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Call for smoking status to be added to the Australian death certificate

23rd August 2013

Leading Australian researchers are calling for a question on smoking to be to be cited on the death registration forms in Australia and across the world.

A new report published today in the Lancet highlights how a simple yes/no question on smoking on the South African death registration form has led to new understandings around deaths caused by smoking that could be replicated globally.

Lead author and cancer epidemiologist Associate Professor Freddy Sitas, Cancer Council NSW plans to present these key findings to the World Health Organization. “This model should become international best practice for any country that has reasonable death certification.”

Eminent international cancer epidemiologist from University of Oxford, Professor Sir Richard Peto, another lead author on the study adds:  A simple question on smoking in the past decade on the death registration form can yield remarkable results and ought to be part of international practice even in countries with sophisticated health systems.  This is a cheap and easy intervention that ought to be implemented worldwide.” 

South Africa is the first, and so far the only country, to record smoking status on the death certificate. A/Prof Sitas adds: “Working with colleagues in South Africa and the UK we analysed half a million deaths from South Africa, making this one of the largest studies on death from tobacco in the world.

“What surprised us were the striking differences in the profile of deaths from smoking in each population group – in the black population we found that the main way it killed was by increasing the mortality rate from tuberculosis, cancer and other lung diseases.  In the white population we saw an increase in risk from cancer and heart disease, but surprisingly an increase in respiratory diseases. The mixed race population smoked more than any other group and had about double the death rate from smoking than that of white South Africans. This is of real relevance to countries with large multi-cultural populations, like Australia.”   

Dr Debbie Bradshaw a lead author on the study from South Africa adds, “This study shows clearly that there will be major increases in tobacco related deaths in many African populations where young adults now smoke unless there is widespread cessation.”

Although smoking levels in Australia are declining, with around 16 per cent of all Australians smoking, tobacco is still one of the leading causes of preventable deaths, including cancer. Currently, in Australia, one in five cancer deaths can be attributed to smoking.

A/Prof Sitas adds, “Current estimates of deaths from smoking in Australia range from 15,000 to 19,000 per annum. Australia extrapolates estimates from other western countries but in a multicultural country like Australia we ought to be getting more accurate data, and importantly trends over a long period of time.”

“If we replicate this work in Australia the results could be more startling than ever expected. There could be a huge variation in smoking related deaths among our Indigenous, migrant, rural populations, or those who are marginalised. This will help us focus our prevention programs better than ever before. We could also find out greater detail about the range of diseases directly linked to smoking. There are about 60,000 doctors in Australia, for about 150,000 deaths per annum.  We are really not talking about a lot of extra work.”

The study was funded by the South African Medical Research Council, the UK Medical Research Council, Cancer Council NSW, Cancer Research UK and the British Heart Foundation.

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Professor Ian Olver, CEO of Cancer Council Australia: “Cancer Council Australia is keen to see more accurate statistics than we currently have on the numbers of deaths caused by smoking, especially now that a simple question on smoking on the death notification form seems to work well.  We will be organising a round table discussion on this in the upcoming year to see if we can bring about some changes here.”

University of Melbourne Laureate Professor Alan Lopez, internationally renowned authority on smoking and its global burden: “We have worked really hard to extrapolate estimates of deaths caused by smoking from one country to another.  This remarkable study paves the way forward for any country to get accurate local data on the real damage caused by smoking.  Local data is far more convincing to policy makers.”

Anne Jones OAM, Chief Executive Officer of Action on Smoking and Health Australia and an international consultant on tobacco control for the International Union Against Tuberculosis and Lung Disease (The Union) in Asia Pacific region adds: “Tobacco deaths are rapidly increasing in the Asia Pacific region and records of deaths and diseases have many gaps.  These findings have enormous potential as tobacco is a major killer of people worldwide.  A simple change to death certificates can improve monitoring records and understanding of the devastating and profound impact that tobacco has on each and every country.”