Tobacco addiction and tobacco mortality. Implications for death certification

Addictive disorders now cause more than one fourth of all deaths in the United States--more than a half million deaths in 1982. But this essential fact is obscured in the nation's vital records and statistics by the general practice of certifying addictive disease deaths to their innumerable anatomic manifestations. However, this situation need not continue indefinitely. Physicians have both an opportunity and a responsibility to state their knowledge of the underlying causes of deaths occurring under their care, and the diagnostic category "Tobacco Use Disorder/Tobacco Dependence," listed in the ninth revision of the International Classification of Diseases is available for their use. By routinely ascertaining the lifetime smoking experience of each patient and stating on each death certificate the role of tobacco, physicians can contribute substantially to improvement of vital statistics, epidemiology, and public health.