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Mortality attributable to passive smoking in Spain, 2002

¹ Evaluation and Intervention Methods Unit, Public Health Agency of Barcelona, Spain
² PhD Program in Public Health and Methodology of Biomedical Research, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
³ Epidemiology Unit, Galician Public Health Directorate, Department of Health, Xunta de Galicia, Spain
⁴ Area of Preventive Medicine and Public Health, University of Santiago de Compostela, Spain
⁵ Cancer Prevention and Control Unit, Catalan Institute of Oncology, L’Hospitalet (Barcelona), Spain
⁶ Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
⁷ Community Health Unit, Municipal Institute of Public Health, Terrassa, Spain

Correspondence to:
M J López, Evaluation and Intervention Methods Unit, Public Health Agency of Barcelona, Spain; mjlopez{at}aspb.es

Objective: Exposure to environmental tobacco smoke (ETS) is associated with a variety of health effects, including lung cancer and ischaemic heart disease. The objective of this study was to estimate the number of deaths caused by exposure to ETS among non-smokers in Spain during the year 2002

Methods: Prevalence of ETS exposure among never smokers was gathered from three region based health interview surveys. The relative risks of lung cancer and ichaemic heart diseases were selected from three meta-analyses. Population attributable risk (PAR) was computed using a range of prevalences (minimum-maximum). The number of deaths attributable to ETS was calculated by applying PARs to mortality not attributable to active smoking in 2002. The analyses were stratified by sex, age and source of exposure (home, workplace and both combined). In addition, a sensitivity analysis was performed for different scenarios.

Results: Among men, deaths attributable to ETS ranged from 408 to 1703. From 247 to 1434 of these deaths would be caused by the exposure only at home, 136–196 by exposure only in the workplace and 25–73 by exposure at both home and the workplace. Among women, the number of attributable deaths ranged from 820 to 1534. Between 807 and 1477 of these deaths would be caused by exposure only at home, 9–32 by exposure only in the workplace and 4–25 by exposure both at home and in the workplace.

Conclusion: Exposure to ETS at home and at work in Spain could be responsible for 1228–3237 of deaths from lung cancer and ischaemic heart disease. These data confirm that passive smoking is an important public health problem in Spain that needs urgent attention.

Abbreviations: AM, attributable mortality; ETS, environmental tobacco smoke; OM, observed mortality; PAF, population attributable fraction; PAR, population attributable risk; RR, relative risks

Keywords: environmental tobacco smoke; cancer; Spain