, 95% confidence interval [CI] : 1.15–1.17), and older (RR 4.61, 95% CI: 4.35–4.88 for decedents older than 85 compared to those aged less than 44), but less likely to be black than white (RR 0.88, 95% CI: 0.87–0.90). The mortality rate, age-adjusted to the 1980 population, increased 23.0%, from 47.9 per 100 000 in 1979 to 58.9 per 100 000 in 1992. Over the study period, black men had the highest mortality rates (117.3–125.2 per 100 000), followed by white men (81.7–88.7 per 100 000), men of other races (37.4–46.7 per 100 000), white women (22. 1–39.1 per 100 000), black women (21.4–38.2 per 100 000), and women of other races (12.6–18.1 per 100 000). Age-adjusted, state specific rates varied threefold, from 30.4 per 100 000 in Utah to 93.9 per 100 000 in Nevada. Conclusions We conclude that the underlying cause of death data base, which captures almost 92% of decedents with lung cancer present, accurately tracks lung cancer mortality trends in the US. Mortality rates of lung cancer, which are decreasing among men, continue to increase among women