Reports of any smoking history signficantly decreased in the U.S. adult population during 1999 to 2016 (p<.001). Approximately 43% of adults were either past (25%) or current (18%) smokers. The mean number of cigarettes smoked per day was slightly lower among current smokers vs. past smokers at quit (12% vs. 16%).
Chart Explanation: Between 1999 and 2016, the prevalence of any report of past or current smoking significantly declined (p<0.001) in the U.S. adult population, from 49.2% in 1999-2000 to 42.8% 2015-2016. Current smoking showed a statistically significant decrease in prevalence (p<0.001) across the 18-year period with 25.0% being reported in 1999-2000 to 18.3% in 2015-2016. Not much change was seen in past smoking over the given time period (24.2% in 1999-2000 vs. 24.5% in 2015-2016).
The National Health and Nutrition Examination Survey (NHANES) is a nationally representative, cross-sectional survey that is currently conducted every 2 years by the Centers for Disease Control and Prevention's National Center for Health Statistics to examine disease prevalence and trends over time in noninstitutionalized U.S. civilian residents.
Smoking is a putative risk factor for chronic kidney disease, and the risk may differ by race/ethnicity. Some cohort studies have shown that smoking is an independent risk factor for development (Fox et al., 2004) or progression (Hallan & Orth, 2011; Lash et al., 2009) of CKD, particularly related to decline in kidney function, in white and African-American populations. However, other studies, including a screening study (Jolly et al., 2009), found that smoking was not a risk factor for CKD among Alaskans and American Indians. Several mechanisms for increased risk of CKD have been proposed, including increased environmental exposure to cadmium among smokers (Mortensen et al., 2011). The NHANES survey consists of a standardized in-home interview and a physical examination and blood and urine collection at a mobile examination center (MEC). Here we examined data from the 1999-2000, 2001-2002, 2003-2004, 2005-2006, 2007-2008, 2009-2010, 2011-2012, 2013-2014, and 2015-2016 NHANES. Smoking history (cigarette use) was determined by questionnaire as part of the home interview for those participants aged 20+.
|Description of Measure||Prevalence of smoking in the general population|
|Type of Data Source||Public|
|Health Care System Data||No|
|Regional or National?||National|
|Demographic Group||Non-institutionalized U.S. residents aged 20+|
|Numerator||Participants 20+ reporting smoking (past or current)|
|Denominator||Participants 20+ responding to smoking survey|
|Primary Data Source Indicator||Questions related to smoking (past, current, amount)|
|Primary Indicator Method of Measurement||Self-report (computer-assisted interview in home) ages 20+|
|Frequency of Measurement (Primary)||Once (cross-sectional)|
|U.S. Region Covered by Primary Variable||All|
|Period Currently Available||1999–2016|
|Additional Data Items of Interest||stratification variables of interest (age, gender, race/ethnicity, BMI)|
|Limitations of Indicator||Smoking may be over- or under-reported by past and current smokers|
|Analytic Considerations||Appropriate NHANES survey weights must be used for all analyses (interview for adults, unless MEC variables such as BMI used)|
References and Sources:
Hallan SI, Orth SR. Smoking is a risk factor in the progression to kidney failure. Kidney Int. 2011;80(5):516-23.
Mortensen ME, Wong LY, Osterloh JD. Smoking status and urine cadmium above levels associated with subclinical renal effects in U.S. adults without chronic kidney disease. Int J Hyg Environ Health. 2011;214(4):305-10.
Fox CS, Larson MG, Leip EP, Culleton B, Wilson PW, Levy D. Predictors of new-onset kidney disease in a community-based population. JAMA. 2004;18;291(7):844-50.
Lash JP, Go AS, Appel LJ, et al. Chronic renal insufficiency cohort (CRIC) study: baseline characteristics and associations with kidney function. Clin J Am Soc Nephrol. 2009;4(8):1302-11.
Jolly SE, Li S, Chen SC, et al. Risk factors for chronic kidney disease among American Indians and Alaska natives--findings from the Kidney Early Evaluation Program. Am J Nephrol. 2009;29(5):440-6.