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The Regional Differences in Mortality Attributable to Tobacco in the Czech Republic in 2017

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The Regional Differences in Mortality Attributable to Tobacco in the Czech Republic in 2017 ADIKTOLOGIE 213 The Regional Differences in Mortality Attributable to Tobacco in the Czech Republic in 2017 GAVUROVÁ, B., TARHANIČOVÁ, M., KULHÁNEK, A. Charles University, First Faculty of Medicine and General University Hospital Citation | Gavurová, B., Tarhaničová, M., Kulhánek, A. (2019). The Regional in Prague, Department of Addictology, Czech Republic Differences in Mortality Attributable to Tobacco in the Czech Republic in 2017. Adiktologie, 19(4), 213–220; doi 10.35198/01-2019-004-0005. BACKGROUND: Smoking, as the leading cause of premature dying, the relative risks in the Czech Republic from 1994 to death, has many negative consequences and represents 2017 were calculated. Cluster analysis was conducted to an economic burden across the globe. There are several compare the regions of the Czech Republic with regard diagnoses caused wholly or partially by tobacco use. The to the number of deaths attributable to smoking. The groups of diagnoses that are mainly related to tobacco comparisons are made within two disease categories. use are neoplasms and diseases of the circulatory and RESULTS: The results show the differences in regional respiratory system. AIMS: This study aims to examine mortality attributable to tobacco use in the Czech whether the probability of dying because of neoplasms Republic. The probability of dying of a disease diagnosed and circulatory diseases is higher in the case of tobacco as a smoking-related neoplasm is higher in comparison smokers compared to non-smokers. Supposing that there to that of death from a disease diagnosed as a smoking- are economic differences between the regions of the related disease of the circulatory system. The level of Czech Republic, the differences between regions in terms deaths as a result of smoking differs between the genders. of the number of deaths attributable to selected groups CONCLUSION: Our findings demonstrate a relationship of diagnoses was examined. The differences between between smoking as a death risk factor and neoplasms groups of regions based on the number of deaths related and diseases of the circulatory system. The specificity of to neoplasms and diseases of the circulatory system diagnoses might be the reason for the greater disparities in were analysed. METHODS: To compare the probability of the mortality connected to neoplasms. Keywords | Czech Republic – Attributable Fractions – Tobacco – Regional Cluster Analysis – Avoidable Mortality – Diseases of the Circulatory System – Neoplasms Submitted | 20 July 2020 Accepted | 1 September 2020 Grant affiliation | This work was supported by the GCDPC, Grant No. A-86-19; GCDPC, Grant No. AA-01-20, the institutional support programme Progres No. Q06/LF1, and by Grant No. 260500 within Specific Academic Research. Corresponding author | Adam Kulhánek, PhD, Charles University, First Faculty of Medicine and General [email protected] University Hospital in Prague, Department of Addictology, Apolinářská 4, 128 00 Prague 2, Czech Republic. 214 ADIKTOLOGIE ORIGINAL ARTICLE 1 INTRODUCTION more deleterious than smoking more cigarettes per day for • a shorter period. Since there are many types of diseases re- Tobacco smoking is one of the leading risk factors linked lated to tobacco, authors tend to analyse groups of diseases, with avoidable mortality and premature deaths (Doll et al., or they select specific diagnoses (Jones et al., 2017; Hack- 2005; Reitsma et al., 2017). Each year eight million deaths shaw, Morris, Boniface, Tang, & Milenković, 2018). are caused by tobacco use, out of which seven million are caused directly by smoking, and the rest are caused indi- In epidemiology, the relationship between variables is rectly; that covers those people who were exposed to cig- quantified by the effect size measures such as the relative arette smoke even though they did not smoke themselves risk, odds ratio, correlation coefficient, and mean. Mean (WHO, 2019c). Even though smoking ranks second in terms value indicators are most often used to monitor the differ- of risk, smoking (or tobacco consumption) is declining ences between the two groups being compared. In the case worldwide (WHO, 2019b). According to a study by Stana- of a correlation coefficient, it is possible to examine what way et al. (2018), the rate of deaths caused by smoking has proportion of the change in a given variable (dependent decreased worldwide, from 146 deaths per 100 thousand variable) is caused by an explanatory variable (independent in 1990 to 90 per 100 thousand in 2017. Central Europe- variable). The group of correlation indicators also includes an countries rank among the states with the highest