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European Heart Journal Advance Access published online on May 15, 2007
European Heart Journal, doi:10.1093/eurheartj/ehm151
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Mortality and morbidity from coronary heart disease attributable to passive smoking

Jan Heidrich, Jürgen Wellmann, Peter U. Heuschmann, Klaus Kraywinkel and Ulrich Keil*

Institute of Epidemiology and Social Medicine, University of Münster, Germany

Received 20 October 2006; revised 14 March 2007; accepted 5 April 2007.

* Corresponding author: Tel: +49 251 8355396/7; fax: +49 251 8355300. E-mail address: keilu{at}uni-muenster.de

Aims: Passive smoking is associated with increased risk of coronary heart disease (CHD). This study estimates CHD mortality and morbidity attributable to passive smoking in Germany and demonstrates variations in the number of estimated deaths depending on underlying assumptions.

Methods and results: Prevalence of passive smoking from the German National Health Survey, CHD deaths from national mortality statistics, number of incident CHD cases, and relative risks from meta-analyses were used to estimate mortality and morbidity from passive smoking applying the concept of population attributable risk. Sensitivity analyses were carried out to investigate the impact of different assumptions in terms of exposure definition, relative risk, and population at risk on estimated mortality. Exposure to environmental tobacco smoke (ETS) at home accounts for 2148 [approximate 95% confidence interval (CI) 1471–2736] deaths from CHD and 3776 (95% CI 2588–4800) incident CHD cases among non-smokers every year in Germany. In sensitivity analyses, consideration of exposure to ETS at work and at any location yielded 2597 (95% CI 1784–3295) and 8970 (95% CI 6252–11 243) attributable CHD deaths, respectively. Applying different populations at risk showed a range of 1174 (95% CI 803–1494) to 13 792 (95% CI 9655–17 225) attributable deaths from CHD.

Conclusion: The estimated burden of passive smoking heavily depends on the definition of underlying parameters. Using an evidence-based approach reveals a substantial burden of passive smoking in terms of CHD mortality and morbidity reflected by six CHD deaths and 10 incident CHD cases every day in Germany.

Key Words: Coronary heart disease • Passive smoking • Population attributable risk • Mortality • Morbidity


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