Estimating the changing disease burden attributable to smoking in South Africa for 2000, 2006 and 2012

Authors

  • P Groenewald Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
  • R Pacella Institute for Lifecourse Development, Faculty of Education, Health and Human Sciences, University of Greenwich, UK
  • F Sitas Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; Centre for Primary Health Care and Equity, School of Population Health, University of NSW-Sydney and Menzies Centre for Health Policy, School of Public Health, University of Sydney, Australia
  • O F Awotiwon Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
  • N Vellios Research Unit on the Economics of Excisable Products, University of Cape Town, South Africa
  • C J van Rensburg Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
  • S Manda Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
  • R Laubscher Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
  • B Nojilana Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
  • J D Joubert Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
  • D Labadarios Emeritus Professor, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
  • L Ayo-Yusuf Deputy Vice-Chancellor: Research and Graduate Studies, Sefako Makgatho Health Sciences University, Pretoria, South Africa; School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, South Africa
  • R A Roomaney Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
  • E B Turawa Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
  • I Neethling Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; Institute for Lifecourse Development, Faculty of Education, Health and Human Sciences, University of Greenwich, UK
  • N Abdelatif Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
  • V Pillay-van Wyk Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
  • D Bradshaw Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa

DOI:

https://doi.org/10.7196/SAMJ.2022.v112i8b.16492

Keywords:

Cancer, heart disease

Abstract

Background. Ongoing quantification of the disease burden attributable to smoking is important to monitor and strengthen tobacco
control policies.
Objectives. To estimate the attributable burden due to smoking in South Africa for 2000, 2006 and 2012.
Methods. We estimated attributable burden due to smoking for selected causes of death in South African (SA) adults aged ≥35 years for 2000, 2006 and 2012. We combined smoking prevalence results from 15 national surveys (1998 - 2017) and smoking impact ratios using national mortality rates. Relative risks between smoking and select causes of death were derived from local and international data.
Results. Smoking prevalence declined from 25.0% in 1998 (40.5% in males, 10.9% in females) to 19.4% in 2012 (31.9% in males, 7.9% in
females), but plateaued after 2010. In 2012 tobacco smoking caused an estimated 31 078 deaths (23 444 in males and 7 634 in females),
accounting for 6.9% of total deaths of all ages (17.3% of deaths in adults aged ≥35 years), a 10.5% decline overall since 2000 (7% in males; 18% in females). Age-standardised mortality rates (and disability-adjusted life years (DALYs)) similarly declined in all population groups but remained high in the coloured population. Chronic obstructive pulmonary disease accounted for most tobacco-attributed deaths (6 373), followed by lung cancer (4 923), ischaemic heart disease (4 216), tuberculosis (2 326) and lower respiratory infections (1 950). The distribution of major causes of smoking-attributable deaths shows a middle- to high-income pattern in whites and Asians, and a middle- to low-income pattern in coloureds and black Africans. The role of infectious lung disease (TB and LRIs) has been underappreciated. These diseases comprised 21.0% of deaths among black Africans compared with only 4.3% among whites. It is concerning that smoking rates have plateaued since 2010.
Conclusion. The gains achieved in reducing smoking prevalence in SA have been eroded since 2010. An increase in excise taxes is the most effective measure for reducing smoking prevalence. The advent of serious respiratory pandemics such as COVID-19 has increased the urgency of considering the role that smoking cessation/abstinence can play in the prevention of, and post-hospital recovery from, any condition.

References

World Health Organization. WHO Report on the Global Tobacco Epidemic, 2019: Offer Help to Quit Tobacco. Geneva: WHO, 2019.

World Health Organization. The Global Status Report on Non-communicable Diseases 2014. Attaining the nine global non-communicable diseases targets; a shared responsibility. Geneva: WHO, 2014.

US Department of Health and Human Services. The Health Consequences of Smoking: A Report of the

Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004.

Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2019 (GBD 2019) Results. Seattle, United States: Institute for Health Metrics and Evaluation (IHME), 2020. http://ghdx. healthdata.org/gbd-results-tool (accessed 25 March 2021).

