Worldwide, smoking is a leading preventable cause of morbidity and mortality, and in Australia is consistently the number one risk factor contributing to disease burden and deaths. 1 In Australia, up to two-thirds of deaths in current smokers can be attributed to smoking, who lose on average a decade of life. 2 Several studies have estimated the numbers of deaths caused by tobacco use in Australia; 1, 3, 4 Some of the key findings are presented in this section.
3.30.1 Estimated mortality and morbidity from tobacco use, 2015—the Australian Institute of Health and Welfare (2019)
The Australian Burden of Disease study estimated that smoking caused a total of 20,933 deaths in 2015, or more than one in every seven deaths (13.3%). 1 In 2015, 9.3% of the disease burden in Australia was due to tobacco use, making it the leading risk factor that contributed to disease burden and deaths. This equated to 443,235 years of healthy life lost (‘disability-adjusted life years’, or DALYs) from death and illness due to tobacco use in Australia in 2015.
Tobacco use was causally linked to the burden of 39 individual diseases including: 19 types of cancer; seven cardiovascular diseases; chronic obstructive pulmonary disease (COPD); and asthma. About three quarters of all DALYs from COPD, lung cancer, and laryngeal cancer were due to tobacco use. Table 3.30.1 shows the DALYs due to tobacco use in Australia in 2015, as well as the proportion of DALYs for each disease attributable to tobacco use.
DALYs attributable to tobacco use by specific cause, Australia, 2015
Source: AIHW Australian Burden of Disease Study, supplementary tables 1
Chronic obstructive pulmonary disease was the leading cause of death and illness due to smoking, followed by lung cancer, coronary heart disease and stroke (Table 3.30.1).
3.30.2 Estimated mortality and morbidity from tobacco use, 2017—the Global Burden of Disease Study
The Global Burden of Disease study estimates levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks factors. Globally, more than eight million deaths and 200 million DALYs were attributable to tobacco in 2017. It estimated that in Australia in 2017, 22,781 deaths and 567,928 disability-adjusted life-years were attributable to tobacco. Disease groups with the greatest DALY burden attributable to tobacco in Australia included chronic respiratory diseases (30%); cancer (21%); and cardiovascular diseases (17%). 5
3.30.3 Estimated mortality from tobacco use, 2010—Peto et al methodology
Estimates of deaths caused by smoking in Australia have been calculated by Peto et al for 2010 and 2015, 4 using a methodology first described in 1992. 6 Extrapolating from WHO mortality for lung cancer and other diseases, and using UN population data, Peto et al estimated that a total of 24,000 deaths would be caused by active tobacco use in Australia in 2015 ; 13,000 among men, and 11,000 among women. 4 These estimates are likely to be conservative, because they do not include any deaths in individuals aged under 35 (including infants). About one quarter of all deaths due to smoking (or 6,300 of 24,000) occur in individuals aged between 35 and 69, who lose, on average, about 23 years of life. 4 Table 3.30.2 shows the estimated number of deaths attributable to smoking in Australia in 2010 by specific cause.
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. 4 (See Section 3.36 ).
Deaths, by cause, attributed to smoking / total deaths by sex, Australia, 2010
Figure 3.30.1 shows that of all deaths due to tobacco in 2010, 39% were cancer deaths, 29% were due to vascular diseases, and a further 21% were caused by respiratory disease.
Deaths attributable to smoking in Australia by disease entity, as a proportion of all tobacco-caused deaths, 2010
Source: Peto et al, 2015 4
1. Australian Institute of Health and Welfare. Australian burden of disease study: Impact and causes of illness and death in Australia 2015. Australian Burden of Disease, Canberra: AIHW, 2019. Available from: https://www.aihw.gov.au/getmedia/c076f42f-61ea-4348-9c0a-d996353e838f/aihw-bod-22.pdf.aspx?inline=true .
2. Banks E, Joshy G, Weber MF, Liu B, Grenfell R, et al. Tobacco smoking and all-cause mortality in a large Australian cohort study: Findings from a mature epidemic with current low smoking prevalence. BMC Medicine, 2015; 13(1):38. Available from: http://www.biomedcentral.com/1741-7015/13/38
3. 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 .
4. Peto R, Lopez AD, Pan H, Boreham J, and Thun M. Mortality from smoking in developed countries 1950 - 2020. 2015. Available from: http://gas.ctsu.ox.ac.uk/tobacco/contents.htm
5. Global Health Data Exchange. Global burden of disease results. Institute for Health Metrics and Evaluation, University of Washington, 2018. Available from: http://ghdx.healthdata.org/gbd-results-tool .
6. 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: https://www.ncbi.nlm.nih.gov/pubmed/1349675