Smoking-Attributable mortality in Spain in 2016

Smoking-attributable mortality (SAM) is a valuable indicator that can be used to characterize the course and health burden of the smoking epidemic. The aim of this paper was to estimate SAM in Spain in 2016 in the population aged 35 and over, using the best available evidence. A smoking prevalence-dependent analysis based on the estimation of population-attributable fractions was performed. Smoking prevalence (never, former, and current smokers) was calculated from a combination of the Spanish Health Survey (2016) and the European Health Survey (2014); the relative risk of death among current and former smokers was taken from the follow-up of various cohorts; and mortality rates were obtained from National Center for Statistics data. SAM estimates are presented globally, and by sex, age groups, and major disease categories: cancer, cardiometabolic diseases and respiratory diseases. In 2016, 56,124 deaths were attributed to tobacco consumption, 84% in men (47,000), and 50% in the population aged over 74 (27,795). Overall, 50% of SAM was due to cancer (28,281), 65% of which was lung cancer. One in 4 attributable deaths (13,849) occurred before the age of 65. One in 7 deaths in Spain in 2016 were attributable to smoking. This estimation of SAM clearly highlights the great impact of smoking on mortality in Spain, mainly due to lung cancer and chronic obstructive pulmonary disease. La mortalidad atribuible (MA) al consumo de tabaco es un indicador valioso que permite caracterizar la evolución y el impacto en la salud poblacional de la epidemia tabáquica. El objetivo de este trabajo es estimar la MA al consumo de tabaco en España en 2016 en población ≥ 35 años utilizando la mejor evidencia disponible. Se aplicó un método dependiente de las prevalencias de consumo de tabaco basado en el cálculo de fracciones atribuidas poblacionales. Las prevalencias de consumo (fumadores-exfumadores-nunca fumadores) proceden de la estimación combinada de la Encuesta Nacional de Salud-2016 y la Europea-2014; el exceso de riesgo de morir en fumadores y exfumadores del seguimiento de diferentes cohortes; y la mortalidad observada del Instituto Nacional de Estadística. Se presenta la estimación global de MA y en función del sexo, grupos de edad y grandes grupos de enfermedades (cáncer, cardiometabólicas y respiratorias), acompañadas de las fracciones atribuidas poblacionales. En 2016 se atribuyeron 56.124 muertes al consumo de tabaco, el 84% sucedieron en hombres (47.000) y el 50% e