title: The future of smoking-attributable mortality: the case of England & Wales, Denmark and the Netherlands.
abstract: OBJECTIVE
  We formally estimate future smoking-attributable mortality up to 2050 for the total national populations of England & Wales, Denmark and the Netherlands, providing an update and extension of the descriptive smoking-epidemic model.
  
  
  METHODS
  We used smoking prevalence and population-level lung cancer mortality data for England & Wales, Denmark and the Netherlands, covering the period 1950-2009. To estimate the future smoking-attributable mortality fraction (SAF) we: (i) project lung cancer mortality by extrapolating age-period-cohort trends, using the observed convergence of smoking prevalence and similarities in past lung cancer mortality between men and women as input; and (ii) add other causes of death attributable to smoking by applying a simplified version of the indirect Peto-Lopez method to the projected lung cancer mortality.
  
  
  RESULTS
  The SAF for men in 2009 was 19% (44 872 deaths) in England & Wales, 22% (5861 deaths) in Denmark and 25% (16 385 deaths) in the Netherlands. In our projections, these fractions decline to 6, 12 and 14%, respectively, in 2050. The SAF for women peaked at 14% (38 883 deaths) in 2008 in England & Wales, and is expected to peak in 2028 in Denmark (22%) and in 2033 in the Netherlands (23%). By 2050, a decline to 9, 17 and 19%, respectively, is foreseen. Different indirect estimation methods of the SAF in 2050 yield a range of 1-8% (England & Wales), 8-13% (Denmark) and 11-16% (the Netherlands) for men, and 7-16, 12-26 and 13-31% for women.
  
  
  CONCLUSIONS
  From northern European data we project that smoking-attributable mortality will remain important for the future, especially for women. Whereas substantial differences between countries remain, the age-specific evolution of smoking-attributable mortality remains similar across countries and between sexes.
authors.affiliation: Department of Demography, Statistics Netherlands, The Hague, the Netherlands; Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, the Netherlands.
authors.forename: Lenny
authors.initials: L
authors.lastname: Stoeldraijer
authors.forename: Luc
authors.initials: L
authors.lastname: Bonneux
authors.forename: Coen
authors.initials: C
authors.lastname: van Duin
authors.forename: Leo
authors.initials: L
authors.lastname: van Wissen
authors.forename: Fanny
authors.initials: F
authors.lastname: Janssen
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D004739:England / Q000453:epidemiology; D005260:Female; D005544:Forecasting; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D017678:Sex Distribution; D012907:Smoking / Q000401:mortality*; D014852:Wales / Q000453:epidemiology
keywords: Age-period-cohort; Europe; Peto-Lopez method; lung cancer mortality; projection; smoking-attributable mortality; smoking-epidemic