Objective: To assess the usefulness of the general framework of the smoking epidemic.
Methods: We use lung cancer mortality as an indicator for smoking intensity and employ an age-cohort model to accommodate the long-lasting and cumulative effects.
Results: Dutch males have higher risks than Danish males, but the risks for the younger cohorts have been declining faster in the Netherlands than in Denmark. Danish women have about twice the risk of Dutch women, and in both countries the risks for the younger cohorts are increasing. The smoking epidemic began at about the same time in Denmark and the Netherlands. Dutch males, however, seem to have smoked more but to have given up smoking more quickly than Danish males. Danish females were quicker to take up smoking than Dutch females.
Conclusions: Within the general framework of the smoking epidemic, differences in timing and levels can produce large differences between countries. For the purposes of assessing smoking-related risks, including projections, the smoking epidemic framework therefore has to be tailored to each study population.