Published in The Lancet medical journal, new analyses of nearly half a million death certificates between 1999 – 2007 shows that more than twice as many coloured South Africans as white South Africans die from tobacco-related causes. Coloured South Africans who smoked were at particularly high risk of developing illnesses such tuberculosis, lung cancer as well as cancers affecting areas such as the throat, mouth and oesophagus.
While authors found that black South Africans smoked less than coloureds or whites, black South Africans accounted for more than half of all smoking-related deaths due to population size. The study did not disaggregate data for the Indian or Asian communities.
South Africa became the first and only country to record recent smoking history as part of death certification in 1998.
Conducted by the Medical Research Council, the National Health Laboratory Service and others, the study also revealed the benefits of quitting. Although a 1998 national demographic and health survey found that white South Africans smoked about twice as many cigarettes as coloured of black South Africans, white South Africans were more likely to have quit the age of 40. Eventually kicking the habit helped reduce the risk of tobacco-related illness in white South Africans, according to the study. Researchers warn that more needs to be done to encourage South Africans smokers to follow suit.
“There is already a high death rate from smoking in the mixed-ancestry coloured population of South Africa, and there will be major increases in tobacco-attributed mortality in many other African populations where young adults now smoke, unless there is widespread cessation,” said the Medical Research Council’s Debbie Bradshaw, who co-authored the study.
Lead author Freddy Sitas first proposed including smoking histories in death registries in South Africa in 1994.
“Our results show that … smoking caused many deaths from cancer and heart disease, but the main way it killed, particularly in the black population, was by increasing mortality from TB and other lung diseases,” he said. “All countries have heterogeneous populations, and need to know how disease-specific mortality from smoking varies with cultural background and socio-economic status.”
The study has prompted researchers to call for official death registries globally to follow South Africa’s lead.
“Death registries around the world should routinely ask whether the dead person was a smoker,” said fellow study author Richard Peto from the UK Oxford University. “This would help assess national death rates from smoking and would help countries discover whether deaths from smoking are increasing or decreasing.”
Peto warned that if current smoking patterns continue, hundreds of millions of people will die from smoking in the next century.