3.30 Deaths attributable to tobacco by disease category

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Three studies conducted in the mid-2000s have estimated the numbers of deaths caused by tobacco use in Australia;1-3.i Some of the key findings are presented in this section.

3.30.1 Estimated mortality from tobacco use in Australia in 2004–05—the Department of Health and Ageing, 2007

The most recent estimates of deaths caused by tobacco use show that almost 15 000 people died due to tobacco use in the financial year 2004–05.1 These calculations are the most recent in a series,2, 4, 5 the first of which was published in 1990.6 The methodology used in these reports has calculated 'attributable fractions' for the proportion of deaths due to specific diseases which can be said to have been caused by tobacco, based on extensive literature reviews and developed progressively since the first publication.

By this methodology, it has been estimated that in 2004–05, tobacco use caused a total of 14 901 deaths.1 Of these deaths, 14 790 were attributable to active smoking (including 56 deaths in infants subjected to maternal smoking) and 113 occurred in adults due to exposure to secondhand smoke (Table 3.30.1).1 As discussed in Section 3.28, smoking also confers a protective effect against a small number of diseases. It is estimated that in 2004–05, smoking prevented death from these specific diseases in 148ii smokers. However it should be noted that prevention of one kind of disease in a certain individual does not confer immunity against other diseases caused by smoking in the same individual; smokers do still die from these specific diseases; and there is no sound medical basis for taking up or continuing smoking in order to prevent or ameliorate the process of any disease.

Table 3.30.1
Estimated deaths caused or prevented by active smoking and secondhand smoke in Australia in 2004–05 according to condition (DoHA* calculations)

Condition

Male deaths

Female deaths

All deaths

Active smoking

 

 

 

Oropharyngeal cancer

214

81

295

Oesophageal cancer

360

152

512

Stomach cancer

39

15

54

Pancreatic cancer

208

198

406

Laryngeal cancer

125

19

144

Lung cancer

4164

1892

6057

Cervical cancer

0

30

30

Endometrial cancer

0

-52

-52

Bladder cancer

214

108

321

Kidney cancer

237

169

407

Ischaemic heart disease

1282

361

1643

Chronic obstructive pulmonary disease

2226

1644

3870

Tobacco abuse

51

40

91

Parkinson's disease

-91

-6

-97

Pulmonary circulation disease

72

97

169

Cardiac dysrhythmias

38

21

59

Heart failure

81

43

124

Stroke

338

215

554

Peripheral vascular disease

38

21

59

Lower respiratory tract infection

58

30

89

Crohn's disease

1

1

2

Ulcerative colitis

0

1

1

Antepartum haemorrhage

3

2

5

Low birthweight

8

4

12

SIDS

8

3

11

Fire injuries

12

12

24

Asthma (under 15 years)

0

0

0

Macular degeneration

0

0

0

Otitis media

0

0

0

Total deaths from active smoking

9686

5101

14790

Secondhand smoke (deaths in adults only)

 

 

 

Lung cancer

2

9

12

Ischaemic heart disease

33

68

101

Total adult deaths from SHS

35

77

113

Total all deaths from active smoking and exposure in adulthood to secondhand smoke

9723

5178

14901

^Columns do not add up to totals due to rounding

*Department of Health and Ageing

Source: Unpublished data from research undertaken for Collins and Lapsley1

The same study also quantified deaths caused by other drug use in Australia. Table 3.30.2 shows that most drug-caused deaths in tobacco are caused by tobacco. Almost 90% of deaths due to drugs in 2004–05 were caused by smoking compared with 6% from alcohol and 5% from illicit drug use.1

Table 3.30.2
Deaths due to drugs in Australia, 2004–05

Drug

Males

Females

Total

% of Total

Numbers of deaths*

Tobacco

9723

5178

14 901

89

Alcohol

1206

-149^

1057

6

Illicit drugs

583

289

872

5

Total

11 512

5318

16 830

100

*Deaths are net of protective effect conferred for some disease entities

^Alcohol was estimated to have caused 913 deaths in females, but to have prevented 1061 deaths.

Source: Collins and Lapsley1

3.30.2 Estimated mortality from tobacco use, 2003–the Australian Institute of Health and Welfare (2007)

The Burden of Disease and Injury in Australia 2003,2 (discussed in Section 3.29.2 above) also quantified deaths due to tobacco use, estimating that smoking caused a total of 15 511 deaths in 2003, or more than 1 in every 10 deaths (11.7%) (Table 3.30.3). The methodology used in this study is similar to that used in the AIHW/DoHA studies described in Section 3.29.1.

