[Trends in the mortality attributable to tobacco use in Spain, 1978-1992: 600,000 deaths in 15 years]

The main objective is to describe time trends and evolution of mortality attributable to tobacco use in Spain in the period 1978-1992.

Spanish pevalences for never smokers, current smokers and former smokers estimated from national health surveys, and relative risks for death attributed to tobacco use from the Cancer Prevention Study II were used. The proportion and number of deaths attributed to tobacco use in the Spanish population of 35 years and over have been calculated by cause of death, sex and age. The trend in mortality attributable to tobacco use over the period 1978-1992 has also been calculated, expressed as the mean percentage change per year in the standardised mortality rates, estimated by a log-lineal model.

Tobacco consumption caused 46,226 deaths in Spain in 1992. Most of them occurred in males (93.4%). One of every 4 deaths in males, and one of every 50 in females were attributable to tobacco consumption. One third of the deaths attributed to tobacco use were premature deaths (under 65 years). Lung cancer, chronic obstructive pulmonary disease, ischemic heart disease and cerebrovascular disease caused 75% of deaths attributed to tobacco use. Lung cancer was the first specific cause in males, and chronic obstructive pulmonary disease was the main cause in females. A total of 621,678 deaths attributed to tobacco consumption were produced in the period (1978-1992). The main percentage change per year in the mortality rates shows a moderate increment of 0.1% (-0.2% in males +6.7% in females).

Mortality attributable to tobacco use in Spain represents a high cost in terms of avoidable deaths and shows the limited impact of the interventions directed to tobacco control in Spain. One of every 4 deaths in males and a disturbing and rapidly increasing proportion in females are attributable to smoking.