SciELO - Scientific Electronic Library Online

 
vol.16 número2Retrospective analysis of oral mucosal lesions between 2008-2015 in the clinical boarding school of dentistry of the University of Costa RicaAssociation of fermented milk intake and hypertension: a systematic review índice de autoresíndice de assuntospesquisa de artigos
Home Pagelista alfabética de periódicos  

Serviços Personalizados

Journal

Artigo

Indicadores

Links relacionados

  • Não possue artigos similaresSimilares em SciELO

Compartilhar


Población y Salud en Mesoamérica

versão On-line ISSN 1659-0201

PSM vol.16 no.2 San Pedro Jan./Jun. 2019

http://dx.doi.org/10.15517/psm.v0i0.34484 

Artículo

Comparison of mortality attributable to tobacco in selected Latin American countries

Mortalidad atribuible al consumo de tabaco en países seleccionados de América Latina

Laura Débora Acosta1 

Florencia Molinatti2 

Enrique Peláez3 

1Centro de Investigaciones y Estudios sobre Cultura y Sociedad (CIECS), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) y Universidad Nacional de Córdoba, Argentina. Correo: laudeac@gmail.com;ldacosta@conicet.gov.ar

2Centro de Investigaciones y Estudios sobre Cultura y Sociedad (CIECS), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) y Universidad Nacional de Córdoba, Argentina. Correo: fmolinatti@hotmail.com; fmolinatti@conicet.gov.ar

3Centro de Investigaciones y Estudios sobre Cultura y Sociedad (CIECS), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) y Universidad Nacional de Córdoba, Argentina. Correo: enpelaez@gmail.com, epelaez@eco.unc.edu.ar

Abstract

Objective: To compare the mortality attributable to tobacco consumption in selected Latin American countries (Argentina, Brazil, Chile, and Mexico) between the years 2009 and 2013. Methods: In order to estimate the mortality attributable to risk factors, the Comparative Risk Assessment (CRA) methodology was used. Years of Life Expectancy Lost (YLEL) were calculated following the methodology proposed by Arriaga. Secondary data from the national statistics agency of each country were used. Results: The highest percentages of all deaths due tobacco were observed among Argentinian and Chilean men (14.4 and 14.3% of the total deaths, respectively), followed by Mexicans (12.5% of the total deaths). Among women, the highest percentage was registered in Chile (8% of total deaths), followed by Mexico and Argentina (5.3, and 5.1% of total deaths, respectively). For both sexes, Brazil recorded the lowest percentages (5.4 and 2.8% of the total deaths, for men and women). In terms of life expectancy, the most affected by mortality due to tobacco consumption were the men and women of Argentina, who lost 1.77 and 0.65 years of life expectancy, respectively, followed very closely by the Chilean men and women. Conclusions: Men and women of Argentina had the greatest loss of life expectancy due to tobacco; this is consistent with the incipient policy against tobacco implemented in that country. In contrast, in the other countries studied, tobacco control policies were implemented earlier. However, tobacco remains an important cause of mortality in all these countries, despite the great efforts to reduce its consumption.

Keywords: Non-communicable diseases- Mortality- Tobacco - Public health - Latin America

Resumen

Objetivo: Comparar la mortalidad atribuible al consumo de tabaco en países seleccionados de América Latina (Argentina, Brasil, Chile y México) entre los años 2009 y 2013. Método: Se utiliza la metodología de Evaluación Comparativa de Riesgos (CRA) para estimar la mortalidad atribuible; luego se calculó los años de esperanza de vida perdidos (AEVP), siguiendo la metodología propuesta de Arriaga. Se utilizaron datos secundarios de la agencia nacional de estadísticas de cada país. Resultados: Los mayores porcentajes de muerte por tabaco se observaron entre los hombres argentinos y chilenos (14,4 y 14,3 % del total de muertes, respectivamente), seguidos por los mexicanos (12,5 % del total de muertes). Entre las mujeres, el mayor porcentaje se registró en Chile (8 % del total de muertes), seguido por México y Argentina (5,3, y 5,1 % del total de muertes, respectivamente). Para ambos sexos, Brasil registró los menores porcentajes (5,4 y 2,8 % del total de muertes, para hombres y mujeres). En términos de esperanza de vida, los más afectados por la mortalidad debido al consumo de tabaco fueron los hombres y las mujeres de Argentina, quienes perdieron 1,77 y 0,65 años de esperanza de vida, respectivamente, seguidos muy de cerca por los hombres y mujeres chilenas. Conclusiones: Los hombres y mujeres de Argentina presentaron la mayor pérdida de años de vida a causa del tabaco. Este hecho concuerda con la incipiente implementación de la política antitabaco en este país. En cambio, en los otros países estudiados las políticas de control han sido implementadas más tempranamente. Sin embargo, el tabaco sigue siendo una importante causa de mortalidad en todos estos países, a pesar de los grandes esfuerzos para reducir su consumo.