preva- what is called the coefficient of determination, which is the lence of tobacco use in the European region (WHO, 2019a). power of the Pearson correlation coefficient. In the case of the relative risk and odds ratio, it is possible to compare the In the Czech Republic, smoking accounted for 18.8% (17.7– effect of the risk factor on the phenomenon being studied 19.9%) of the total deaths in 2017 (GBD, 2017; Sovinová et and compare it between two groups (Richardson, 1996). As al., 2007). As with alcohol, tobacco use is subject to sever- stated by Newcombe (2012), effect size indicators are divid- al risks, which increase the overall number of avoidable ed into absolute and relative. Mean value indicators belong deaths. The results of national population-based preva- among the absolute indicators. The odds ratio and relative lence studies revealed a high rate of tobacco smoking that risk are relative indicators. In the case of relative risks and varied between 28% and 32% in the decade leading up to odds ratio authors (Kraemer et al., 2003; Henson, 2006; 2013 (Sovinová et al., 2014). However, the implementation LeCroy & Krysik, 2007) consider whether the risk factor af- of essential tobacco control measures (Kulhánek & Koste- fects the phenomenon under observation or not. lecká, 2020) based on the WHO Framework Convention on Tobacco Control contributed to the slightly decreasing Gavurová and Kubák (2017) analysed how sociodemo- trend of tobacco use in the Czech Republic. For example, in graphic indicators, e.g. age, region, gender, and marital 2016, Decree No. 261/2016 Coll., on tobacco products, in- status, influence the odds ratio of dying as a result of coro- troducing a combined health warning on tobacco packages, nary disease. Coronary disease is associated with smoking. came into force. In 2017, what was termed the smoke-free Therefore the effect of smoking on the outbreak of coronary law (Law No. 65/2017 Coll., on the protection of health from disease is also considered in this study. As the study of Ga- the harmful effects of drugs) prohibiting smoking in indoor vurová and Kubák also showed, the territory proved to be public spaces (such as bars, pubs, and restaurants) was an essential variable in relation to coronary disease, and it adopted and helped to reduce daily tobacco consumption is necessary to study and compare the level of deaths attrib- and increase motivation to quit smoking (Kulhánek et al., utable to tobacco regionally. This was also the case in the 2019). Furthermore, the excise duty on tobacco increased study by Boffett et al. (2008), where the authors examine sharply in 2020. These legislative changes resulted in a de- the relationship between territory and diseases caused by cline of the prevalence of tobacco use among the Czech smoking. The authors showed the dependence between re- adult population to 24.9% in 2019 (Csémy et al., 2020). The gions and the outbreak of diseases related to smoking and most significant decrease has been observed in the young- so the next part of the work examines the mortality caused est target group (15–24 years). by tobacco for two categories of diseases from the perspec- tive of the regions of the Czech Republic that fill the scien- tific gap in the problem of smoking. As studies concerning 2 LITERATURE REVIEW the same problem that compare the genders in the Czech • Republic are still lacking, this study fills this gap as well. According to the observation study of Doll, Peto, Boreham, and Sutherland (2005), the life expectancy of smokers is ten years shorter than that of non-smokers. As stated by Mehta 3 METHODOLOGY and Preston (2012), the contribution of smoking to national • mortality patterns is not decreasing. To reduce the increas- In this study, data from the Registry of Deaths of the Czech ing mortality related to smoking, it is necessary to reduce Republic is used. This data was provided by the Institute the prevalence of smoking. Lochen et al. (2017) state that of Health Information and Statistics of the Czech Repub- occasional smoking is not a healthier alternative to continu- lic as part of the research project Grant No. A-86-19. The ous smoking. There is a need for information for the general Registry of Deaths contains information about individual public and healthcare workers about the harms of occasion- deaths. Each death in the registry is described by the fol- al smoking. As shown by the results of Lubin et al. (2016), lowing attributes: gender, age at death, the primary cause smoking fewer cigarettes per day for a longer period was of death (ICD-10), the external cause of death (ICD-10), the The Regional Differences in Mortality Attributable to Tobacco in the Czech Republic in 2017 ADIKTOLOGIE 215 Neoplasms Diseases of the coronary system ICD–10 code Diagnosis group name ICD–10 code Diagnosis group name C00–C09 Malignant neoplasms of lip, oral cavity,
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