Active and passive smoking causes disease

Diseases caused by cigarette smoking are listed in Diseases and adverse health effects caused by smoking. Two diseases that are largely caused by smoking and have the greatest impact on the health of EU citizens in terms of mortality and disability are lung cancer and COPD.

Objective biomarkers for involuntary exposure to tobacco, such as serum cotinine, have been identified and validated. Measurements taken over a number of decades, indicate a significant decline in serum cotinine concentration levels among non-smokers during the 1990s. This decline probably reflects the decrease in exposure on ETS due to anti-smoking interventions, such as restrictions of smoking in the workplace and other public places (Pirkle, 2006).

Smoking plays an important role in early death

Smoking attributable mortality mainly due to CVD and cancer

Cardiovascular disease (CVD) is the largest single cause of death in the EU, accounting for about 40% of male and female deaths. Smoking contributes significantly to mortality via cardiovascular diseases. It has a synergistic effect with other risk factors for cardiovascular disease, such as high cholesterol levels in blood and hypertension (Keil U, et al., 1998).

Cancers of the respiratory tract (lungs, bronchi, and larynx) are responsible for one in 20 deaths in the EU. These cancers are mainly due to smoking (Eurostat, 2002). See also Mortality from lung cancer in the EU-27.

Mortality due to COPD varies from country to country and is influenced by smoking and other factors. According to estimates from vital statistics, smoking is the cause of 62% of all deaths from COPD in the EU-25 (Peto et al., 2005). See also Mortality from lower respiratory disease).

The proportion of deaths attributable to smoking are presented in Percentage of deaths attributabe to smoking, for the main categories of diseases for the year 2000.

Read here about the trends in smoking attributable mortality .

No distinction in health risk between light and regular cigarettes

There is no evidence that so-called light cigarettes (low-nicotine / low-tar) bear reduced health risks in comparison to regular cigarettes. People that switch from regular cigarettes to light cigarettes are likely to inhale the same amount of hazardous chemicals, and thus remain at high risk for developing smoking-related diseases (NCI, 2001).

Tobacco is the leading cause for disease burden in the EU

The term Burden of disease denotes the gap between the current health status and an ideal situation in which everyone lives into old age free of disease and disability. It is usually measured in DALYs. Tobacco is a leading risk factor for disease burden in the developed world, accounting for 12% of the total DALYs (Lopez, 2005).

Ten selected risk factors and ten leading diseases and injuries in the developed world are ranked in Major burden of disease - 10 selected risk factors and 10 leading diseases. This document shows the magnitude of the population attributable fraction that links risk factors with diseases. Tobacco is strongly linked to both COPD and lung cancer, and is known to combine with other risk factors to cause ischaemic heart disease and cerebrovascular disease. The WHO has estimated that in 2000, non-communicable diseases (NCDs) accounted for about 75% of the European burden of disease expressed in DALYs. The most prominent NCDs, such as CVD, cancer and COPD have a common preventable lifestyle-related risk factor, namely tobacco use (WHO, 2002a).

The economic burden of smoking probably exceeds 1% of European GDP

The impact of tobacco morbidity and mortality on society can be expressed in:

• direct costs, associated with health care (hospitalisation, ambulatory care, prescription drugs, home health care and nursing home services) for smoking related diseases among smokers and second-hand smoke (SHS) victims; and
• indirect costs, associated with the loss of human capital due to tobacco attributable premature deaths, productivity losses, unpaid income taxes and contributions to social security from smokers, patient-SHS victims and carers who would otherwise be in paid employment (informal care).

The current existing estimates of the total smoking-attributable costs for the two leading (groups) of smoking related diseases in Europe: COPD and CVD, amount to between €105.83 billion and €130.31 billion for the year 2000, or about 1% of the region’s GDP. The indirect costs of smoking account for two-thirds of this amount. This is a very conservative estimate, considering the fact that only two major diseases have been included, and even for these two diseases not all the costs have been taken into account (e.g. the costs of informal care, the costs linked to the treatment of reproductive problems, the costs related to SHS and budgetary costs related to social services). A more comprehensive estimate of net social costs has been recorded for Australia and ranges between 2.1% and 3.4% of their GDP (ASPECT, 2004; Collins & Lapsley, 2002).