Comparison of physician based reporting of tobacco attributable deaths andcomputer derived estimates of smoking attributable deaths, Oregon, 1989 to1996

Background-Tobacco use prevention programmes need accurate information abou t smoking related mortality. Beginning in 1989, Oregon began asking physici ans to report on death certificates whether tobacco use contributed to the death. Objective-To determine the long term comparability of this method of estima ting tobacco attributable mortality to estimates of smoking attributable mo rtality derived from a computer model. Design-For the period 1989 to 1996, we compared mortality resulting from to bacco use reported by Oregon physicians to estimates of smoking attributabl e deaths (SADs) derived by "Smoking attributable mortality, morbidity and e conomic costs)) software version 3.0 (SAMMEC 3.0), a widely used software p rogram that estimates SADs on the basis of smoking prevalence and relative risks of specific diseases among current and former smokers. Main outcome measures-Numbers of deaths, age, sex, and category of disease. Results-Of 212 448 Oregon deaths during 1989-1996, SAMMEC 3.0 estimated tha t 42 778 (20.1%) were attributable to cigarette smoking. For the same 27 di agnoses, physicians reported that tobacco contributed to 42 839 (20.2%) dea ths-a cumulative difference of only 61 deaths over the eight year period. T he age and sex distributions of tobacco and smoking attributable deaths rep orted by the two systems were also similar. By category of disease, the rat io of SAMMEC 3.0 estimates to physician reported deaths was 1.11 for neopla sms, 0.88 for heart disease, and 1.04 for respiratory disease. Conclusions-Physician reporting provides comparable estimates of smoking at tributable mortality and can be a valuable source of data for communicating the risks of tobacco use to the public.