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. 2021 Feb 11;21(1):169.
doi: 10.1186/s12889-021-10167-3.

Changes over 15 years in the contribution of adiposity and smoking to deaths in England and Scotland

Frederick K Ho #  1 , Carlos Celis-Morales #  1   2   3   4 , Fanny Petermann-Rocha  1   2 , Solange Liliana Parra-Soto  1   2 , James Lewsey  1 , Daniel Mackay  1 , Jill P Pell  5
Affiliations

Changes over 15 years in the contribution of adiposity and smoking to deaths in England and Scotland

Frederick K Ho et al. BMC Public Health. .

Abstract

Background: For many years smoking has been the major threat to public health in developed countries. However, smoking prevalence has declined over a period when adiposity has increased. The aim of this study was to determine whether adiposity now accounts for more deaths than smoking in the general population as a whole or sub-groups of it.

Methods: This is a comparative risk assessment study using Health Surveys for England and Scottish Health Surveys from 2003 to 2017. Annual prevalence of overweight, obesity, current and former smoking were obtained and combined using population-based weights. Sex-specific risk ratios for all-cause mortality were obtained from the most recently published meta-analyses. Population attributable fractions across yeas were then estimated.

Findings: Overall, deaths attributable to current/former smoking declined from 23.1% (95% CI 20.6-25.8%) in 2003 to 19.4% (95% CI 17.3-21.6%) in 2017, whilst those attributable to adiposity (overweight or obesity) increased from 17.9% (95% CI 17.3-18.4%) in 2003 to 23.1% (95% CI 22.3-23.8%) in 2017 with cross-over occurring in 2013. Cross-over occurred earlier in men (2011) than women (2014). It occurred in 2006 for those aged over 65 years of age and in 2012 for those aged 45-64 years. Below 45 years, smoking remained the larger contributor to mortality.

Interpretation: Adiposity now accounts for more deaths in England and Scotland than smoking among people in middle- and old-age. National strategies to address adiposity should be a public health priority.

Keywords: Adiposity; Mortality; Obesity; Population attributable fraction; Smoking.

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Conflict of interest statement

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig. 1
Fig. 1
Percentage of all-cause deaths attributable to adiposity and smoking. Shaded areas are 95% confidence bands. Vertical dashed line indicates cross-over
Fig. 2
Fig. 2
Percentage of all-cause deaths attributable to adiposity and smoking by sex. Shaded areas are 95% confidence bands. Vertical dashed line indicates cross-over
Fig. 3
Fig. 3
Percentage of all-cause deaths attributable to adiposity and smoking by age group. Shaded areas are 95% confidence bands. Vertical dashed line indicates cross-over
Fig. 4
Fig. 4
Percentage of all-cause deaths attributable to adiposity and smoking by age at completion of full-time education. Shaded areas are 95% confidence bands. Vertical dashed line indicates cross-over
See this image and copyright information in PMC

References

    1. Ockene IS, Miller NH. Cigarette smoking, cardiovascular disease, and stroke: a statement for healthcare professionals from the American Heart Association. Circulation. 1997;96(9):3243–3247. doi: 10.1161/01.CIR.96.9.3243. - DOI - PubMed
    1. Willi C, Bodenmann P, Ghali WA, et al. Active smoking and the risk of type 2 diabetes: a systematic review and meta-analysis. Jama. 2007;298(22):2654–2664. doi: 10.1001/jama.298.22.2654. - DOI - PubMed
    1. Sasco A, Secretan M, Straif K. Tobacco smoking and cancer: a brief review of recent epidemiological evidence. Lung Cancer. 2004;45:S3–S9. doi: 10.1016/j.lungcan.2004.07.998. - DOI - PubMed
    1. World Health Organization . Global health risks: mortality and burden of disease attributable to selected major risks. Geneva: World Health Organization; 2009.
    1. Ezzati M, Lopez AD. Regional, disease specific patterns of smoking-attributable mortality in 2000. Tob Control. 2004;13(4):388–395. doi: 10.1136/tc.2003.005215. - DOI - PMC - PubMed

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