More than 20,000 years of life lost to smoking in Estonia every year

A master’s thesis defended at the University of Tartu revealed that in 2018 in Estonia, the burden of disease associated with smoking totalled to 23,634 years of life, that is 38.9 years per 1,000 inhabitants. Men lost more than four times more years of life than women due to smoking, and most years of life were lost outside Tallinn and Tartu.

World Health Organization has estimated that tobacco use is currently responsible for the death of about six million people across the world each year, with many of these deaths occurring prematurely. In her master’s thesis defended at the University of Tartu Institute of Family Medicine and Public Health, Säsil Rammo found that in 2018, the Estonian population lost 416,510 years of life in total, of which the loss of 74,829 years was caused by four medical conditions – lung cancer, chronic obstructive pulmonary disease, cerebral infarction and ischaemic heart disease. 35.1% of this burden of disease could be associated with smoking.

Men lost more than four times more years (71.4) than women (15.4) due to smoking-related diseases per 1,000 inhabitants in 2018. “According to various studies, smoking among men has decreased over time, but the health damage caused by smoking is known to occur dozens of years later,” said Säsil Rammo, the author of the thesis, adding that the difference may also be attributed to the higher number of years of life lost due to mortality among men: “The burden of disease is linked to the number of years left to live at the time of death. The younger people die, the greater the burden of disease.”

Burden of disease by county

Rammo’s master’s thesis is known to be the first in Estonia where smoking-attributable burden of disease is presented by counties and age groups. According to Rammo, local experts and policymakers can use the county-based results to support the municipality and organisations in smoking prevention and to draw constant attention to the harm associated with smoking.

The analysis showed that the burden of disease among men was the highest in Valga and Ida-Viru County, followed by Hiiu and Põlva County. In Ida-Viru, Pärnu, Rapla and Saare counties, the figure was the lowest among 50–54-year-olds. “In Ida-Viru, Jõgeva and Saare counties, men lost most years of life per 1,000 inhabitants due to ischaemic heart disease associated with smoking. In other counties, lung cancer accounted for the largest part of smoking-attributable burden of disease,” said Rammo.

Among women, the highest smoking-attributable burden of disease per 1,000 inhabitants was among women aged 65–69 in Jõgeva County, followed by women in Lääne-Viru and Rapla counties. “In Lääne County, women lost most years of life per 1,000 inhabitants due to chronic obstructive pulmonary disease associated with smoking; in Ida-Viru, Valga and Võru counties due to ischaemic heart disease; in Põlva County equally to ischaemic heart disease and lung cancer, and to lung cancer in the rest of counties,” Rammo described.

According to age groups, smoking-attributable burden of disease per 1,000 inhabitants was the highest in the younger retirement age, among those aged 65–69.

Need for regular studies

Based on the results of her master’s thesis, Rammo recommends taking regional disparities into account when implementing programmes aimed at reducing smoking and facilitating the availability of such programmes in counties with increased burden of disease. “It is also very important to conduct regular studies on smoking-attributable health impacts to assess the trends in smoking prevalence and the resulting harm,” Rammo added.