Tobacco mortality ........

One of the purposes of this blog is to provide a place where I can store answers to questions that continually arise. Uncle E is becoming involved in the tobacco wars. Two issues have come up recently, the first having to do with mortality rates. The long and short of it is that mortality from smoking is large, accounting for ~20% of male and 10% of female deaths in developed countries. The situation in developing countries is not as well defined because the data is not of the same standard.

A motherload of data can be found at the Oxford Clinical Trial Service Unit site. Richard Peto and his colleagues have been keeping track of tobacco related mortality in developed countries. The seriousness of the situation can be seen in the graphic to the left. For those of you who are chauvinistic, the data from individual countries is available.

Below you will find a couple of abstracts that back up and expand on the information in the graphic. The take home message is that in 2000, 22% of all male deaths and 8.1% of female deaths in developed countries were tobacco related.

Those interested in looking further into this issue are referred to the Oxford CTSU site and to PubMed where you can search on "mortality from tobacco"

From PubMed:

Br Med Bull. 1996 Jan;52(1):12-21.
Mortality from smoking worldwide.

Peto R, Lopez AD, Boreham J, Thun M, Heath C Jr, Doll R.
ICRF/MRC/BHF Clinical Trial Service Unit, Radcliffe Infirmary, Oxford, UK.

Estimates are made of the numbers and proportions of deaths attributable to smoking in 44 developed countries in 1990. In developed countries as a whole, tobacco was responsible for 24% of all male deaths and 7% of all female deaths, rising to over 40% in men in some former socialist economies and 17% in women in the USA. The average loss of life for all cigarette smokers was about 8 years and for those whose deaths were attributable to tobacco about 16 years. Trends in mortality attributable to tobacco differed between countries. In some the mortality in middle age (35-69 years) had decreased by half in men since 1965; in others it was continuing to increase. In women, the proportion was mostly increasing, almost universally in old age. Mortality not attributable to smoking decreased since 1955 in all OECD (Organization for European Collaboration and Development) countries, by up to 60% in men and more in women. No precise estimate can be made of the number of deaths attributable to smoking in undeveloped countries, but the prevalence of smoking suggests that it will be large. In the world as a whole, some 3 million deaths a year are estimated to be attributable to smoking, rising to 10 million a year in 30-40 years' time.

Lancet. 1992 May 23;339(8804):1268-78.
Mortality from tobacco in developed countries: indirect estimation from national vital statistics.

Peto R., Lopez AD, Boreham J, Thun M, Heath C Jr.
Imperial Cancer Research Fund Cancer Studies Unit, University of Oxford, Radcliffe Infirmary, UK.

Prolonged cigarette smoking causes even more deaths from other diseases than from lung cancer. In developed countries, the absolute age-sex-specific lung cancer rates can be used to indicate the approximate proportions due to tobacco of deaths not only from lung cancer itself but also, indirectly, from vascular disease and from various other categories of disease. Even in the absence of direct information on smoking histories, therefore, national mortality from tobacco can be estimated approximately just from the disease mortality statistics that are available from all major developed countries for about 1985 (and for 1975 and so, by extrapolation, for 1995). The relation between the absolute excess of lung cancer and the proportional excess of other diseases can only be approximate, and so as not to overestimate the effects of tobacco it has been taken to be only half that suggested by a recent large prospective study of smoking and death among one million Americans. Application of such methods indicates that, in developed countries alone, annual deaths from smoking number about 0.9 million in 1965, 1.3 million in 1975, 1.7 million in 1985, and 2.1 million in 1995 (and hence about 21 million in the decade 1990-99: 5-6 million European Community, 5-6 million USA, 5 million former USSR, 3 million Eastern and other Europe, and 2 million elsewhere, [ie, Australia, Canada, Japan, and New Zealand]). More than half these deaths will be at 35-69 years of age: during the 1990s tobacco will in developed countries cause about 30% of all deaths at 35-69 (making it the largest single cause of premature death) plus about 14% of all at older ages. Those killed at older ages are on average already almost 80 years old, however, and might have died soon anyway, but those killed by tobacco at 35-69 lose an average of about 23 years of life. At present just under 20% of all deaths in developed countries are attributed to tobacco, but this percentage is still rising, suggesting that on current smoking patterns just over 20% of those now living in developed countries will eventually be killed by tobacco (ie, about a quarter of a billion, out of a current total population of just under one and a quarter billion).