Sunday, February 27, 2011

Guest Blog: Avoiding "excess deaths"

Dr. Ed Pullen is a family physician who practices at Sound Family Medicine in Puyallup, WA. The following piece is excerpted from a previously published post on his blog,


"Excess death" or excess mortality is defined by the free medical dictionary as “a premature death, or one that occurs before the average life expectancy for a person of a particular demographic category.” Smoking is one of the major causes of excess death. There is lots of debate about smokers rights, government intrusion into private lives, and reduction of government spending these days. Here are some thoughts on government-backed efforts to encourage and help citizens quit smoking. This is on my mind today because my Mom died this week of a smoking-related illness, throat cancer, and I was looking for any good news about smoking cessation programs or population-based success stories.

I found one success story in a press release from the MMWR outlining a program in Minnesota from 1999 through 2010. Over that time, Minnesota instituted state-wide smoking cessation programs, a comprehensive smoke-free law, increased tobacco taxes, and mass media campaigns. As a result, Minnesota outperformed the rest of the U.S. by having the prevalence of tobacco use in adults drop by 27 percent, from 22.1 percent in 1999 to 16.1 percent in 2010, compared to very modest reductions nationwide.

Minnesota is a fairly large state with a population of 5.27 million, and an estimated 3.87 million adults. This means that about 231,900 fewer Minnesota adults smoke now than smoked in 1999. If the smokers who quit reflect the demographics of the adult population in Minnesota, then using the excess death data from 2004 BMJ British physician study, a rough estimate would be that about 2,085,000 life years were extended to the citizens of Minnesota as a result of quitting smoking in this time frame.

If the entire U.S. replicated this program, and had smoking cessation rates that matched those in Minnesota, then by extrapolation we could add about 122 million years to the lives of Americans over a 10-year period if 6 percent less Americans smoked after the program.

When I think if the dollars spent to add a year of life of many medical interventions, this type of program seems like a bargain. In fact, one study suggests that for every dollar spent on tobacco cessation, a state saves $1.26 in lost revenue from work missed and tax revenue. If that’s true, then states can actually improve their bottom line while they improve the health of their citizens. Sounds pretty good to me.

- Ed Pullen