Issues in estimating smoking attributable mortality in Israel.

Area of Science:

• Public Health
• Epidemiology
• Biostatistics

Background:

• The US Centers for Disease Control's SAMMEC tool for estimating smoking-attributable mortality (SAM) has limitations.
• These limitations include inflexibility in disease selection, outdated relative risk (RR) estimates, and lack of consideration for latency periods.

Purpose of the Study:

• To estimate smoking-attributable mortality (SAM) in Israel.
• To improve upon existing SAM estimation methods by incorporating lag times and updated disease categories.

Main Methods:

• Adapted the SAMMEC approach for estimating SAM in Israel.
• Incorporated past and present smoking prevalence data, accounting for lag-times between exposure and mortality.
• Utilized new and expanded disease categories for a more comprehensive analysis.

Main Results:

• The final SAM estimate for 2003 was 8664 deaths, a substantial increase from the un-lagged estimate of 3859 deaths.
• Introduction of lag times accounted for approximately 50.3% of this increase.
• More robust risk estimates and inclusion of additional disease categories contributed significantly to the higher SAM figures.

Conclusions:

• Updated methods, including lag times, expanded disease lists, and current RR estimates, provide more accurate SAM figures.
• The substantial burden of smoking in Israel necessitates a multi-faceted intervention strategy.
• Establishing an authoritative body is recommended to implement effective tobacco control measures.