Smoking-related deaths ‘higher among coloureds’
CAPE TOWN — Middle-aged coloured people are twice as likely to die from smoking as whites, partly because so few of them succeed in kicking the habit, concludes a South African study published today in the Lancet.
The study is the biggest of its kind to date in Africa, and indicates that the government needs to invest more in public health programmes that help poorer people stop smoking, said coauthor Debbie Bradshaw, director of the Medical Research Council’s burden of disease unit.
The government had, so far, put its energy into “populationwide” control measures, such as raising taxes and restricting smoking in public spaces, she said. “We’d like to see providers of primary healthcare (such as nurses) assist smokers to quit,” said Dr Bradshaw. “We’d also like to see nicotine-replacement therapy (such as patches) provided in the public sector.”
The research adds ammunition to Health Minister Aaron Motsoaledi’s anti-tobacco drive.
The government is proposing further restrictions on tobacco, which will effectively ban smoking in public areas and within five metres of their entrances. The proposed laws will also tighten up on the promotion of cigarettes and other tobacco products.
The researchers scrutinised the death records of 481,640 South Africans aged between 35 and 74. They found smoking was responsible for 27% of the deaths among coloured men and one in six (17%) of deaths among coloured women in this age group. Smoking-related diseases killed 14% of white men and 12% of white women, and were responsible for 8% of the deaths among black men, and 2% of the deaths among black women.
Further analysis showed that among middle-aged people (35-64 years), the risk of death among coloured male smokers was 14% higher than among nonsmokers— double the rate found among white males (7.6%).
The risk of death among coloured-women smokers was 11% higher than among nonsmokers, compared with 7.7% among white women. The proportion of coloured males who were smokers (68%) was markedly higher than their white counterparts (47%). A similar pattern was seen among women: almost half of all coloured women (46%) had smoked, compared with just 28% of white women.
“Our results show that between 1999 and 2007, smoking caused many deaths from cancer and heart disease, but the main cause of (smoking-related) deaths, particularly among Africans, were from tuberculosis and other lung diseases,” said co-author Freddy Sitas from the Cancer Council of New South Wales in Australia.
“It is important to understand the patterns of smoking and disease in every different country and how they vary with cultural background and socio-economic status,” he said.
In 1994, Prof Sitas proposed including a question on death notification forms that asked whether a person was a smoker in the previous five years. The researchers said SA was the only country that required this information for death notification forms. SA introduced this question in 1998, as the government stepped up its tobacco-control initiatives under then health minister Nkosazana DlaminiZuma, Dr Bradshaw said.
“Incorporation of this one easy question about smoking five years ago in the death notification process would, at little expense, greatly facilitate monitoring of tobacco-attributed mortality.
“Other countries should now consider following SA’s example in doing so,” said Lionel Opie, a professor in the department of medicine the at University of Cape Town, in a linked commentary published in the Lancet.