Palabras clave: Enfermedades No transmisibles- Mortalidad- Tabaco - Salud Pública - América Latina

1. Introduction

Preventable risk factors are the basis of most non-communicable diseases (NCD) such as cancer, diabetes mellitus, cardiovascular diseases, chronic respiratory diseases, and external causes. Risk factors such as smoking, physical inactivity, an unhealthy diet, and harmful alcohol use are responsible for a large part of the global burden of morbidity and mortality, either directly or through conditions such as hypertension, hyperglycemia, and hypercholesterolemia (World Health Organization [WHO], 2016).

Particularly, tobacco use is associated with disabilities and NCD deaths: cancers, especially lung cancer, cardiovascular disease, and diseases of the respiratory system (Öberg, Jaakkola Maritta, Woodward, Peruga, & Prüss-Ustün, 2011). According to World Health Organization (2013) data, tobacco kills up to half of its consumers, about 6 million people, more than 5 million of whom are consumers of the product and more than 600 000 are non-smokers exposed to other people’s smoke. Almost 80% of the world's 1 billion smokers live in low- or middle-income countries. It is the leading cause of worldwide preventable death.

Nearly 70 million smokers in Latin America are at risk of tobacco-related death and disease, according with The Tobacco Atlas, Sixth Edition (American Cancer Society, 2016). For example, smoking is the single most important cancer risk factor and accounts for 26% of all cancer deaths and 84% of lung cancer deaths in Latin America (Yamaguchi et al., 2017). While the proportion of the population who use tobacco has nearly halved across the region thanks to strong tobacco control policies in some countries, the region is seeing an increase in tobacco-related deaths, to more than 300 000 in 2016 (American Cancer Society, 2016).

To reduce the public health threat of tobacco use, the WHO has promoted the ratification of the WHO Framework Convention on Tobacco Control (FCTC) and developed demand reduction tools to help countries reduce tobacco use.

Specifically, the “MPOWER” package advocates the following evidence-based strategies: Monitor tobacco use and prevention policies; Protect people from tobacco smoke; Offer help to quit tobacco use; Warn about the dangers of tobacco; Enforce bans on tobacco advertising, promotion, and sponsorship; and Raise taxes on tobacco. (Ahluwalia, Arrazola, & Graffunder, 2017, p.10)

Argentina, Chile, Cuba, and Uruguay have the highest smoking prevalence in Latin American-Caribbean countries and, in the last ten years, the impact of smoking meant the loss of between two and six years in life expectancy among men 50 years and over (Palloni, Novak, & Pinto-Aguirre, 2015). In these countries, the level of implementation of MPOWER package has not been homogeneous, but most of them (Argentine, Chile, Brazil, and Uruguay) implemented four to six strategies (Blanco, Sandoval, Martínez-López & Caixeta, 2017).

Raising tobacco taxes to make these deadly products unaffordable is the most cost-effective measure to reduce tobacco use or to prevent its initiation among youth. Argentina and Chile are the only countries in Latin America that have taxes on tobacco products of at least 80% of the retail price. In contrast, in Brazil and Mexico the share of total taxes in the retail price does not reach 70% but the cigarettes are less affordable since 2008 (World Health Organization, 2017).

Based on this background, the goal of this study is to compare the mortality attributable to tobacco use, in selected Latin American countries (Argentina, Brazil, Chile, and Mexico) between the years 2009 and 2013.

2. Methods

2.1 Data

This study compared the differences in mortality attributable to tobacco use1 in Argentina, Brazil, Chile, and Mexico, by using official secondary data. The data on the smoking prevalence (Pi) were obtained from several surveys carried out in the countries studied:

Argentina. Encuesta Nacional de Factores de Riesgo (ENFR) 2013 [2013 National Survey of Risk Factors],

Brazil. Pesquisa Nacional de Saúde (PNS) 2013 [2013 National Health Survey],

Chile. Encuesta Nacional de Salud (ENS) 2009-2010 [2009-2010 National Health Survey], and

Mexico. Encuesta Nacional de Salud y Nutrición (ENSANUT) 2012 [2012 National Health and Nutrition Survey].

