Estimating smoking related cause of death: a cohort approach based on lung cancer mortality in six European countries

Mariachiara Di Cesare, London School of Economics and Political Science (LSE)
Michael Murphy, London School of Economics and Political Science (LSE)

It is estimated (WHO, 2002; WHO, 2007) that in 2002 in Europe tobacco use represented the second most important risk factor for mortality accounting for 12.3% (2000) of years of life lost due to premature mortality and years lived in disability (DALYs). It is the principal cause of premature death, exceeding by two thirds that of any other addiction, exposure or injury (Lopez, Collishaw, and Piha, 1994; Peto et al. 2006). Tobacco use increases the risk of lung cancer, oral cancer, coronary heart diseases and emphysema among others (Rogers et al. 2005; Ravenholt, 1990). According to Peto et al. (2006) in the period between 1960 and 2000 almost 24 million people have died from smoking in EU-25, of whom 13.3 million were in their middle age (35-69 years old). International comparisons suggest that the impact of smoking on the burden of disease varies among countries and sexes depending on differences among cohorts in lifetime exposure to smoking (Janssen, Kunst, and Mackenbach, 2007; Preston and Wang, 2006) Although it is widely recognised that many of the smoking related causes of death have a strong cohort effect, especially in the case of lung cancer, most of the estimates are period based (Peto, 1992). However, in the recent years, there has been renewed interest in cohort approaches (Preston and Wang, 2006). This paper presents cohort-based estimates for lung cancer mortality (using data from the WHO Mortality database) for six European countries that include a variety of levels and trends in smoking-related causes of death over recent decades- Austria, Denmark, Greece, Hungary, Netherlands, and United Kingdom – using Age-Period-Cohort models.