Tobacco smoking and mortality among Aboriginal and Torres Strait Islander adults in Australia

Abstract

Background Despite generally high smoking prevalences, stemming from colonization, the relationship of smoking to mortality has not been quantified reliably in an Indigenous population. We investigate smoking and mortality among Aboriginal and Torres Strait Islander adults in Australia, where current adult daily smoking prevalence is 40.2%. Methods A prospective study of 1388 cardiovascular disease- and cancer-free Aboriginal adults aged ≥45 years, of the 267 153 45 and Up Study participants randomly sampled from the New South Wales general population over 2006–09. Questionnaire and mortality data were linked (through the Centre for Health Record Linkage) to mid-2019. Adjusted hazard ratios (called relative risks, RRs) for all-cause mortality—among current- and past- versus never-smokers—were estimated overall, by smoking intensity and by age at cessation. Smoking-attributable fractions and associated deaths were estimated. Results Over 14 586 person-years’ follow-up (median 10.6 years), 162 deaths accrued. Mortality RRs [95% confidence interval (CI)] were 3.90 (2.52–6.04) for current- and 1.95 (1.32–2.90) for past- versus never-smokers, with age heterogeneity. RRs increased with smoking intensity, to 4.29 (2.15–8.57) in current-smokers of ≥25 cigarettes/day. Compared with never-smokers, RRs were 1.48 (0.85–2.57) for those quitting at <45 years of age and 2.21 (1.29–3.80) at 45–54 years. Never-smokers lived an average >10 years longer than current-smokers. Around half of deaths among adults aged ≥45 years were attributable to smoking, exceeding 10 000 deaths in the past decade. Conclusions In this population, >80% of never-smokers would survive to 75 years, versus ∼40% of current-smokers. Quitting at all ages examined had substantial benefits versus continuing smoking; those quitting before age 45 years had mortality risks similar to never-smokers. Smoking causes half of deaths in older Aboriginal and Torres Strait Islander adults; Indigenous tobacco control must receive increased priority.

Tobacco Related Attitudes and Behaviours in Relation to Exposure to the Tackling Indigenous Smoking Program: Evidence from the Mayi Kuwayu Study

“…For current smokers, residing in a TIS-funded area compared to a non-TIS-funded area was also associated with a significant 21% lower prevalence of high smoking intensity (≥21 cigarettes per day). Given that increasing smoking intensity is associated with increasing mortality risk for Aboriginal and Torres Strait Islander adults [3], the observed lower smoking intensity within TIS-funded areas is likely to reduce mortality risk for these participants. Smoking intensity is also an indicator of nicotine dependence.…”

“…These systemic practices promoted, embedded and normalised widespread tobacco use within the Aboriginal and Torres Strait Islander population. As a result, smoking is the leading contributor to the burden of disease and mortality for Aboriginal and Torres Strait Islander peoples [2], with an estimated 37% of all Aboriginal and Torres Strait Islander deaths attributed to smoking [3]. The Aboriginal and Torres Strait Islander tobacco epidemic is unique due to the extended duration of high prevalence, similarity in prevalence among men and women, and distinct trends between urban, regional and remote settings [4].…”

Dose-Response Reduction in Risk of Nasopharyngeal Carcinoma From Smoking Cessation: A Multicenter Case-Control Study in Hong Kong, China

“…The most plausible explanation is reverse causality that quitting was driven by illness or ascertainment of NPC. Therefore, we classified recent quitting as current smoking, in line with other smoking-related epidemiological studies ( 13 , 47 , 48 ). On the other hand, if the recent quitters had higher NPC risk, classifying them as current smokers would diminish the differences in NPC risk between the remaining former smokers and never smokers.…”

Reflections on Indigenous commercial tobacco control: ‘The dolphins will always take us home’

“…51 Further, Indigenous-specific evidence indicated that smoking causes 37% of all Aboriginal and Torres Strait Islander peoples' deaths, 50 almost twice the previous estimates. 50 Consequently, there is even greater potential to improve Indigenous health outcomes by reducing commercial tobacco use. 50 Working together as Indigenous peoples with the support of, and in collaboration with, our non-Indigenous allies, governments and non-government organisations, we have a stronger and more focused means of improving Indigenous health outcomes and countering the tobacco industry's activities.…”

“…50 Consequently, there is even greater potential to improve Indigenous health outcomes by reducing commercial tobacco use. 50 Working together as Indigenous peoples with the support of, and in collaboration with, our non-Indigenous allies, governments and non-government organisations, we have a stronger and more focused means of improving Indigenous health outcomes and countering the tobacco industry's activities. There are opportunities to learn from each other around the world.…”