The Relative Risks (RR) corresponding to each cause of death related to tobacco use were obtained from meta-analyses (United States Department of Health and Human Services, 2014), as established by the Comparative Risk Assessment (CRA) methodology.

Mortality observed (MO) and population data were obtained from public-use microdata files and statistical yearbooks prepared by the national agencies responsible for their registration:

  • Argentina. Ministerio de Salud de la Nación, Dirección de Estadísticas e Investigación en Salud (MSAL-DEIS) 2012-2014

  • Brazil. Ministério de Saúde do Brasil. Sistema de Informações sobre Mortalidade (MS-SIM) 2012-2014

  • Chile. Ministerio de Salud de Chile, Departamento de Estadísticas e Información de Salud (MINSAL-DEIS) 2009-2011, and

  • Mexico. Secretaría de Salud de México. Sistema Nacional de Información en Salud (SSA-SINAIS) 2011-2013).

The quality and internal consistency of the databases were evaluated. According to the latest report on health statistics of the World Health Organization (2014b), the four countries analyzed have a mortality registry coverage of more than 90% and the proportion of deaths without registration of sex or age is less than 2%; these were imputed according to the distribution of the valid data.

The calculations of mortality attributable (MA) and Years of Life Expectancy Lost (YLEL) were performed using the Epidat (2016) software: a piece of software for epidemiological data analysis, Version 4.2.

2.2 Attributable Risk Calculation

To estimate the mortality attributable to tobacco, the Comparative Risk Assessment methodology [CRA] (Ezzati et al., 2006) was used. The CRA methodology is based on the fact that the contribution of a risk factor to mortality can be estimated by means of the Population Attributable Fraction (PAF), comparing the burden due to the exposure observed in the population with a hypothetical distribution. This hypothetical distribution is defined as a counterfactual scenario (Mathers, Vos, Lopez, Salomon, & Ezzati, 2001). The PAF formula for discrete variables tobacco use with n exposure levels is (see equation 1):

PAF= i=1 n P i × RR i − i=1 n P′× RR i i=1 n P i × RR i (equation 1)

where n is the number of exposure categories or levels, P i the prevalence of the exposure category (prevalence of smoking prevalence obtained from several surveys carried out), RR i is the relative risk in the exposure category (United States Department of Health and Human Services, 2014), and P´ i the prevalence of exposure in the counterfactual scenario.

Then, MO due to tobacco use was multiplied by the attributable fraction obtained and the MA to tobacco use was obtained (see equation 2).

𝑀𝐴=𝑀𝑂×𝑃𝐴𝐹 (equation 2)

2.3 Years of Life Expectancy Lost Calculation

Once the attributable deaths were estimated, the YLEL were calculated following the methodology proposed by Arriaga (2014). The method of calculation of the YLEL is based on the life tables and allows adjustment by age structure of the population. Unlike other methods, such as the Years of Potential Life Lost (YPLL) developed by Pan American Health Organization, or the Healthy Life Years (HLY) index, the YLEL index is not affected by the age structure of the population. YLEL were calculated between ages 35 and 80. These age limits were used for two reasons: first, because the RRs estimated in the meta-analyses were estimated as of 35 years; second, because the average life expectancy in the countries studied is approximately 80 years.

3. Results

Argentina, Brazil, and Mexico had a prevalence of smoking among men higher than 20% and lower than 30%, while Chile is 37.7 % (see table 1). In the case of Chilean women, a smoking prevalence of 33% stands out. Argentina and Brazil had a prevalence among women lower than 20%, and Mexican women had the lowest prevalence (8.7%).

Table 1: Argentina, Brazil, Chile and Mexico, 2009-2013: Prevalence of smokers, former smokers and people who never smoked for the adult population aged 35 and over, by gender and age group 

