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.

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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 Dec. 12];112(8B):649-61. Available from: https://samajournals.co.za/index.php/samj/article/view/218

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