title: Mortality and morbidity from coronary heart disease attributable to passive smoking.
abstract: OBJECTIVE
  Passive smoking is associated with increased risk of coronary heart disease (CHD). This study estimates CHD mortality and morbidity attributable to passive smoking in Germany and demonstrates variations in the number of estimated deaths depending on underlying assumptions.
  
  
  RESULTS
  Prevalence of passive smoking from the German National Health Survey, CHD deaths from national mortality statistics, number of incident CHD cases, and relative risks from meta-analyses were used to estimate mortality and morbidity from passive smoking applying the concept of population attributable risk. Sensitivity analyses were carried out to investigate the impact of different assumptions in terms of exposure definition, relative risk, and population at risk on estimated mortality. Exposure to environmental tobacco smoke (ETS) at home accounts for 2148 [approximate 95% confidence interval (CI) 1471-2736] deaths from CHD and 3776 (95% CI 2588-4800) incident CHD cases among non-smokers every year in Germany. In sensitivity analyses, consideration of exposure to ETS at work and at any location yielded 2597 (95% CI 1784-3295) and 8970 (95% CI 6252-11 243) attributable CHD deaths, respectively. Applying different populations at risk showed a range of 1174 (95% CI 803-1494) to 13 792 (95% CI 9655-17 225) attributable deaths from CHD.
  
  
  CONCLUSIONS
  The estimated burden of passive smoking heavily depends on the definition of underlying parameters. Using an evidence-based approach reveals a substantial burden of passive smoking in terms of CHD mortality and morbidity reflected by six CHD deaths and 10 incident CHD cases every day in Germany.
authors.affiliation: Institute of Epidemiology and Social Medicine, University of Münster, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Heidrich
authors.forename: Jürgen
authors.initials: J
authors.lastname: Wellmann
authors.forename: Peter U
authors.initials: PU
authors.lastname: Heuschmann
authors.forename: Klaus
authors.initials: K
authors.lastname: Kraywinkel
authors.forename: Ulrich
authors.initials: U
authors.lastname: Keil
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000209:etiology / Q000401:mortality*; D004781:Environmental Exposure; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*
chemical_list: D014028:Tobacco Smoke Pollution