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Mortality and morbidity from coronary heart disease attributable to passive smoking

Jan Heidrich, Jürgen Wellmann, Peter U. Heuschmann, Klaus Kraywinkel, Ulrich Keil
DOI: http://dx.doi.org/10.1093/eurheartj/ehm151 2498-2502 First published online: 15 May 2007


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.

  • Coronary heart disease
  • Passive smoking
  • Population attributable risk
  • Mortality
  • Morbidity
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