Lung cancer was the leading cause of deaths due to smoking, followed by chronic obstructive pulmonary disease, coronary heart disease and stroke (Table 3.30.3). This study did not report separately on fatalities due to tobacco by age or gender. The calculations includes deaths attributable to secondhand smoke, but separate estimates for the numbers of deaths caused by active smoking and exposure to secondhand smoke are not provided.2

Table 3.30.3
Deaths attributable to tobacco by specific cause, Australia, 2003 (Burden of Disease calculations)

Specific cause

Number of deaths

Percentage of all tobacco-caused deaths (rounded)*

Lung cancer

6309

41

COPD

4175

27

CHD

1962

13

Stroke

577

4

Oesophageal cancer

572

4

Other

1916

12

Total

15 511

 

*Column does not add up to 100% due to rounding.

Source: Derived from Begg et al2

3.30.3 Estimated mortality from tobacco use, 2000–Peto et al methodology

Estimates of deaths caused by smoking in Australia have been calculated by Peto et al for 2000,3 using a methodology first described in 1992.7 Extrapolating from WHO mortality for lung cancer and other diseases, and using UN population data, Peto et al estimate that a total of 19 184 deaths were caused by active tobacco use in Australia in 2000 (Table 3.30.4).3 These estimates are likely to be conservative, because they do not include any deaths in individuals aged under 35 (including infants). Just under one third (about 6,000) of all deaths due to smoking occur in individuals aged between 35 and 69, who lose, on average, about 23 years of life.3

Table 3.30.4
Deaths attributable to smoking in Australia by sex, 2000, Peto et al methodology

Cause

Males

Females

Total

 

Number of deaths caused by smoking

% of all deaths from this disease attributable to smoking

Number of deaths caused by smoking

% of all deaths from this disease attributable to smoking

Number of deaths caused by smoking

% of all deaths from tobacco attributable to this disease

Lung cancer

4029

88

1720

74

5749

30

Upper aero-digestive ca

683

50

225

43

908

5

Other cancers

1393

10

307

2

1700

9

COPD

2384

67

1553

63

3937

21

Other respiratory

251

10

173

7

424

2

Vascular disease

2657

11

1851

7

4508

23

Other medical

1086

10

872

7

1958

10

All causes

12 483

19

6701

11

19 184

100

Source: Peto et al3

The robustness and wide applicability of this methodology has enabled Peto et al to expand their calculations to worldwide estimates of mortality due to tobacco.8 (See Section 3.36).

Figure 3.30.1 presents the final column from Peto et al's data shown in the table above. This pie chart shows that of all deaths due to tobacco, 44% are cancer deaths, 23% are due to heart and circulatory diseases, and a further 23% are caused by lung and other respiratory disease.

Figure 3.30.1
Deaths attributable to smoking in Australia by disease entity, as a proportion of all tobacco-caused deaths, 2000

Source: Peto et al, 20063


i
This section will be updated when estimates covering more recent years are published.

ii From Table 13, Collins and Lapsley.1

References

1. Collins D and Lapsley H. The costs of tobacco, alcohol and illicit drug abuse to Australian society in 2004-05. P3 2625. Canberra: Australian Government Department of Health and Ageing, 2008. Available from: http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/mono64/$File/mono64.pdf

2. Begg S, Vos T, Barker B, Stevenson C, Stanley L and Lopez A. The burden of disease and injury in Australia 2003. AIHW cat. no. PHE 82. Canberra: Australian Institute of Health and Welfare, 2007. Available from: http://www.aihw.gov.au/publications/index.cfm/title/10317

3. Peto R, Lopez A, Boreham J and Thun M. Mortality from smoking in developed countries 1950-2000. Australia. Oxford: Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, 2006. Available from: http://www.ctsu.ox.ac.uk/~tobacco/C5020.pdf

4. English D, Holman C, Milne E, Winter M, Hulse G, Codde J, et al. The quantification of drug caused morbidity and mortality in Australia, 1992. Canberra: Commonwealth Department of Human Services and Health, 1995.

5. Ridolfo B and Stevenson C. Quantification of drug-caused mortality and morbidity in Australia, 1998. Drug statistics series no. 7, AIHW cat. no. PHE-29. Canberra, Australia: Australian Institute of Health and Welfare (2001. Available from: http://www.aihw.gov.au/publications/phe/qdcmma98/

6. Holman C, Armstrong B, Arias L, Martin CA, Hatton WM, Hayward LD, et al. The quantification of drug caused morbidity and mortality in Australia 1988, Parts 1 and 2. Canberra: Commonwealth Department of Health, Housing, Local Government and Community Services, 1990.

7. Peto R, Lopez AD, Boreham J, Thun M and Heath CJ. Mortality from tobacco in developed countries: indirect estimation from national vital statistics. The Lancet 1992;339(8804):1268–78. Available from: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T1B-49K5B71-35G&_user=559483&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000028178&_version=1&_urlVersion=0&_userid=559483&md5=fb759ffdab48100b2337fb626258540e

8. Ezzati M and Lopez AD. Regional, disease specific patterns of smoking-attributable mortality in 2000. Tobacco Control 2004;13(4):388–95. Available from: http://tc.bmjjournals.com/cgi/content/abstract/13/4/388

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