Age group Tobacco use Argentina 2013 - Brazil 2013 - Chile 2009-10 - Mexico 2012 -
- - Men Women Men Women Men Women Men Women
35 to 64 years Smokers 30.6 22.7 21.9 14.9 42.6 37.6 30.2 9.6
- Former smokers 23.3 16.7 23.8 17.5 30.0 21.4 26.4 10.2
- Never smoked 46.1 60.6 54.3 67.6 27.4 41.1 43.5 80.2
Aged 65 and over Smokers 12.4 10.4 13.9 7.1 11.8 14.4 17.1 4.5
- Former smokers 44.3 17.3 45.7 20.7 42.2 22.2 45.2 13.5
- Never smoked 43.3 72.3 40.4 72.2 46.0 63.4 37.7 82.0
Total population aged 35 and over Smokers 26.7 19.3 20.4 13.3 37.7 33.0 27.9 8.7
- Former smokers 27.8 16.8 27.9 18.2 32.0 21.5 29.7 10.8
- Never smoked 45.5 63.9 51.7 68.5 30.4 45.5 42.5 80.5

Source: Argentina: ENFR 2013 / Brazil: PNS 2013 / Chile: ENS 2009-10 / Mexico: ENSANUT 2012. Own research with Epidat (2016) 4.2

In the case of people over 65, both Brazilian and Mexican men had the highest prevalence among smokers and former smokers, covering approximately 60% of the population of that age, followed by Argentinian and Chilean men. In the case of women, Mexican women were the smokers (both current and past) who smoke the least, with a prevalence of 18%.

In the case of the 35-64 age group, the trend was quite different: Chilean men had the highest prevalence, more than 72% of the population of that age (including smokers and ex-smokers). In the second place were the Chilean women, with a prevalence close to 59%. Among women, less than 40% of Argentinian women smoked at least once in their lifetime and that percentage was lower among Brazilian women, less than 33%.

Regarding the weight of the deaths attributable to tobacco in the general mortality of the country, it was observed that among Argentinian and Chilean men, smoking deaths accounted for just over 14% of the total. Among women, the highest percentage of all deaths due to tobacco was recorded in Chile (8%) (see table 2).

Table 2 : Argentina, Brazil, Chile and Mexico, 2009-2013: Mortality attributable to tobacco use by gender and large groups of causes of death 

Causes of death (ICD-10 code) Argentina 2013 - Brazil 2013 - Chile 2009-10 - Mexico 2012 -
- Men Women Men Women Men Women Men Women
Malignant neoplasms 9,195 2,916 29,028 9,800 2,843 1,223 7,316 2,180
Cardiovascular diseases 7,890 2,626 29,267 12,877 2,260 1,101 13,479 3,779
Respiratory diseases 4,780 1,887 33,801 17,814 1,510 1,037 43,291 6,522
All deaths attributable to tobacco 21,865 7,430 92,347 40,581 6,614 3,360 35,511 12,481
All deaths 151,969 146,779 1,701,410 1,426,386 46,353 41,970 278,393 235,543
Percentage of all deaths attributable to tobacco 14.4 5.1 5.4 2.8 14.3 8.0 12.6 5.3

Source: Argentina: ENFR 2013. MSAL-DEIS, 2012-2014 / Brazil: IBGE - PNS 2013. MS-SIM, 2012-2014 / Chile: ENS 2009-10. MINSAL-DEIS, 2009-2011 / Mexico: ENSANUT 2012. SSA-SINAIS, 2011-2013. Own research with Epidat (2016) 4.2

Performing a simple cause analysis, it could be observed that among men and women in Argentina and Chile, the main cause of death attributable to smoking was cancer of the trachea, lung or bronchus. In Brazil and Mexico, however, others chronic obstructive pulmonary diseases (COPD) were the leading cause of death (see table 3in the end of article).

Table 3: Argentina, Brazil, Chile and Mexico, 2009-2013: Number and percentage of all deaths attributable to tobacco by gender and cause of death 

