The future of smoking‐attributable mortality: the case of England & Wales, Denmark and the Netherlands. (26th November 2014) - Stoeldraijer, Lenny
Abstract Aims 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. Findings 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.