Estimate of deaths attributable to passive smoking among UK adults: database analysis

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC556069/

Estimate of deaths attributable to passive smoking among UK adults: database analysis

Konrad Jamrozik, professor of evidence based healthcare1

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Abstract

Objective To estimate deaths from passive smoking in employees of the hospitality industry as well as in the general workforce and general population of the United Kingdom.

Design Calculation, using the formula for population attributable proportion, of deaths likely to have been caused by passive smoking at home and at work in the UK according to occupation. Sensitivity analyses to examine impact of varying assumptions regarding prevalence and risks of exposure.

Setting National UK databases of causes of death, employment, structure of households, and prevalences of active and passive smoking.

Main outcome measures Estimates of deaths due to passive smoking according to age group (< 65 or ≥ 65) and site of exposure (domestic or workplace).

Results Across the United Kingdom as a whole, passive smoking at work is likely to be responsible for the deaths of more than two employed people per working day (617 deaths per year), including 54 deaths in the hospitality industry each year. Each year passive smoking at home might account for another 2700 deaths in persons aged 20-64 years and 8000 deaths among people aged ≥ 65.

Conclusion Exposure at work might contribute up to one fifth of all deaths from passive smoking in the general population aged 20-64 years, and up to half of such deaths among employees of the hospitality industry. Adoption of smoke free policies in all workplaces and reductions in the general prevalence of active smoking would lead to substantial reductions in these avoidable deaths.

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Introduction

Evidence that exposure to passive smoking increases the risk of adults developing fatal diseases first emerged in 1981.1,2 Many epidemiological studies have been carried out, and reviews in three continents have now concluded that passive smoking is a cause of serious disease in adults and children.3-5 Smoke free policies have been introduced in various settings, but some workplaces still permit smoking and making hospitality venues (pubs, bars, nightclubs, hotels, and restaurants) smoke free is contentious. As the generation of tobacco smoke is not intrinsic to the process of selling food and drink, such venues could be made smoke free to protect the health of employees. Nevertheless, some organisations and individuals in the hospitality industry vigorously oppose this, claiming that such policies are an infringement of the personal liberty of their customers and will lead to damage to themselves.

It is important to distinguish between the economic impact people believe smoke free policies are likely to have before the policies themselves are introduced, the impact they are perceived to have had after their introduction, and careful studies of accepted economic indicators. The best economic indicators take into account the general economic conditions prevailing before and after smoke free policies are introduced because discretionary expenditure, such as that on drinking and dining, is particularly sensitive to these. Objective evidence has shown that smoke free policies have no adverse economic impact on the hospitality industry.6,7

By contrast, there have not been any calculations of the harm done to health from smoking in hospitality venues and certain other workplaces. I estimated the number of deaths due to passive smoking in employees of the hospitality industry and in the general workforce and general population of the United Kingdom.

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 In 2003, an estimated 617 people died from the effects of passive smoking at work across the whole of the United Kingdom, 54 of whom were long term employees of the hospitality industry. Of the 54 people who died, almost half were employed in the pub/bar/nightclub sector, despite the smaller size of its workforce, because staff are exposed to higher concentrations of tobacco smoke. In the whole population aged 20-64, more than 2700 deaths attributable to passive smoking at home brought the total fatalities related to passive smoking to 3343. In those aged ≥ 65, the total number of attributable deaths approaches 8000, with fatal strokes and heart disease each contributing more than three thousand events.