Levy DT, Tam J, Kuo C, Fong GT, Chaloupka F. The impact of implementing tobacco control policies: The 2017 Tobacco Control Policy Scorecard. J Pub Health Management Practice: 2018;24(5):448-457. https://doi/org/10.1097/PHH.0000000000000780

Levy DT, Ellis JA, Mays D, Huang AT. Smoking-related deaths averted due to three years of policy progress. Bull World Health Organ 2013;91(7):509-518. https://doi.org/10.2471/BLT.12.113878

World Health Organization. WHO Framework Convention on Tobacco Control. Article 8(2). https:// www.who.int/fctc/text_download/en (accessed 25 March 2021).

Van Walbeek CP. Tobacco excise taxation in South Africa. Published report for the Tobacco Free Initiative of the World Health Organization. Report WHO/NMH/TFI/FTC/03.4. Geneva: WHO, 2003.

Van Walbeek CP. Recent trends in smoking prevalence in South Africa – some evidence from AMPS

data. S Afr Med J 2002;92(6):462-468.

Swart D, Reddy P, Ruiter RAC, de Vries H. Cigarette use among male and female grade 8 - 10 students of different ethnicity in South African schools. Tob Control 2003;12(1):e1-e1. https://doi.org/10.1136/

tc.12.1.e1

Reddy SP, James S, Sewpaul R, Koopman F. The 2008 Global Youth Tobacco Survey: The 3rd GYTS in South Africa. Cape Town: South African Medical Research Council, 2010.

Reddy P, James S, Sewpaul R, et al. A decade of tobacco control: The South African case of politics, health policy, health promotion and behaviour change. S Afr Med J 2013;103(11):835-840.

Shisana O, Labadarios D, SANHANES-1 Team. South African National Health and Nutrition Examination Survey (SANHANES-1). Cape Town: HSRC Press, 2013.

Reddy P, Zuma K, Shisana O, Jonas K, Sewpaul R. Prevalence of tobacco use among adults in South Africa: Results from the first South African National Health and Nutrition Examination Survey. S Afr Med J 2015;105(8):648-655. https://doi/org/10.7196/SAMJnew.7932

WHO Africa. Tobacco Control. https://www.afro.who.int/health-topics/tobacco-control (accessed 27 August 2021).

Groenewald P, Nojilana B, Janse van Rensburg C, et al. The impact of tobacco control policy interventions on the prevalence of tobacco smoking in South Africa, 1998 - 2017. NCD Symposium, Stellenbosch University, 4 March 2020.

Norman R, Bradshaw D, South African Comparative Risk Assessment Collaborating Group. A comparative risk assessment for South Africa in 2000: Towards promoting health and preventing disease. S Afr Med J 2007;97(8):637.

Groenewald P, Vos T, South African Comparative Risk Assessment Collaborating Group. Estimating the burden of disease attributable to smoking in South Africa in 2000. S Afr Med J 2007;97(8):674-681. 19. Sitas F, Egger S, Bradshaw D, et al. Differences among the coloured, white, black, and other South African populations in smoking-attributed mortality at ages 35 - 74 years: A case-control study of

640 deaths. Lancet 2013;382(9893):685-693. https://doi.org/10.1016/S0140-6736(13)61610-4.

Garfinkel L. Selection, follow‐up, and analysis in the American Cancer Society prospective studies. Nat

Cancer Inst Mongr 1985;67:49-52.

Pillay-van Wyk V, Msemburi W, Laubscher R, et al. Mortality trends and differentials in South Africa

from 1997 to 2012: Second National Burden of Disease Study, Lancet Glob Health 2016;4(9). https://

doi.org/10.1016/S2214-109X(16)30113-9

Lim SS, Vos T, Flaxman AD, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990 - 2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380(9859):2224-2260. https://doi. org/10.1016/S0140-6736(12)61766-8

GBD 2016 Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990 - 2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017;390(10100):1345- 1422. https://doi.org/10.1016/S0140-6736(17)32366-8

GBD 2017 Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990 - 2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018;392(10159):1923-1994. https://doi.org/10.1016/S0140-6736(18)32225-6. Erratum in: Lancet 2019;393(10167):132. Erratum in: Lancet 2019;393(10190):e44.

Peto R, Lopez AD, Boreham J, Thun M, Heath C Jr. Mortality from tobacco in developed countries: Indirect estimation from national vital statistics. Lancet 1992;339(8804):1268-1278.

Pillay van Wyk et al. 2nd Comparative Risk Assessment for South Africa (SACRA2) highlights need to strengthen health promotion and surveillance (in this issue).

