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Smoking Deaths in England: If Information Changes

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Today we released new estimates based on an updated methodology Smoking deaths and hospital admissions. The numbers are about 15% lower than previously published, but what does that tell us about smoking in England?

Why do estimates of deaths and illnesses from smoking seem to have fallen so sharply?

Cigarettes are still mankind’s most dangerous consumer product. It has been estimated that half of lifelong smokers would die from it, but a 2015 study suggests the number could be as high as two-thirds. Why have smoking-related deaths and hospital admissions estimates decreased?

Our estimates are based on a complex method of looking at the proportion of deaths or hospital admissions likely to be caused by smoking.

Smokers are much more likely than non-smokers to develop a variety of diseases, including respiratory diseases, cardiovascular disease, and a variety of cancers. For these diseases, the risk of their occurrence in smokers compared to non-smokers can be calculated. This is known as the relative risk and is specific to each disease, age group, and gender. To determine the percentage of deaths and admissions specifically attributable to smoking, we combine these relative risks with the most recent smoking prevalence for each municipality.

The number of deaths and illnesses from smoking has not suddenly decreased, but the information we use to estimate has been updated. The relative risks to date have been based on data from 1982 to 1988. Since then, various studies have been carried out to investigate the extent to which smoking is a risk factor for a number of diseases. Using the latest scientific knowledge and in particular the report Hiding in Plain Sight (HiPS) from the Royal College of Physicians, our estimates of smoke-related deaths and hospital admissions are lower than in the past.

So that you can compare the same with the same, we have also calculated the figures from previous years on this basis.

The burden of death and illness from smoking has hardly changed in recent years. Figure 1 shows the current trend in smoking-related mortality calculated using both the old and new methods. The direction of travel is largely the same.

Graph depicting smoking-related mortality, New Method vs. Old Method, England
Figure 1: Smoking-attributable mortality, new method vs. old method, England

Since when has this work been going on and why publish now?

This work has been in the pipeline for over three years. The RCP’s HiPS report, released in 2018, was a monumentally thorough recalculation of smoking-related risk in the UK, which made us wonder if it was time to update our calculations of smoking-related deaths and hospital admissions. We have each other with our. advise first suggestions in September 2020 and after a 5-month consultation, we have our answer.

Does that mean the estimates were artificially high in the past?

With the updated methodology, we have improved the accuracy of the estimate of deaths and admissions attributable to smoking. Previously, we used the then widely accepted evidence, and as soon as the new data from the RCP report became available, we began to examine how this would affect our estimates of deaths and hospital admissions.

The RCP included 17 cancers, 8 respiratory diseases, 7 mental illnesses, and more in their report. The current estimates are the most accurate we have made.

There is almost half a million smoke-related hospital admissions every year in England. Most importantly, we can reliably compare year to year so that we can measure our progress. For this reason, it is better to change the methods from time to time, but not every year.

So how much of a difference does that make in numbers?

The number of smokers is not affected, nor is the likelihood that a smoker will die as a result of smoking. About 1 in 7 adults smokes and about 2 in 3 lifelong smokers die from smoking-related deaths.

What has changed is the estimated number of deaths and hospitalizations from various smoking-related illnesses that we attribute to smoking. With our new method, our estimate for the last year is about 15% lower than before.

Figure 2 shows the difference in the number of deaths attributed to smoking by disease group according to the old and new method for the years 2016-18.

Table showing the difference in the number of deaths attributed to smoking by disease group using the old and new method for the years 2016-18.
Figure 2: Smoking-related mortality compared between 2016 and 2018 by disease group, England

Doesn’t that mean smoking is less harmful than we thought and what about alcohol and obesity?

On an individual level, the lethality of smoking hasn’t changed – if you smoked 20 a day last year and do so this year, you will suffer the same harm. What has changed is our estimate of the total number of smoking deaths and hospital admissions in England. Not so long ago in England, smoking alone caused more deaths than alcohol, obesity, drug use and AIDS combined. Last year, around as many people died from smoking in England as from COVID-19. As the number of smokers falls, so will the overall burden of death and illness in England.

Thank You For Reading!


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