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Deaths from Smoking in Sweden and other European Union Countries

The Burden of Mortality from Smoking: Comparing Sweden with Other Countries in the European Union. Published in the European Journal of Epidemiology, Volume 19, pages 129-131, February, 2004. By Brad Rodu and Philip Cole. (UAB TRF)

Birmingham, AL -- Smoking-related deaths in the European Union would plummet 200,000 each year if men in all EU countries smoked at the same rate as those in Sweden, according to research published in the European Journal of Epidemiology.

“Overall tobacco use among Swedish men is the same as that for men in all EU countries – 40 percent,” said Brad Rodu, Professor of Pathology at the University of Alabama at Birmingham, who co-authored the study with UAB epidemiologist Philip Cole. “However, Swedish men smoke at less than half the rate of their EU counterparts, resulting in dramatically lower rates of fatal disease.” The difference is in their use of Swedish smokeless tobacco (called snus, pronounced ‘”snoos”), for which “there is no demonstrable incremental burden of mortality,” according to the study.

The likely beneficial effect of snus on smoking rates in Sweden raises policy questions because its sale is prohibited in all other EU countries. In 2003, several prominent EU tobacco researchers and policy experts wrote in the journal Tobacco Control, “It is wrong to deny other Europeans this option [snus] for risk reduction… the current ban violates rights of smokers to control their own risks.” In 2002, Britain’s Royal College of Physicians reported that “the consumption of non-combustible [smokeless] tobacco is on the order of 10-1,000 times less hazardous than smoking.”

There are 50 million male smokers age 25 and over in the EU. Each year, almost 500,000 die from smoking-related diseases, although death rates vary considerably among member countries. Drs. Rodu and Cole estimate that the Swedish model would result in a reduction in smoking-related deaths in every EU country, ranging from 30 percent in France to 60 percent in Greece. Over 100,000 deaths would be avoided in just three countries -- Germany, France and the UK.

Our previous studies showed that the high rate of smokeless tobacco use among Swedish men is strongly associated with low smoking rates, owing to reduced smoking initiation and increased smoking cessation (See "How Smokeless Tobacco Snuffed Out Smoking" and "How Swede It Is" in the Research section of this website). Snus produces very low risk for cardiovascular diseases and no risk for pulmonary diseases or oral or other cancers. Although few Swedish women currently use snus, new user-friendly smokeless tobacco products are overcoming traditional gender barriers.

Drs. Rodu and Cole used a systematic approach to estimate both EU smoking prevalence and its impact on mortality. First, they used EU census data and Eurobarometer surveys to determine the number of smokers in each country. Then they constructed a set of age-, gender- and smoking-specific mortality rates to estimate the current number of smoking-attributable deaths. Those numbers were compared to estimates of the number of deaths expected if each EU country had the smoking prevalence of Sweden.

The following table presents some of the research findings from this study. The first column lists all 15 countries in the European Union. The next column gives the number of male smokers in each country (in millions) followed by the smoking prevalence rate (ie 47% of men smoke in Austria). The third column estimates the number of men who die annually from smoking-related diseases. The last two columns on the right reflect revised estimates if men in each country smoked at Swedish smoking rates. Notice how the number of smokers would decline (In Austria the number of smokers would fall from 1.28 million to 540,000). But even more important are how many lives would be saved each year. For example, in Austria the number is 5,058, or 46% fewer than the 10,897 smokers who currently die in that country.

 

Smoking Rates and Deaths Among Men Age 25+ in the EU


Country

Current Smokers
In Millions (%)


Deaths

Smokers At
Swedish Rate

Lives
Saved (%)

Austria

1.28 (47)

10,897

0.54

5,058 (46)

Belgium

1.57 (45)

16,227

0.68

8,213 (51)

Denmark

0.63 (35)

8,236

0.36

4,195 (51)

Finland

0.69 (41)

5,293

0.34

1,570 (30)

France

7.72 (40)

63,153

3.80

19,240 (30)

Germany

11.47 (40)

112,274

5.66

48,912 (44)

Greece

2.19 (61)

22,131

0.71

13,281 (60)

Ireland

0.44 (40)

4,462

0.22

2,169 (49)

Italy

7.07 (35)

76,234

3.99

28,437 (37)

Luxembourg

0.06 (38)

475

0.03

171 (36)

Netherlands

1.99 (37)

17,345

1.07

6,199 (36)

Portugal

1.48 (47)

11,082

0.62

3,878 (35)

Spain

6.30 (47)

53,681

2.65

22,509 (42)

Sweden

0.59 (19)

7,396

0.59

No change (0)

UK

6.97 (36)

76,771

3.88

32,032 (42)

All Countries

50.45 (40)

485,657

25.14

195,864 (40)

Note: This study was supported by the Tobacco Research Fund (UAB).