TRENDS IN THE MORTALITY ATTRIBUTABLE TO T OBACCO USE IN SPAIN, 1978-1992 - 600,000 DEATHS IN 15 YEARS

BACKGROUND: The main objective is to describe time trends and evolutio n of mortality attributable to tobacco use in Spain in the period 1978 -1992. MATERIAL AND METHODS: Spanish pevalences for never smokers, cur rent smokers and former smokers estimated from national health surveys , and relative risks for death attributed to tobacco use from the Canc er Prevention Study II were used. The proportion and number of deaths attributed to tobacco use in the Spanish population of 35 years and ov er have been calculated by cause of death, sex and age. The trend in m ortality attributable to tobacco use over the period 1978-1992 has als o been calculated, expressed as the mean percentage change per year in the standardised mortality rates, estimated by a log-lineal model. RE SULTS: Tobacco consumption caused 46,226 deaths in Spain in 1992. Most of them occurred in males (93.4%). One of every 4 deaths in males, an d one of every 50 in females were attributable to tobacco consumption. One third of the deaths attributed to tobacco use were premature deat hs (under 65 years). Lung cancer, chronic obstructive pulmonary diseas e, ischemic heart disease and cerebrovascular disease caused 75% of de aths attributed to tobacco use. Lung cancer was the first specific cau se in males, and chronic obstructive pulmonary disease was the main ca use in females. A total of 621,678 deaths attributed to tobacco consum ption were produced in the period (1978-1992). The main percentage cha nge per year in the mortality rates shows a moderate increment of 0.1% (-0.2% in males +6.7% in females). CONCLUSIONS: Mortality attributabl e to tobacco use in Spain represents a high cost in terms of avoidable deaths and shows the limited impact of the interventions directed to tobacco control in Spain. One of every 4 deaths in males and a disturb ing and rapidly increasing proportion in females are attributable to s moking.