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Health See other Health Articles Title: Smoking Habit Should Be Part of Death Records Editors' Recommendations Teen Smoking Linked to Earlier Death Quitting Smoking Decreases Death Risk Even in Older People Smoking Set to Cause 40 Million Extra Tuberculosis Deaths Recording the smoking habit on death registration forms is of great value, according to a case-control study from South Africa, the first — and to date only — country to follow this practice. In this analysis, published in the August 24 issue of the Lancet, tobacco-related deaths in the population with mixed black and white ancestry were more than twice that seen among whites. "Death registries around the world should routinely ask whether the dead person was a smoker," senior author Sir Richard Peto, MD, FRS, from the University of Oxford, United Kingdom, said in a news release. "This would help assess national death rates from smoking and would help countries discover whether deaths from smoking are increasing or decreasing. There will be hundreds of millions of tobacco deaths this century if current smoking patterns continue." The investigators reviewed 481,640 South African death notifications at ages 35 to 74 years between 1999 and 2007 and extracted data on age, sex, population group, education, whether or not the person smoked 5 years previously, and underlying disease. They compared cases, or deaths from diseases affected by smoking, with controls, or deaths from selected other diseases, excluding HIV, cirrhosis, unknown or external causes, and mental disorders. Smoking prevalence was high in men (68%) and women (46%) in the population with mixed black and white ancestry compared with 47% and 28%, respectively, among whites. Overall mortality was about 50% higher in smokers from the population with mixed black and white ancestry than in otherwise similar nonsmokers or ex-smokers. For men, smoking-associated relative risk (RR) was 1.55 (95% confidence interval [CI], 1.43 - 1.67), and for women, RR was 1.49 (95% CI, 1.38 - 1.60). In the white population, RRs were similar (men, 1.37; 95% CI, 1.29 - 1.46; women, 1.51; 95% CI, 1.40 - 1.62). However, RRs were lower among Africans (men, 1.17; 95% CI, 1.15 - 1.19; women, 1.16; 95% CI, 1.13 - 1.20). Assuming causal associations, smoking-attributed proportions for overall male deaths were 27% in the population with mixed black and white ancestry, 14% in the white population, and 8% in the African population. Among women, these rates were 17%, 12%, and 2%, respectively. Clinical Implications "There is already a high death rate from smoking in the mixed-ancestry coloured population of South Africa, and there will be major increases in tobacco-attributed mortality in many other African populations where young adults now smoke, unless there is widespread cessation," coauthor Debbie Bradshaw, DPhil, from the South African Medical Research Council, Tygerberg, said in the news release. Hazards from smoking in the population with mixed black and white ancestry were more than double those in the white population, as national mortality rates were also substantially higher in the population with mixed black and white ancestry than in the white population. "Our results show that in 1999 - 2007, smoking caused many deaths from cancer and heart disease, but the main way it killed, particularly in the black population, was by increasing mortality from [tuberculosis] and other lung diseases," coauthor Freddy Sitas, DPhil, from New South Wales Cancer Council, Sydney, Australia, said in the news release. "All countries have heterogeneous populations, and need to know how disease-specific mortality from smoking varies with cultural background and socioeconomic status." Limitations of this study include possible underestimation of deaths from particular diseases, exclusion of some deaths because of missing data, reliance on control group exposure prevalences being representative of the target population, and attenuated estimates of smoker vs nonsmoker RRs. In an accompanying comment, Lionel Opie, MD, DPhil, from the Hatter Institute for Cardiovascular Diseases in Africa, University of Cape Town, concurs that even in countries with sophisticated health systems, it should become routine to determine whether the person smoked or not 5 years before death. "[The World Health Organization] estimates that about 100 million deaths worldwide were caused by tobacco during the past century, and that if current smoking habits persist there could well be about a billion tobacco deaths this century," Dr. Opie writes. "In each population where underlying causes of death are registered, incorporation of this one easy question about smoking 5 years ago into the death notification process would, at little expense, greatly facilitate monitoring of tobacco-attributed mortality." The South African Medical Research Council, UK Medical Research Council, Cancer Research UK, British Heart Foundation, and New South Wales Cancer Council funded this study. The study authors and Dr. Opie have disclosed no relevant financial relationships. Lancet. 2013;382:661-662, 685-693. Article abstract, Commentary extract Poster Comment: Hybrid vigor apparently doesn't always work. Post Comment Private Reply Ignore Thread
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