Back to Conference page
The 13th World Conference on Tobacco OR Health
Building capacity for a tobacco-free world
July 12-15, 2006, Washington, DC, USA
Objective: To develop a direct method of measuring tobacco attributed mortality
Methods: In mid-1998, a question ‘Was the deceased a smoker five years ago?' was introduced on the South African death notification form. Smoking rates among those who died of different causes was used to estimate, by case-control comparisons, tobacco attributed mortality in South Africa. Cases comprised deaths from causes known to be causally associated with smoking. Controls comprised deaths from medical conditions unrelated to smoking. Those who died from external causes, and diseases strongly related to alcohol consumption, were excluded.
Results: In this pilot study, reports were available from 5,340 deceased adults (age 25+), whose smoking status was given by a family member. Odds ratios (OR) were standardised for age, sex and education. Significantly increased risks (OR) were found for deaths from tuberculosis (TB: OR = 1.61, 95%CI = 1.2-2.1), chronic obstructive pulmonary disease (COPD: OR = 2.5, 95%CI = 1.9-3.4), lung cancer (OR = 4.8, 95%CI = 2.9-8.0), other upper aerodigestive cancer (OR = 3.0, 95%CI = 1.9-4.9) and ischaemic heart disease (OR = 1.7, 95%CI = 1.2-2.3). If smokers had the same death rate as non-smokers, 58% of lung cancer, 37% of COPD, 20% of TB and 23% of vascular deaths would have been avoided.
Eight percent of all adult deaths in South Africa (> 20,000 annual deaths) were due to smoking. Using death notifications to ask questions about the smoking status of the deceased is a robust way to monitor tobacco-attributed deaths.