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Projecting the Effect of Changes in Smoking and Obesity on Future Life
Expectancy in the United States
Samuel H. PrestonUniversity of Pennsylvania
Retirement Research Consortium ConferenceWashington, D.C.August 2, 2012
In Collaboration with Andrew Stokes and Bochen Cao, University of Pennsylvania and Neil Mehta, Emory
University
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Figure 1. Trends in Smoking and Obesity in the United States
Sources: Cigarette consumption data per adult per year are extracted from Tobacco Situation and Outlook Report Yearbook. U.S. Department of Agriculture, October 2007. Obesity data based on measured body mass index in NHANES from 1960 to 2010.
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Contrasting the Dynamics of Smoking and Obesity in the United States
Prevalence
Duration of Habit
Associated Mortality
Risk
Smoking
Obesity
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Table 1A. Transition Probabilities across Categories of Body Mass Index, US Adults Ages 25-84, 1998-2008
BMI in 2008
BMI in 1998 Normal Over Obese 1 Obese 2
Normal 0.63 0.33 0.03 0.01
Overweight 0.09 0.51 0.31 0.09
Obese Class 1 0.02 0.21 0.42 0.35
Obese Class 2 0.00 0.06 0.24 0.70
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Table 1B. Differences in Transition Probabilities (Standard Errors) between 1980-1990 and 1990-2000, US Adults Ages 25-84
BMI in later year
BMI in early year Normal Over Obese 1 Obese 2
Normal -0.057* (0.019)
0.044* (0.016)
0.011* (0.004)
0.002* (0.001)
Overweight -0.012 (0.011)
-0.040* (0.017)
0.030 (0.015)
0.022* (0.010)
Obese Class 1 -0.006 (0.004)
-0.061* (0.023)
-0.033 (0.019)
0.100* (0.035)
Obese Class 2 -0.002 (0.001)
-0.026* (0.013)
-0.089* (0.035)
0.117* (0.047)
* p<0.05
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Table 1C. Differences in Transition Probabilities (Standard Errors) between 1990-2000 and 2000-2010, US Adults Ages 25-84
BMI in later year
BMI in early year Normal Over Obese 1 Obese 2
Normal 0.022 (0.020)
-0.011 (0.017)
-0.009* (0.005)
-0.001 (0.001)
Overweight -0.010 (0.013)
0.029 (0.022)
-0.014 (0.021)
-0.004 (0.014)
Obese Class 1 0.003 (0.004)
0.046 (0.024)
0.010 (0.022)
-0.059 (0.031)
Obese Class 2 0.001 (0.001)
0.015 (0.014)
0.041 (0.039)
-0.056 (0.053)
* p<0.05
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Figure 2A. Actual and Projected Trends in Body Mass Index (Males)
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Figure 2B. Actual and Projected Trends in Body Mass Index (Females)
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Data and Methods for the Analysis of the Mortality Risks of Obesity
Data: Baseline data are obtained by pooling NHANES 3 (1988-1994) and NHANES continuous waves 1999-2004. Mortality data are obtained from the National Death Index. Sample size: 21,554 respondents and 2,976 deathsMethod: Discrete hazards model, controlling for sex, race/ethnicity, educational attainment and smoking
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Baseline Model Parameters for Regression Equation Predicting Mortality as a Function of Current Obesity and Obesity at Age 25
Covariates Coefficients SE t P>t
Female -0.309 0.050 -6.13 0.000
Age 0.099 0.004 25.58 0.000
Age 25
Overweight (BMI 25-30) 0.131 0.063 2.06 0.043
Obese (BMI>30) 0.309 0.106 2.91 0.005
Baseline
Obese class 1 (BMI 30-35) 0.355 0.339 1.05 0.299
Obese class 2 (BMI>35) 0.897 0.282 3.18 0.002
Obese class 1 x Age -0.008 0.009 -0.87 0.385
Obese class 2 x Age -0.018 0.008 -2.08 0.040
Constant -9.994 0.186 -53.79 0.000
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Figure 3A. Effect of Projected Trends in Body Mass Index on Age-Specific Death Rates (Males)
40 45 50 55 60 65 70 75 80 850.80
0.85
0.90
0.95
1.00
1.05
1.10
1.15
1.20
1.25
1.30
2020
2030
2040
Age
Mor
tali
ty R
ate
in P
roje
ctio
n Y
ear/
201
0
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40 45 50 55 60 65 70 75 80 850.80
0.85
0.90
0.95
1.00
1.05
1.10
1.15
1.20
1.25
1.30
2020
2030
2040
Age
Mor
tali
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ear/
201
0
Figure 3B. Effect of Projected Trends in Body Mass Index on Age-Specific Death Rates (Females)
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Table 5B. Changes in Life Expectancy at Age 40 Resulting from Changes in Obesity
Year Males Females
2020 -0.241 -0.174
2030 -0.467 -0.391
2040 -0.733 -0.677
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Figure 4. Trends in Smoking and Lung Cancer Mortality in the United States
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
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2005
0
2
4
6
8
10
12
0.0
0.5
1.0
1.5
2.0
2.5
Daily cigarettes per adultLung Cancer Mortality
Ciga
rett
es p
er d
ay
Mor
talit
y ra
te (p
er 1
,000
)
Sources: Cigarette consumption data: International Smoking Statistics (2011); Lung cancer mortality data: National Center for Health Statistics.
