Background:
The objective of this study is to compare African American and White excess mortality caused by smoking cigarettes.

Methods:
Estimates of relative risks and smoking attributable fractions were made using U.S. nationally representative data. We constructed a longitudinal cohort by linking respondents to the U.S. National Health Interview Surveys with death records. Smoking history was obtained on respondents to 11 annual waves from 1999-2009. Data from 200,000 respondents were linked to the National Death Index with follow-up through December 31, 2011.
Relative risks comparing current and former smokers to lifetime nonsmokers were estimated. Estimates were adjusted for possible confounders including income, health insurance, access to health care, physical activity, obesity, hypertension, alcohol use, and birth country (U.S. or other). Attributable fractions showing the proportion of deaths caused by smoking were estimated.

Results:
Among African American men, 82% of lung cancer, 78% of COPD, 26% of ischemic heart disease, 28% of other heart disease, and 18% of cerebrovascular disease deaths were caused by smoking. Patterns among African American women were similar but the attributable fractions were lower. The African American male attributable fraction for total cancer deaths was 22% higher than for white men. The attributable fraction for ischemic heart disease was 30% higher for African American men. The attributable fraction for all smoking-related causes was 6% higher for African American than White men. Attributable fractions for African American women were higher than those observed for White women for chronic obstructive pulmonary disease, ischemic heart disease, other heart disease, cerebrovascular disease, and all cancers.

Conclusions:
Large mortality disparities exist for African Americans compared with Whites. The disparities cannot be explained by smoking rates alone. Other factors that may contribute include greater smoke intake per cigarette, obesity, hypertension, diabetes, exposure to environmental toxins, and a higher rate of menthol cigarette use.