Original article
Smoking-attributable mortality in the autonomous communities of Spain, 2017Mortalidad atribuida al consumo de tabaco en las comunidades autónomas de España, 2017

https://doi.org/10.1016/j.rec.2020.10.023Get rights and content

Abstract

Introduction and objectives

To estimate smoking-attributable mortality (SAM) in the regions of Spain among people aged ≥ 35 years in 2017.

Methods

SAM was estimated using a prevalence dependent method based calculating the population attributable fraction. Observed mortality was derived from the National Statistics Institute. The prevalence of smoking by age and sex was based on the Spanish National Health Survey for 2011 and 2017 and the European Survey for 2014. Relative risks were reported from the follow-up of 5 North American cohorts. SAM and population attributable fraction were estimated for each region by age group, sex, and causes of death. Cause-specific and adjusted SAM rates were estimated.

Results

Smoking caused 53 825 deaths in the population aged ≥ 35 years (12.9% of all-cause mortality). SAM ranged from 10.8% of observed mortality in La Rioja to 15.3% in the Canary Islands. The differences remained after rates were adjusted by age. The highest adjusted SAM rates were observed in Extremadura in men and in the Canary Islands in women. Adjusted SAM rates in men were inversely correlated with those in women. The percentage of total SAM represented by cardiovascular diseases in each region ranged from 21.8% in Castile-La Mancha to 30.3% in Andalusia.

Conclusions

The distribution of SAM differed among regions. Conducting a detailed region-by-region analysis provides relevant information for health policies aiming to curb the impact of smoking.

Resumen

Introducción y objetivos

Estimar la mortalidad atribuida (MA) al consumo de tabaco en las comunidades autónomas (CCAA) de España en población de edad ≥ 35 años en 2017.

Métodos

Se estimó la MA empleando un método dependiente de prevalencias basado en el cálculo de fracciones atribuidas poblacionales. La mortalidad observada procede del Instituto Nacional de Estadística; las prevalencias de consumo por sexo y edad, de la Encuesta Nacional de Salud de 2011 y 2017 y la Encuesta europea de 2014, y los riesgos relativos, del seguimiento de 5 cohortes norteamericanas. Se presentan estimaciones de MA y fracciones atribuidas poblacionales para cada comunidad autónoma por causa de muerte, sexo y edad y tasas de MA específicas y ajustadas.

Resultados

El tabaco causó 53.825 muertes en España en la población de 35 o más años (el 12,9% de la mortalidad total). La carga de MA sobre la mortalidad observada varía del 10,8% en La Rioja al 15,3% en Canarias. Tras ajustar las tasas de MA por edad, las diferencias entre CCAA se mantienen, y las tasas más altas en los varones se observan en Extremadura y en las mujeres, en Canarias. Las tasas ajustadas de los varones se correlacionan negativamente con las de las mujeres. El porcentaje que suponen las enfermedades cardiovasculares sobre la MA total de cada comunidad autónoma oscila entre el 21,8% de Castilla-La Mancha y el 30,3% de Andalucía.

Conclusiones

La carga de MA al consumo de tabaco varía entre las CCAA. Realizar un análisis detallado por regiones aporta información relevante para la implantación de políticas sanitarias dirigidas a frenar el impacto del tabaquismo.

Section snippets

INTRODUCTION

In 2016, more than 7 million deaths were attributed to smoking worldwide, making it the preventable risk factor with the highest mortality.1 Smoking raises the risk of death associated with an increasingly higher number of conditions. For instance, the 2014 report entitled The health consequences of smoking: 50 years of progress2 established 4 new causal relationships with smoking: rectal and colon cancer, hepatocellular carcinoma, diabetes mellitus, and tuberculosis.

One of the indicators used

Estimation method

The method used to estimate SAM depended on smoking prevalence and calculated the population-attributable fractions (PAFs). This method estimates SAM as the product of observed mortality (OM) and PAF9:PAF=P0+P1RR1+P2RR21P0+P1RR1+P2RR2

wherein P is smoking prevalence and RR is the relative risk between current smokers (1) and former smokers (2) of dying due to smoking-related diseases, compared with never-smokers (0).

Data sources

Cause-specific OM data were obtained from the National Statistics Institute

RESULTS

In 2017, smoking caused 53 825 deaths in Spain among the population aged ≥ 35 years, accounting for 12.9% of all-cause mortality in the country that year. Additionally, 84.6% of SAM was men (45 519), and 49.6% were older than 74 years (26 691); 49.7% of SAM was due to tumors (26 774); 66.6% due to lung cancer (17 842); 27.5% due to cardiovascular disease and diabetes (14 289 and 534), and 22.7% due to respiratory diseases (12 228). Table 1 and table 2 list the SAM estimates for the various

DISCUSSION

This study is the first to estimate SAM for a single year in all Spanish regions, using the same information sources and a common methodology. The results show that the impact of smoking on mortality varied among the regions. The category of causes with the highest SAM was tumors, followed by cardiovascular disease/diabetes, and respiratory disease. Once the SAM rate was adjusted for age, the highest rates among men were observed in Extremadura, Andalusia, Castile-La Mancha, and Asturias, and

CONCLUSIONS

In 2017, a total of 53 825 deaths were attributed to smoking, accounting for 12.9% of all-cause mortality that year. The SAM portion of total OM is unequal between regions and varies from 10.8% in La Rioja to 15.3% in the Canary Islands. Among men, the weight of SAM in total OM ranged from 24.6% in Extremadura to 18.4% in La Rioja; among women, the figures were 6.6% in Canary Islands to 2.3% in Castile-La Mancha. In all regions, SAM was higher in men. Among the major causes of death,

FUNDING

This project was funded by the Carlos III Health Institute (No. PI19/00288). The sponsors did not participate in the study in any way.

AUTHORS’ CONTRIBUTIONS

This study was part of the research undertaken by Julia Rey for her doctoral degree.

CONFLICTS OF INTEREST

None declared.

WHAT IS KNOWN ABOUT THE TOPIC?

  • Smoking is an avoidable risk factor increasingly found to be associated with more diseases. One of the indicators used to characterize the smoking epidemic among the population is smoking-attributable mortality. Only a few studies in Spain have estimated region-specific smoking-attributable mortality. To date, attributable mortality estimates are only available for 6 regions, and all refer to different time points. The latest estimate was for 2001 to 2006 in Galicia.

WHAT DOES THIS STUDY ADD?

  • This is the

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