Last updated: November 2017
Suggested citation: Winstanley, MH & Greenhalgh, EM. 3.30 Total burden of death and disease attributable to tobacco by disease category. In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2017. Available from http://www.tobaccoinaustralia.org.au/chapter-3-health-effects/3-30-total-burden-of-death-and-disease-attributable-to-tobacco-by-disease-category
Several studies have estimated the numbers of deaths caused by tobacco use in Australia;1-3. Some of the key findings are presented in this section.
The Australian Burden of Disease study estimated that smoking caused a total of 18,762 deaths in 2011, or more than 1 in every 8 deaths (12.8%).2
Table 3.30.1 shows the years of healthy life lost (‘disability-adjusted life years’, or DALY) from death and illness due to tobacco use in Australia in 2011.
DALYs attributable to tobacco by specific cause, Australia, 2011
Source: AIHW Australian Burden of Disease Study, supplementary material for chapter 62
Lung cancer was the leading cause of death and illness due to smoking, followed by chronic obstructive pulmonary disease, coronary heart disease and stroke (Table 3.30.3).
Estimates of deaths caused by smoking in Australia have been calculated by Peto et al for 2010,3 using a methodology first described in 1992.4 Extrapolating from WHO mortality for lung cancer and other diseases, and using UN population data, Peto et al estimate that a total of 22,900 deaths were caused by active tobacco use in Australia in 2010 (Table 3.30.4).3 These estimates are likely to be conservative, because they do not include any deaths in individuals aged under 35 (including infants). About one quarter of all deaths due to smoking (or 6,100 of 22,900) occur in individuals aged between 35 and 69, who lose, on average, about 23 years of life.3
Deaths, by cause, attributed to smoking / total deaths by sex, Australia, 2010
Source: Peto et al3
Figure 3.30.1 shows that of all deaths due to tobacco, 39% are cancer deaths, 29% are due to vascular diseases, and a further 21% are caused by respiratory disease.
Deaths attributable to smoking in Australia by disease entity, as a proportion of all tobacco-caused deaths, 2010
Source: Peto et al, 20153
The most recent of a series of reports by the Department of Health and Ageing—first published in 19905-8—estimates that almost 15,000 people died due to tobacco use in the financial year 2004–05.1 The methodology used in these reports has calculated ‘attributable fractions’ for the proportion of deaths due to specific diseases caused by tobacco, based on extensive literature reviews and developed progressively since the first publication.
By this methodology, it was estimated that in 2004–05, tobacco use caused a total of 14,901 deaths.1 Of these deaths, 14,790 were attributable to active smoking (including 56 deaths in infants subjected to maternal smoking) and 113 occurred in adults due to exposure to secondhand smoke (Table 3.30.1).1 As discussed in Section 3.28, smoking also confers a protective effect against a small number of diseases. It was estimated that in 2004–05, smoking prevented death from these specific diseases in 148i smokers. However it should be noted that prevention of one disease in one individual does not protect against other diseases caused by smoking in the same individual; there is no sound medical basis for taking up or continuing smoking in order to prevent or ameliorate the process of any disease.
Estimated deaths caused or prevented by active smoking and secondhand smoke in Australia in 2004–05 according to condition (DoHA* calculations)
^Columns do not add up to totals due to rounding
*Department of Health and Ageing
Source: Unpublished data from research undertaken for Collins and Lapsley1
The same study also quantified deaths caused by other drug use in Australia. Table 3.30.2 shows that most drug-caused deaths in tobacco are caused by tobacco. Almost 90% of deaths due to drugs in 2004–05 were caused by smoking compared with 6% from alcohol and 5% from illicit drug use.1
Deaths due to drugs in Australia, 2004–05
*Deaths are net of protective effect conferred for some disease entities
^Alcohol was estimated to have caused 913 deaths in females, but to have prevented 1061 deaths.
Source: Collins and Lapsley1
1. Collins D and Lapsley H. The costs of tobacco, alcohol and illicit drug abuse to Australian society in 2004-05. P3 2625. Canberra: Australian Government Department of Health and Ageing, 2008. Available from: http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/mono64/$File/mono64.pdf
2. Australian Institute of Health and Welfare, Australian Burden of Disease Study: Impact and causes of illness and death in Australia 2011. Australian Burden of Disease Study series no. 3. BOD 4 Canberra: AIHW; 2016. Available from: https://www.aihw.gov.au/reports-statistics/health-conditions-disability-deaths/burden-of-disease/overview .
3. Peto R, Lopez AD, Pan H, Boreham J, and Thun M. Mortality from smoking in developed countries 1950 - 2020. 2015. Available from: http://gas.ctsu.ox.ac.uk/tobacco/contents.htm
4. Peto R, Lopez AD, Boreham J, Thun M, and Heath CJ. Mortality from tobacco in developed countries: indirect estimation from national vital statistics. The Lancet, 1992; 339(8804):1268–78. Available from: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T1B-49K5B71-35G&_user=559483&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000028178&_version=1&_urlVersion=0&_userid=559483&md5=fb759ffdab48100b2337fb626258540e
5. English D, Holman C, Milne E, Winter M, Hulse G, et al. The quantification of drug caused morbidity and mortality in Australia, 1992. Canberra: Commonwealth Department of Human Services and Health, 1995.
6. Ridolfo B and Stevenson C. Quantification of drug-caused mortality and morbidity in Australia, 1998. Drug statistics series no. 7, AIHW cat. no. PHE-29.Canberra, Australia: Australian Institute of Health and Welfare (2001. Available from: http://www.aihw.gov.au/publications/phe/qdcmma98/.
7. Begg S, Vos T, Barker B, Stevenson C, Stanley L, et al. The burden of disease and injury in Australia 2003. AIHW cat. no. PHE 82.Canberra: Australian Institute of Health and Welfare, 2007. Available from: http://www.aihw.gov.au/publications/index.cfm/title/10317 .
8. Holman CD, Armstrong B, Arias L, Martin CA, Hatton WM, et al., The quantification of drug caused morbidity and mortality in Australia 1988, Parts 1 and 2. Commonwealth Department of Health, Housing, Local Government and Community Services Canberra 1990.