Janse van Rensburg C, Groenewald P, Awotiwon O, et al. Trends in smoking prevalence in South Africa for 1988 - 2014: Overcoming the challenge of multiple data sources. Tob Induc Dis 2018;16(Suppl 1):A780. https://doi.org/10.18332/tid/84201

Pillay-van Wyk V, Roomaney RA, Awotiwon OF, et al. Burden of disease review manager for systematic review of observational studies: Technical report and user guide. Cape Town: South African Medical Research Council, 2018.

Ezzati M, Lopez AD. Measuring the accumulated hazards of smoking: Global and regional estimates for 2000. Tob Control 2003;12(1):79-85.

Kontis V, Mathers CD, Rehm J, et al. Contribution of six risk factors to achieving the 25×25 non- communicable disease mortality reduction target: A modelling study. Lancet 2014;384(9941):427-437. https://doi.org/10.1016/S0140-6736(14)60616-4

GBD 2013 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990 - 2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015;386(10010):2287-2323. https://doi.org/10.1016/S0140-6736(15)00128-2

Baskaran V, Murray RL, Hunter A, Lim WS, McKeever TM. Effect of tobacco smoking on the risk of developing community acquired pneumonia: A systematic review and meta-analysis. PLoS ONE 2019;14(7):e0220204. https://doi.org/10.1371/journal.pone.0220204

National Department of Health, Statistics South Africa, South African Medical Research Council and ICF. South Africa Demographic and Health Survey 2016. Pretoria, South Africa, and Rockville, Maryland, USA: NDoH, Stats SA, SAMRC, ICF, 2019.

Department of Health, South Africa and Macro International. South Africa Demographic and Health Survey 1998. Pretoria: DoH, 2002.

Department of Health, Medical Research Council, ORC Macro. South Africa Demographic and Health Survey 2003. Pretoria: DoH, 2003.

Southern Africa Labour and Development Research Unit. National Income Dynamics Study (NIDS) Wave 1, 2008. Version 6.1. Cape Town: Southern Africa Labour and Development Research Unit, 2016. Cape Town: DataFirst, 2016.

Southern Africa Labour and Development Research Unit. National Income Dynamics Study Wave 2, 2010 - 2011. Version 3.1. Cape Town: Southern Africa Labour and Development Research Unit, 2016. 38. Southern Africa Labour and Development Research Unit. National Income Dynamics Study Wave 3, 2012 . Version 3.0.0. Pretoria: SA Presidency; Cape Town: Southern Africa Labour and Development Research Unit, 2018. https://doi.org/10.25828/7pgq-q106.

Lin HH, Ezzati M, Murray M. Tobacco smoke, indoor air pollution and tuberculosis: A systematic

review and meta-analysis. PLoS Med 2007;4(1):e20. https//:doi/org/10.1371/journal.pmed.0040020 40. Baskaran V, Murray RL, Hunter A, Lim WS, McKeever TM. Effect of tobacco smoking on the risk of developing community acquired pneumonia: A systematic review and meta-analysis. PLoS ONE 14(7):e0220204. https://doi.org/10.1371/journal.pone.0220204

Dorrington R. Alternative South African mid-year estimates, 2013. Cape Town: Centre for Actuarial Research, University of Cape Town, 2013.

Ahmad OB, Boschi-Pinto C, Lopez AD, Murray CJL, Lozano R, Inoue M. Age standardisation of rates:

A new WHO standard. GPE Discussion Paper Series: No. 31 EIP/GPE/EBD. Geneva: World Health Organization, 2001.

Namale G, Kamacooko O, Kinengyere A, et al. Risk factors for hemorrhagic and ischemic stroke in sub-saharan Africa. J Trop Med 2018(2018):11. https://doi.org/10.1155/2018/4650851

Thun M, Peto R, Boreham J, Lopez AD. Stages of the cigarette epidemic on entering its second century. Tob Control 2012;21(2):96-101. https://doi.org/10.1136/tobaccocontrol-2011-050294

Gaiha SM, Cheng J, Halpern-Felsher B. Association between youth smoking, electronic cigarette use, and coronavirus disease 2019. J Adolesc Health 2020;67(4):519-523. https://doi.org/10.1016/j.jadohealth.2020.07.002

Li X, Zhong X, Wang Y, Zeng X, Luo T, Liu Q. Clinical determinants of the severity of COVID-19: A systematic review and meta-analysis. PLoS One 2021;16(5):e0250602. https://doi.org/10.1371/ journal.pone.0250602

