The European Journal of Public Health Advance Access first published online on August 19, 2009
This version published online on September 10, 2009
The European Journal of Public Health, doi:10.1093/eurpub/ckp111
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Issues in estimating smoking attributable mortality in Israel
Gary M. Ginsberg1, Elliot Rosenberg2 and Laura Rosen3
1 Department of Technology Assessment, Israel Ministry of Health, Jerusalem, Israel
2 Office of the Associate Director General, Israel Ministry of Health, Healthy Israel 2020, Jerusalem, Israel
3 Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Correspondence: Dr Gary Michael Ginsberg, Department of Technology Assessment, Israel Ministry of Health, Ben Tbai 2, San Simone, Jerusalem, Israel, tel: +972 2 5657736, fax: +972 2 5657740, e-mail: gary.ginsberg{at}moh.health.gov.il; ginsbergg{at}hotmail.com
Received August 23, 2008 , accepted July 15, 2009
Background: The US Centres for Disease Control provides a widely used online user-friendly computational program, called SAMMEC (Smoking Attributable Mortality, Morbidity and Economic Costs) to produce estimates of tobacco-related mortality. However, the SAMMEC tool loses accuracy because it lacks flexibility in deciding which diseases enter into the calculations, has estimates of relative risk (RR) attributable to smoking based on old studies, and does not allow for the latency period that occurs between initial exposure and mortality. Methods: Smoking attributable mortality (SAM) due to active smoking in Israel was estimated with the approach used by SAMMEC taking into account past and present smoking prevalence (lag-times) as well as using new and expanded disease categories. Results: Around 50.3% of the increase from the un-lagged SAM estimate of 3859 deaths to the final SAM estimate of 8664 deaths in 2003 is attributable to the introduction of lag times. More robust estimates of risk accounted for a further 29.6% of the increase. While 21.2% is attributable to the inclusion of additional disease categories, only 1.5% was attributable to the widening of existing diseases categories. Conclusion: This difference in estimates is attributable to expansion of the list of diseases included, updating the estimates of RR for smoking-attributable death, and the use of smoking prevalence from previous years to more accurately reflect the effect of tobacco use on disease occurrence. There is a need to establish an ‘authority’ to implement a multi-faceted intervention strategy to decrease the considerable burden from smoking in Israel.
Keywords: mortality, relative risk, smoking, smoking attributable mortality.
An earlier version of this paper contained errors in the Abstract and Acknowledgments. The authors apologize for this error.