Estimating the burden of disease attributable to smoking in South Africa in 2000.
OBJECTIVE
To quantify the burden of disease attributable to smoking in South Africa for 2000.


METHODS
The absolute difference between observed lung cancer death rate and the level in non-smokers, adjusted for occupational and indoor exposure to lung carcinogens, was used to estimate the proportion of lung cancer deaths attributable to smoking and the smoking impact ratio (SIR). The SIR was substituted for smoking prevalence in the attributable fraction formula for chronic obstructive pulmonary disease (COPD) and cancers to allow for the long lag between exposure and outcome. Assuming a shorter lag between exposure and disease, the current prevalence of smoking was used to estimate the population-attributable fractions (PAF) for the other outcomes. Relative risks (RR) from the American Cancer Society cancer prevention study (CPS-II) were used to calculate PAF.


METHODS
South Africa.


METHODS
Deaths and disability-adjusted life years (DALYs) due to lung and other cancers, COPD, cardiovascular conditions, respiratory tuberculosis, and other respiratory and medical conditions.


RESULTS
Smoking caused between 41,632 and 46,656 deaths in South Africa, accounting for 8.0 - 9.0% of deaths and 3.7 - 4.3% of DALYs in 2000. Smoking ranked third (after unsafe sex/ sexually transmitted disease and high blood pressure) in terms of mortality among 17 risk factors evaluated. Three times as many males as females died from smoking. Lung cancer had the largest attributable fraction due to smoking. However, cardiovascular diseases accounted for the largest proportion of deaths attributed to smoking.


CONCLUSIONS
Cigarette smoking accounts for a large burden of preventable disease in South Africa. While the government has taken bold legislative action to discourage tobacco use since 1994, it still remains a major public health priority.
Groenewald
Pam
P
Burden of Disease Research Unit, Medical Research Council of South Africa, Cape Town. pamela.groenewald@mrc.ac.za
Vos
Theo
T
Norman
Rosana
R
Laubscher
Ria
R
van Walbeek
Corné
C
Saloojee
Yussuf
Y
Sitas
Freddy
F
Bradshaw
Debbie
D
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D017281:Cost of Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D044469:Racial Groups / Q000706:statistics & numerical data*; D017678:Sex Distribution; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology*; D013019:South Africa / Q000453:epidemiology; D014029:Tobacco Use Disorder / Q000150:complications* / Q000453:epidemiology*