Mortality from tobacco in developed countries: indirect estimation from national vital statistics.
Abstract
Prolonged cigarette smoking causes even more deaths from other diseases than from lung cancer. In developed countries, the absolute age-sex-specific lung cancer rates can be used to indicate the approximate proportions due to tobacco of deaths not only from lung cancer itself but also, indirectly, from vascular disease and from various other categories of disease. Even in the absence of direct information on smoking histories, therefore, national mortality from tobacco can be estimated approximately just from the disease mortality statistics that are available from all major developed countries for about 1985 (and for 1975 and so, by extrapolation, for 1995). The relation between the absolute excess of lung cancer and the proportional excess of other diseases can only be approximate, and so as not to overestimate the effects of tobacco it has been taken to be only half that suggested by a recent large prospective study of smoking and death among one million Americans. Application of such methods indicates that, in developed countries alone, annual deaths from smoking number about 0.9 million in 1965, 1.3 million in 1975, 1.7 million in 1985, and 2.1 million in 1995 (and hence about 21 million in the decade 1990-99: 5-6 million European Community, 5-6 million USA, 5 million former USSR, 3 million Eastern and other Europe, and 2 million elsewhere, [ie, Australia, Canada, Japan, and New Zealand]). More than half these deaths will be at 35-69 years of age: during the 1990s tobacco will in developed countries cause about 30% of all deaths at 35-69 (making it the largest single cause of premature death) plus about 14% of all at older ages. Those killed at older ages are on average already almost 80 years old, however, and might have died soon anyway, but those killed by tobacco at 35-69 lose an average of about 23 years of life. At present just under 20% of all deaths in developed countries are attributed to tobacco, but this percentage is still rising, suggesting that on current smoking patterns just over 20% of those now living in developed countries will eventually be killed by tobacco (ie, about a quarter of a billion, out of a current total population of just under one and a quarter billion).
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Previous estimates of smoking-attributable burden in GBD relied on dichotomous exposures, despite well documented dose-response associations.
“Previous estimates of smoking-attributable burden in GBD relied on dichotomous exposures, despite well documented dose-response associations.”
For health outcomes modelled using daily prevalence in previous studies, risks among occasional smokers and former smokers were not included, and methods did not reflect dose-response associations between smoking intensity and risk of disease.
“For health outcomes modelled using daily prevalence, risks among occasional smokers and former smokers were not included, and methods did not reflect well described dose-response associations between smoking intensity and risk of disease.”
For health outcomes modelled using the Smoking Impact Ratio method, reliability was low in countries with scarce or poor quality data on lung cancer mortality and in countries with other important competing risks for lung cancer.
“For the health outcomes modelled using the Smoking Impact Ratio method, reliability was low in countries with either scare or poor quality data on lung cancer mortality and in countries with other important competing risks for lung cancer, such as air pollution.”
For each risk factor-disease pair, the same relative risk was used for men and women except where empirical evidence indicated that the relative risk differed by sex: colon and pancreas cancers caused by high BMI, and all disease outcomes caused by alcohol use and tobacco smoking.
“For each risk factor–disease pair, we used the same RR for men and women except where empirical evidence indicated that the RR differed by sex: colon and pancreas cancers caused by high BMI [17], and all disease outcomes caused by alcohol use and tobacco smoking, for which there are sex differences in factors such as smoking duration and intensity [18] and type of alcohol consumed [19].”
From The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors (2009) · cites this paper as [18]
Because smoking prevalence has declined in the US, the use of the smoking impact ratio (SIR) as the metric of cumulative exposure may have overestimated the cardiovascular deaths attributable to smoking.
“Because smoking prevalence has declined in the US, the use of the smoking impact ratio (SIR) as the metric of cumulative exposure [18] may have overestimated the cardiovascular deaths attributable to smoking.”
From The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors (2009) · cites this paper as [18]
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Self-citation
- Authors
- Peto, R., Boreham, J., Lopez, A. D., Thun, M., & Heath, C.
- Affiliations
- University of Oxford (GB)
- American Cancer Society (US)
- ORCID
- Peto, R.
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 1992-05
- Volume
- 339
- Issue
- 8804
- Pages
- 1268-1278
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2114616454
- Cited by
- 1,394
- References
- 13
- Citations by year
- 2026: 7 · 2025: 15 · 2024: 19 · 2023: 23 · 2022: 37 · 2021: 33 · 2020: 32 · 2019: 22 · 2018: 35 · 2017: 29 · 2016: 38 · 2015: 44 · 2014: 41 · 2013: 41 · 2012: 48
- FWCI
- 25.83
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
- Keywords
- smoking-related mortality, cigarette smoking, lung cancer, vascular disease, indirect estimation, excess mortality, premature mortality, age-specific mortality, life expectancy, developed countries
- MeSH terms
- Adult, Aged, Aged, 80 and over, Cardiovascular Diseases, Data Interpretation, Statistical, Europe, Female, Humans, Life Expectancy, Lung Diseases, Male, Middle Aged, Neoplasms, Population Surveillance, Prospective Studies, Risk, Smoking, United States
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