Tobacco use contributes to health burden more than any other risk factor and was responsible for 9.3% of the total burden of disease in Australia in 2015.
This report extends estimates published in the Australian Burden of Disease Study (ABDS) 2015 (AIHW 2019a). It provides insight into the health impact of tobacco use in Australia, including as a risk factor for specific diseases such as lung cancer, chronic obstructive pulmonary disease (COPD) and coronary heart disease. The health impact comprises both fatal burden (dying prematurely) and non-fatal burden (living with disease) and is reported using a summary measure of health called disability-adjusted life years, or DALY.
Most of the burden attributable to tobacco use was fatal
Tobacco use contributed to 13% of deaths in Australia in 2015, equivalent to 20,933 deaths. It contributed to more deaths in males than females. Almost three-quarters of the tobacco use burden was due to fatal outcomes. Tobacco use was responsible for 14% of all fatal burden and 5.0% of all non-fatal burden.
Cancers accounted for nearly half of the burden due to tobacco use
Forty-three per cent of the burden attributable to tobacco use was due to cancer, and almost two-thirds of this was from lung cancer (28% of total tobacco burden).
COPD accounted for 30% of the burden attributable to tobacco use, with the burden higher in females (38%) than males (25%).
Cardiovascular diseases were responsible for 17% of the burden due to tobacco use—primarily related to coronary heart disease (10%) and stroke (3.1%). Males experienced 2.2 times the amount of cardiovascular disease burden due to tobacco use than females.
Tobacco use burden is higher for some population groups
The burden from tobacco use varied according to where a person lived, their socioeconomic group and mental health status. Age-standardised rates were higher in:
- the Northern Territory (2.1 times as high) than in all of Australia
- the lowest socioeconomic areas (2.6 times as high) than in the highest socioeconomic areas
- Remote and very remote areas combined (1.8 times as high) than in Major cities
- people with a mental health condition (1.5 times as high) than in people without a mental health condition.
Past smoking is still causing disease burden, especially in females
The overall burden attributable to tobacco use (number of DALY) rose by 2.0% between 2003 and 2015. The change in tobacco use burden between 2003 and 2015 varied by sex and for current and past smoking. There was a:
- 6.8% decrease for burden in males and a 17% increase in females
- 20% decrease for burden linked to current smoking (23% in males and 14% in females)
- 15% increase for burden linked to past smoking (3.2% in males and 33% in females).
Given that some linked diseases such as lung cancer and COPD can take a number of years to develop, the effects of past smoking are expected to continue to have an impact on disease burden into the near future, particularly on females.
Tobacco use burden rate has decreased over time
After accounting for population increase and ageing, the rate of disease burden due to tobacco use fell between 2003 and 2015 by 24%. The decrease was seen in all the leading 6 linked diseases: COPD, lung cancer, coronary heart disease, oesophageal cancer, stroke and asthma.
Potential burden rate is predicted to fall by 2020 and 2025
The age-standardised rate of attributable burden due to tobacco use is projected to decrease by 5.8% by 2020 (from 16.4 DALY per 1,000 population in 2015 to 15.5 DALY per 1,000 in 2020) and by 9.5% by 2025 (to 14.9 DALY per 1,000). The decline projected by 2025 is greater for males (a 12% decline) than for females (a 6.1% decline).
Tobacco, alcohol and illicit drug use combined contributed to more burden and deaths in males than in females
Tobacco, alcohol and illicit drug use combined contributed to 16% of the total burden of disease in 2015. This was greater in males (19%) than in females (12%). After adjusting for age, the rate of combined burden for these risk factors was almost twice (1.9 times) as high in males (39 DALY per 1,000 population) than in females (20 per 1,000).
Together, tobacco, alcohol and illicit drug use contributed to 18% of deaths in Australia in 2015, equivalent to 28,552 deaths. These risk factors combined contributed to more than 1 in 5 deaths in males (21%), and 15% of deaths in females.
AIHW (Australian Institute of Health and Welfare) 2019a. Australian Burden of Disease Study: impact and causes of illness and death in Australia 2015. Australian Burden of Disease series no. 19. Cat. no. BOD 22. Canberra: AIHW.