4.15 Estimates of morbidity and mortality attributable to secondhand smoke

As noted elsewhere in this chapter, active smokers are at greater risk of disease or death due to smoking than are non-smokers from exposure to secondhand smoke. However the amount of injury caused by secondhand smoke is not trivial. Estimates based on data from the US1 and the UK1,2 show that for every 10 deaths caused by smoking among smokers, one death occurs in a non-smoker due to exposure to secondhand smoke. Secondhand smoke is thought to be responsible for as many as 2.7% of all deaths in the US each year.3

A small number of reports have published estimates of deaths caused by secondhand smoke in Australia over the past decade. Estimates vary depending on the methodology used and disease entities included, and some estimates are more conservative due to greater limitations. Key findings from these reports are presented below.

4.15.1Estimated mortality from secondhand smoke in Australia in 2004–05

Secondhand smoke caused the deaths of an estimated 141 Australians in 2004–05, according to the Commonwealth Department of Health and Ageing.i 4 Of this total, 113 occurred in adults and 28 deaths occurred in babies (Table 4.15.1).

About 90% of the deaths caused by secondhand smoke in adulthood were due to ischaemic heart disease. Most deaths caused by secondhand smoke occur later in life, reflecting the contribution of chronic lifelong exposure to the development of heart disease and lung cancer. There were more than twice as many deaths among adult women as there were among men. This reflects the historically higher rates of active smoking among men compared with women in previous decades.

These estimates are likely to be conservative, since they do not include deaths from all diseases now considered by some agencies to be caused by exposure to secondhand smoke. Additionally, the estimates for deaths from lung cancer caused by secondhand smoke are restricted to exposed non-smokers married to a smoker (so excluding non-smokers exposed in workplaces and other settings). Also, a cautious approach to quantifying deaths from ischaemic heart disease has been adopted compared with other methodologies (shown by the findings of the report prepared for The Cancer Council New South Wales—see Section 4.15.2).

The report for 2004–05 does not quantify morbidity (non-fatal illness) caused by secondhand smoke, but makes the comment that 'the overwhelming proportion of the morbidity attributable to involuntary smoking ... is borne by the young'.4 In a previous report, it was estimated that secondhand smoking caused close to 2000 hospital admissions in Australia in 1998. About three-quarters of these admissions occurred in children under the age of 14.5

Table 4.15.1
Estimated numbers of deaths caused by secondhand smoke in Australia, 2004–05 (Department of Health and Ageing, 2007)


Male deaths

Female deaths


In adults aged 15 and over

Lung cancer




Ischaemic heart disease




In infancy*

Antepartum haemorrhage




Low birthweight








Total deaths all ages




* Deaths in infancy are based on exposure to active maternal smoking during pregnancy and/or following birth

Note: Columns may not add up to total due to rounding

Source: Unpublished data from research undertaken for Collins and Lapsley, 20084

4.15.2 Estimated deaths due to secondhand smoke in Australia in 1998—Cancer Council New South Wales, 2004

Calculations of deaths in Australia caused by secondhand smoke have also been published in a report commissioned by Cancer Council New South Wales. Main findings are summarised in Table Based on scaling from US data based on relative population size, James Repace estimated that in 1998, about 4200 adult non-smokers may have died in Australia from secondhand smoke.6 The estimates by Repace include a wider range of diseases than those considered in the Department of Health and Ageing and Australian Institute of Health and Welfare reports discussed above, but exclude deaths in infancy. Repace makes the observation that even if only deaths from lung cancer and heart disease caused by secondhand smoke are considered, for which the greatest amount of scientific evidence exists, then the annual toll from secondhand smoke is still in the order of 3464 deaths.6

Table 4.15.2
Estimated numbers of deaths caused by secondhand smoke in Australia, 1998*

Lung cancer


Heart disease


Breast cancer


Cervical cancer


Nasal sinus cancer


Brain cancer, leukaemia and lymphoma




*Adults aged 15+

Source: Excerpt from Table 1 in Repace6

4.15.3Estimated mortality and morbidity from secondhand smoke in Australia—National Health and Medical Research Council, 1997

Estimates of mortality published by the National Health and Medical Research Council (NHMRC) in 1997 showed that 11 deaths from lung cancer and 77 deaths from a major coronary event could be attributable to secondhand smoke annually.7 The authors of this information paper commented that these estimates were likely to be very conservative, because they were restricted to never smokers who had been exposed in the home environment, due to limitations in availability of more general Australian exposure data.

The NHMRC's information paper also estimated that secondhand smoke was a factor in causing asthma symptoms in 46,500 Australian children annually, and caused lower respiratory illness in 16,300 children. More than 5000 hospital separations in children every year could be attributable to secondhand smoke.7

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i The calculations by the Department of Health and Ageing are the most recent in a series dating back to 1990. The Department of Health and Ageing and the Australian Institute of Health and Welfare have progressively developed and revised their methodology, which is described in detail in their publications.


1. Armour BS, Woollery T, Malarcher A, Pechacek TF and Husten C. Annual smoking-attributable mortality, years of potential life lost, and productivity losses--United States, 1997–2001. Morbidity and Mortality Weekly Report 2005;54(25):625–8. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5425a1.htm

2. Jamrozik K. Estimate of deaths attributable to passive smoking among UK adults: database analysis. British Medical Journal 2005;330:812–16. Available from: http://www.bmj.com/cgi/content/abstract/bmj.38370.496632.8Fv3

3. Repace J. Exposure to secondhand smoke. In Ott, W, Steinemann, A, and Wallace, L, eds, In: Exposure analysis. Boca Raton, Florida: Taylor & Francis Group - CRC Press, 2007. 201–31. Available from: http://tobaccosmoke.exposurescience.org/abcs-of-shs/references

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

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: Australian Institute of Health and Welfare, 2001. Available from: http://www.aihw.gov.au/publications/phe/qdcmma98/

6. Repace J. Estimated mortality from secondhand smoke among club, pub, tavern and bar workers in New South Wales, Australia. A report commissioned by The Cancer Council New South Wales. Woolloomooloo, Australia: The Cancer Council New South Wales, 2004. Available from: http://www.cancercouncil.com.au/editorial.asp?pageid=1020

7. National Health and Medical Research Council. The health effects of passive smoking: a scientific information paper. Canberra: Australian Government Publishing Service, 1997.

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