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Figure 5. U.S. Male Lung Cancer Mortality by Cohorts
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Figure 6. U.S. Male Lung Cancer Mortality by Period
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Equation for Projecting the Mortality Effects of Smoking
𝑙𝑛𝑀 (𝑎 ,𝑐 )=𝐴+𝐵𝛼 𝑋𝛼+𝐵𝑠 𝑙𝑛𝑆(𝑎 ,𝑐)Where,
• is the death rate at age a in cohort c• is the mean cumulative number of years smoked prior to age
40 for cohort c at age a• is an indicator of age category a• is the coefficient of age category a• is the coefficient of
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Figure 7. Mean Number of Years Spent as a Cigarette Smoker before Age 40 by Cohort
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40 45 50 55 60 65 70 75 80 850.75
0.80
0.85
0.90
0.95
1.00
1.05
1.10
1.15
2020
2030
2040
Age
Mor
tali
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roje
ctio
n Y
ear/
201
0
Figure 9A: Effect of Projected Trends in Smoking on Age-Specific Death Rates (Males)
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Figure 9B: Effect of Projected Trends in Smoking on Age-Specific Death Rates (Females)
40 45 50 55 60 65 70 75 80 850.75
0.80
0.85
0.90
0.95
1.00
1.05
1.10
1.15
2020
2030
2040
Age
Mor
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0
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Table 5A. Changes in Life Expectancy at Age 40 Resulting from Changes in Smoking
Year Males Females
2015 0.281 -0.012
2020 0.576 0.089
2025 0.865 0.245
2030 1.115 0.477
2035 1.387 0.858
2040 1.617 1.142
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40 45 50 55 60 65 70 75 80 850.80
0.85
0.90
0.95
1.00
1.05
1.10
1.15
1.20
1.25
1.30
2020
2030
2040
Age
Mor
tali
ty R
ate
in P
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ear/
201
0
Figure 10A. Effect of Projected Trends in Smoking and Body Mass Index on Age-Specific Death Rates (Males)
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40 45 50 55 60 65 70 75 80 850.80
0.85
0.90
0.95
1.00
1.05
1.10
1.15
1.20
1.25
1.30
2020
2030
2040
Age
Mor
tali
ty R
ate
in P
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ctio
n Y
ear/
201
0
Figure 10B. Effect of Projected Trends in Smoking and Body Mass Index on Age-Specific Death Rates (Females)
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Table 5C. Changes in Life Expectancy at Age 40 Resulting from Changes in Smoking and Obesity
Changes in
Smoking Alone
Changes in Obesity Alone
Changes in
Smoking and Obesity
Year Males Females Males Females Males Females
2015 0.281 -0.012
2020 0.576 0.089 -0.241 -0.174 0.338 -0.076
2025 0.865 0.245
2030 1.115 0.477 -0.467 -0.391 0.662 0.117
2035 1.387 0.858
2040 1.617 1.142 -0.733 -0.677 0.914 0.539
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Projected Changes in Life Expectancy at Age 40, 2010-2040
Males Females
SSA projected increase* 2.55 2.17
Gain from reduced smoking 1.62 1.14
Penalty from higher obesity -0.73 -0.68
*Source: Felicitie C.Bell and Michael L. Miller. 2005. Life Tables for the United States Social Security Area 1900-2100. Social Security Administration Actuarial Study No. 120. Washington, D.C.
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Table 6. Sensitivity of Results to Changes in Procedures
Change in Procedure Effect on Life Expectancy at age 40 Relative to Main Projection
2020 2030 2040Male Female Male Female Male Female
Use of mortality rates with no control except age & sex 0.016 0.009 0.023 0.018 0.029 0.031
Use of mortality rates without inclusion of BMI at age 25
0.029 0.012 0.131 0.082 0.293 0.198
Use of uncorrected data on obesity at age 25 -0.024 -0.026 -0.005 -0.036 0.044 -0.002
Use of alternative series translating lung cancer into all-cause mortality
-0.069 0.000 -0.178 -0.159 -0.330 -0.474