MCH SAMMEC Help - Computing Smoking-Attributable Health Outcomes

Smoking-Attributable Mortality, Morbidity and Economic Costs (SAMMEC) Help

MCH SAMMEC — Computing Smoking-Attributable Health Outcomes

Overview | How to Compute | Methodology | Definitions

Overview

The MCH smoking-attributable health outcomes computation page allows you to estimate adverse health outcomes from specific diseases where maternal cigarette smoking is a significant risk factor. The application will calculate the number of infant deaths caused by maternal smoking using smoking-attributable fractions (SAF) of deaths for each smoking related disease. It will also calculate the years of potential life lost from premature death caused by maternal smoking.

The Health Outcomes Data Elements report displays the data for the selected population before smoking-attributable calculations have been applied. The Health Outcomes report displays the results of the smoking-attributable calculations for the same population.

For details, refer to MCH Methodology.

How to Compute
1.	Select United States or individual state from the drop down menu and click Change.
2.	Select a Health Outcome Report.
3.	(Optional) To enter alternative health outcome data, select My MCH Health Outcome Data from the drop down menu and click Change.
4.	(Optional) Name the dataset by overtyping My MCH Health Outcome Data in the Label field.
5.	(Optional) Overtype My MCH Health Outcome Data with alternative smoking prevalence, mortality, and life expectancy data names. Note: Name each component of the computation individually if appropriate.
6.	(Optional) Add notations in the Description field.
7.	Click Save.

Methodology

The MCH SAMMEC program derives smoking-attributable mortality (SAM) using an attributable-fraction formula (Lilienfeld and Lilienfeld, 1980) originally described by Levin (1953). The smoking attributable fractions (SAFs) of infant death for four perinatal conditions are calculated using maternal smoking prevalence and relative risk (RR) of death for infants of maternal smokers relative to infants of maternal nonsmokers. SAFs for each disease and sex are derived using the following formula:

SAF = [p0 + p1(RR1) - 1] / p0 + p1(RR1)

p0 is the percentage of current maternal nonsmokers in the study group
p1 is the percentage of current maternal smokers in the study group
RR1 is the relative risk of death for infants of current maternal smokers compared with the risk of death for infants of current maternal nonsmokers

National maternal smoking estimates used by MCH SAMMEC for 1999 to 2004 were obtained from Vital Statistics from the National Center for Health Statistics (NCHS), with some exceptions. California does not report smoking during pregnancy on the birth certificate, and prevalence estimates were derived from the California Maternal and Infant Health Assessment (MIHA) for the entire time frame. For 1999, Indiana, New York State, and South Dakota maternal smoking estimates were obtained from the Behavioral Risk Factor Surveillance System (BRFSS).

MCH SAMMEC uses RR estimates for short gestation/low birth weight, Sudden Infant Death Syndrome (SIDS), Respiratory Distress (Syndrome) - newborn (RDS), and other infant conditions of the newborn obtained from a meta analysis of the epidemiological literature conducted by Gavin et al. (2001).

MCH SAMMEC applies the SAF to infant mortality data derived from CDC's WONDER mortality records maintained on the Web at http://wonder.cdc.gov/. MCH SAMMEC use the following formula to calculate SAM:

SAM = Number of deaths x SAF

MCH SAMMEC multiplies the number of smoking-attributable deaths by the remaining life expectancy (RLE) at birth for each sex to estimate YPLL.

Smoking-attributable YPLL = SAM x RLE

Life expectancy data for the nation were obtained from NCHS. YPLL can also be calculated using a fixed life expectancy estimate, such as age 75, and can use data for different study populations. Total YPLL estimates are generated for each infant condition by sex and both sexes combined.

Definitions
MCH	Maternal and Child Health
Smoking-Attributable Fraction (SAF)	The proportion of infant deaths that can be attributed to maternal cigarette smoking.
Smoking-Attributable Mortality (SAM)	Number of infant deaths from specific conditions that can be attributed to maternal cigarette smoking.
Maternal Smoker	An individual mother who smoked any cigarettes at any time during pregnancy.
Maternal Smoking Prevalence	Percentage of women who gave birth and smoking during pregnancy was indicated on the birth certificate.
Life Expectancy	Number of years an individual is expected to live as determined by statistical average.
Study Population	The specific population for which the adverse outcomes of smoking are being calculated.

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