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Does smoking kill? A study of death certification and smoking
Ian Proctor1, Vijay Sharma, Mohammad Khoshzaban
1Department of Pathology, University College London, London, UK. ian.proctor@nhs.net
Journal of Clinical Pathology
|October 26, 2011
Summary
Smoking is rarely listed as a cause of death on death certificates, even for smoking-related diseases. This underreporting omits crucial epidemiological data, unlike alcohol
Area of Science:
- Public Health
- Epidemiology
- Medical Records Analysis
Background:
- Death certificates are vital for public health surveillance.
- Accurate cause of death (COD) data is essential for epidemiological research and policy.
- Previous studies suggest potential underreporting of lifestyle factors on death certificates.
Purpose of the Study:
- To quantify the frequency of smoking as a cited cause of death (COD) on death certificates.
- To compare the reporting of smoking versus alcohol as causes of death.
- To evaluate the completeness of epidemiological data on death certificates.
Main Methods:
- Retrospective analysis of 2128 death certificates and 236 postmortem reports.
- Data collected from a large teaching hospital between 2003 and 2009.
- Examination of underlying COD and contributing factors listed on certificates.
Main Results:
- Smoking was the underlying COD in only 0.1% of certificates and mentioned in Part II in 0.5%.
- Postmortem reports did not cite smoking as a cause of death.
- Alcohol use was cited in Part I of 57.4% of relevant death certificates, contrasting sharply with smoking's low reporting rate.
Conclusions:
- Smoking is significantly underreported as a cause of death on death certificates, even in cases with strong causal links.
- Physician reluctance to stigmatize deceased individuals may contribute to underreporting, a bias not observed for alcohol.
- Failure to accurately record smoking as a COD hinders the collection of critical epidemiological and pathological data.
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