ESTIMATING SMOKING ATTRIBUTABLE MORTALITY

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ESTIMATING SMOKING ATTRIBUTABLE MORTALITY

• Smoking is the single largest avoidable cause of
  premature deaths and disability in Britain.
  Nicotine Addiction (RCP, 2000)
• Can estimate the proportion of total deaths from
  a specific cause which are attributable to
  smoking .

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DISEASES SMOKING CAN CAUSE What was included in
our estimate?
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AND . . . . What was excluded from our estimate?

• Deaths under the age of 35 including neonatal
  deaths and still births
• Deaths from external causes such as fires and
  accidents
• Deaths which may have been caused by passive
  smoking

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Smoking attributable proportions

• An estimate of the percentage of deaths caused by
  cigarette smoking in each disease category were
  published in The Smoking Epidemic HEA 1998.
• Vary from as high as 91 for male lung cancers
  deaths between the ages of 35 and 44 and as low
  as 3 for female deaths from cerebrovascular
  disease over the age of 75.

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Male smoking attributable mortality in
Bedfordshire Hertfordshire
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Female smoking attributable mortality in
Bedfordshire Hertfordshire
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WARD LEVEL ANALYSIS

• Standardised mortality ratios, compared to a
  Bedfordshire Hertfordshire as a whole, were
  calculated for men and women using ten year age
  bands.
• Due to the small population of the wards some of
  the confidence intervals associated with these
  estimates are relatively large.

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Male smoking attributable mortality in Stevenage
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Female smoking attributable mortality in Luton
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Male smoking attributable mortality in Watford
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Smoking cessation uptake data

• Approximately 12 months for Hertfordshire
• Approximately 18 months for Bedfordshire
• Data quality issues not all records had
  complete postcodes posing difficulties when
  attempting to map back into wards.
• Data difficult to obtain
• Total numbers very small due to short time period
  and incomplete data.

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Equity audit

• An attempt to assess whether the provision of
  smoking cessation services is equitable across
  Bedfordshire Hertfordshire.
• Measure of SERVICE (smoking cessation uptake)
  plotted against measure of NEED (age standardised
  smoking attributable mortality in the over 35s)
  by ward per LA.

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Some examples of equity audit Luton Females
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Equity audit for Welwyn Hatfield males
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Equity audit for St Albans males
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Future directions data requirements

• SMOKING CESSATION DATA we need more complete
  records over a longer time period to provide a
  more accurate picture of service provision across
  PCTs and wards
• SMOKING PREVALENCE data is not yet available at
  PCT or ward level. Could provide a much more
  timely measure of need.
• An area where an equity audit could be conducted
  in the future.