Key Point

Cancer mortality rates and disparities in those rates among US Asians/Pacific Islanders are closely related to the levels of tobacco smoke exposure in these individuals.

DAVIS, CALIF—Although Asians and Pacific Islanders are important segments of the US population, the contribution of tobacco smoke exposure to lung cancer and nonlung cancer death in those groups has not been thoroughly studied. Bruce N. Leistikow, MD, and colleagues therefore completed such a study and found some gender and geographic disparity in smoking-related cancer mortality among Asians/Pacific Islanders in the US.¹

Smoking contributed minimally to cancer mortality in South Asian–Californians. But it had a major influence on cancer death in the other Asian groups studied, especially Korean-Californian men and male Asians/Pacific Islanders residing in Hawaii.

"We believe that tobacco control for Asian and Pacific Islander Americans, and probably other Americans, deserves more effort, funding, and study," said Dr. Leistikow, Associate Professor of Public Health Sciences at the University of California, Davis. He specifically advised raising cigarette taxes, banning smoking, and having more culturally and linguistically appropriate antismoking advertisements and stop-smoking programs.

Using data from the Surveillance, Epidemiology, and End Results registry, the investigators examined cancer mortality in US Asians/Pacific Islanders during several periods between 1980 and 2002. The mortality rates were then adjusted to the 2000 US age standard.

Nationally, the proportion of cancer-related deaths in Asians/Pacific Islanders that could be attributed to tobacco smoke exposure was 37%; for women and 57%; for men. By contrast, those percentages were 0%; and 6%, respectively, for South Asian women and men; 69%; of cancer deaths among male Asians/Pacific Islanders in Hawaii and 71%; in Korean-Californian men were attributable to tobacco smoke.

Associations between smoke exposure and cancer mortality in Asians/Pacific Islanders were observed in three states other than California and Hawaii—Illinois, New York, and New Jersey. Sixty-three percent of the Asians/Pacific Islanders living in the US reside in those five states, reported the investigators.

"The associations remained consistent across gender, Asian/Pacific Islander ethnic group, state of residence, and year," pointed out Dr. Leistikow, "despite substantial differences among the populations studied in terms of income, diet, pollution exposure, length of time in the United States, psychosocial stressors, and other factors."

The investigators also reported two worrisome trends. The lung cancer mortality rate doubled between 1988 and 2001 among South Asian men in California, and there was a 4%; to 5%; annual increase in lung cancer deaths among Filipina-Californian and Korean-Californian women. "Based on our work, we can predict that these trends will be accompanied by parallel increases in nonlung cancer deaths," Dr. Leistikow said.

Regarding possibilities for future research to build on their present findings, the investigators recommended similar studies with larger, more recent Asian/Pacific Islander populations and efforts to determine the reasons for the disparities in tobacco smoke–related cancer mortality in those groups. A biochemical means of assessing individual smoke exposure would also be helpful, they added.

—Timothy Begany

Reference
1. Leistikow BN, Chen M, Tsodikov A. Tobacco smoke overload and ethnic, state, gender, and temporal cancer mortality disparities in Asian-Americans and Pacific Islander-Americans. Prev Med. 2006 Mar 22; [Epub ahead of print].

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