Xiang G, Xie L, Chen Z, et al. Clinical risk factors for mortality of hospitalised patients with COVID-19: Systematic review and meta-analysis. Ann Palliat Med 2021;10(3):2723-2735. https://doi. org/10.21037/apm-20-1278

Sitas F, Harris-Roxas B, Bradshaw D, Lopez A. Smoking and epidemics of respiratory infections. Bull WHO 2021;99(2):164-165. https://doi.org/10/2471/BLT.20.273052

World Health Organization. Smoking and COVID 19 scientific briefing. 30 June 2020. https://apps.who. int/iris/handle/10665/332895 (accessed 18 May 2022).

Mdege ND, Shah S, Ayo-Yusuf OA, Hakim J, Siddiqi K. Tobacco use among people living with HIV: Analysis of data from demographic and health surveys from 28 low-income and middle-income countries. Lancet Glob Health 2017;5(6):e578-e592. https://doi.org/10.1016/S2214-109X(17)30170-5

Reddy KP, Parker RA, Losina E, et al. Impact of cigarette smoking and smoking cessation on life expectancy among people with HIV: A US-based modeling study. J Infect Dis 2016;214(11):1672-1681. https://doi.org/10.1093/infdis/jiw430

Ashare RL, Bernstein SL, Schnoll R, et al. The United States National Cancer Institute’s coordinated research effort on tobacco use as a major cause of morbidity and mortality among people with HIV. Nicotine Tob Res 2021;23(2):407-410. https://doi.org/10.1093/ntr/ntaa155

Shepherd L, Ryom L, Law M, et al. Data collection on adverse events of anti-HIV drugs (D:A:D) Study Group. Cessation of cigarette smoking and the impact on cancer incidence in human immunodeficiency virus-infected persons: The data collection on adverse events of anti-HIV drugs study. Clin Infect Dis 2019;68(4):650-657. https://doi.org/10.1093/cid/ciy508

Petoumenos K, Worm S, Reiss P, et al.; D:A:D Study Group. Rates of cardiovascular disease following smoking cessation in patients with HIV infection: Results from the D:A:D study. HIV Med 2011;12(7):412-421. https://doi.org/10.1111/j.1468-1293.2010.00901.x

Louwagie GM, Ayo-Yusuf OA. Tobacco use patterns in tuberculosis patients with high rates of human immunodeficiency virus co-infection in South Africa. BMC Public Health 2013;13(1):1031. https://doi. org/10.1186/1471-2458-13-1031

Pool ER, Dogar O, Lindsay RP, Weatherburn P, Siddiqi K. Interventions for tobacco use cessation in people living with HIV and AIDS. Cochrane Database Syst Rev 2016;13(6):CD011120. https://doi. org/10.1002/14651858.CD011120.pub2

International Agency for Research on Cancer. 2011. IARC Handbooks of Cancer Prevention, Tobacco Control, Volume 14: Effectiveness of Tobacco Tax and Price Policies for Tobacco Control. Lyon, France: IARC, 2011.

Chelwa, G, Van Walbeek, C, Blecher, E. Evaluating South Africa’s tobacco control policy using a synthetic control method. Tob Control 2016; 26(5). https://doi.org/10.1136/tobaccocontrol-2016-053011

US National Cancer Institute and World Health Organization. The Economics of Tobacco and Tobacco Control. National Cancer Institute Tobacco Control Monograph 21. NIH Publication No. 16-CA-8029A. Bethesda, MD: US Department of Health and Human Services, National Institutes of Health, National Cancer Institute; Geneva, CH: World Health Organization, 2016.

Vellios N, Ross H, van Walbeek C. Illicit cigarette trade in South Africa: 2002 - 2017. Tob Control 2019;29(4). https://doi.org/10.1136/tobaccocontrol-2018-054798

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Published

2022-09-30

How to Cite

1.
Groenewald P, Pacella R, Sitas F, Awotiwon OF, Vellios N, van Rensburg CJ, et al. Estimating the changing disease burden attributable to smoking in South Africa for 2000, 2006 and 2012. S Afr Med J [Internet]. 2022 Sep. 30 [cited 2024 Jul. 14];112(8B):649-61. Available from: https://samajournals.co.za/index.php/samj/article/view/218

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