- Argentina 2013 - - - Brazil 2013 - - - Chile 2009-2010 - - - Mexico 2012 - - -
Causes of death (ICD-10 code) Men - Women - Men - Women - Men - Women - Men - Women -
- N % N % N % N % N % N % N % N %
Malignant neoplasms 9,195 61.2 2,916 32.3 29,028 61.5 9,800 33.1 2,843 49.1 1,223 30.5 7,316 57.4 2,180 17.7
Lip, oral cavity, pharynx (COO-C14) 454 72.7 90 36.2 4,079 73.3 559 37.4 100 70.4 28 41.9 509 74.7 103 28.6
Esophagus (C15) 846 69.7 249 42.1 4,302 70.1 848 48.2 280 66.2 120 48.4 526 71.8 85 36.9
Pancreas (C25) 401 21.3 359 17.3 935 22.0 766 17.9 113 23.0 138 23.0 428 24.7 257 12.8
Larynx (C32) 561 81.3 69 62.2 2,999 81.8 339 65.1 94 76.8 10 53.6 604 82.5 58 53.0
- Argentina 2013 - - - Brazil 2013 - - - Chile 2009-2010 - - - Mexico 2012 - - -
Causes of death (ICD-10 code) Men - Women - Men - Women - Men - Women - Men - Women -
- N % N % N % N % N % N % N % N %
Trachea, lung, bronchus (C33-C34) 5,530 87.1 1,845 63.9 12,736 87.1 6,147 63.8 1,419 85.7 676 68.2 3,682 88.0 1,240 53.0
Cervix uteri (C53) n/a n/a 114 11.8 n/a n/a 445 9.0 n/a n/a 78 n/a 0 n/a 214 n/a
rinary bladder (C67) 427 42.8 64 18.0 1,070 44.0 233 20.8 113 40.4 35 24.8 308 46.9 51 15.7
Kidney and renal pelvis (C64-C65) 457 37.1 24 4.2 631 36.8 37 3.7 149 37.1 11 5.1 460 39.6 18 2.5
Stomach (C16) 473 25.8 89 8.5 2,277 25.8 427 8.8 557 25.4 119 11.0 799 28.0 153 6.1
Acute myeloid leukemia (C92.0) 46 21.7 13 7.4 /a/ /a/ /a/ /a/ 17 22.9 7 9.4 /a/ /a/ /a/ /a/
Cardiovascular diseases 7,890 18.5 2,626 6.1 29,267 21.0 12,877 11.1 2,260 19.7 1,101 10.6 13,479 21.2 3,779 6.5
- Argentina 2013 - - - Brazil 2013 - - - Chile 2009-2010 - - - Mexico 2012 - - -
Causes of death (ICD-10 code) Men - Women - Men - Women - Men - Women - Men - Women -
- N % N % N % N % N % N % N % N %
Coronary heart disease (I20-I25) 2,570 21.8 728 8.8 14,256 23.5 5,321 12.1 1,029 23.1 376 12.9 9,229 22.5 2,321 7.1
Other heart diseases (I00-I09, I26-I28, I29-I51) 3,284 16.0 974 4.0 4,189 18.5 1,402 7.7 389 16.6 187 7.1 1,313 19.2 345 4.3
Cerebrovascular disease (I60-I69) 1,412 15.6 791 8.2 7,856 15.9 4,887 10.0 634 15.3 439 10.1 2,594 17.4 1,023 6.3
Atherosclerosis (I70) 32 20.1 5 1.6 132 24.6 23 3.4 25 39.9 7 8.8 39 26.8 6 3.2
Aortic aneurysm (I71) 560 61.0 109 34.2 2,566 62.5 1,062 39.5 162 61.3 76 44.2 215 64.1 39 29.5
Other arterial disease (I72-I78) 32 11.8 18 7.1 269 13.7 183 9.0 21 12.2 16 9.5 89 15.9 45 6.8
Respiratory diseases 4,780 34.4 1,887 13.9 33,801 51.7 17,814 31.0 1,510 46.4 1,037 33.5 43,291 217.2 6,522 39.5
- Argentina 2013 - - - Brazil 2013 - - - Chile 2009-2010 - - - Mexico 2012 - - -
Causes of death (ICD-10 code) Men - Women - Men - Women - Men - Women - Men - Women -
- N % N % N % N % N % N % N % N %
Influenza, pneumonia (J10-J11, J12-J18) 1,975 19.1 691 5.9 6,182 20.2 2,366 7.4 303 18.3 133 7.5 2,120 28.9 407 6.6
Bronchitis, emphysema (J40-J42, J43) 186 86.9 87 63.4 2.796 89.3 1,425 72.0 95 84.3 68 75.3 8,296 353.1 1,027 67.0
Other chronic obstructive pulmonary diseases (J44) 2,619 78.4 1,109 59.9 24,823 78.5 14,023 59.9 1,112 74.9 836 67.8 32,875 320.9 5,089 57.5
TOTAL deaths attributable to tobacco 21,865 30.5 7,430 11.3 92,347 36.5 40,581 19.8 6,614 32.3 3,360 19.3 64,086 66.5 12,481 14.4

Notes: N: Number of deaths attributable to tobacco; %: Percentage; ICD-10: International Classification of diseases. Tenth version; n/a: not applicable data; /a/ Cause of death excluded due to non-availability of the fourth digit in the Sistema de Informações sobre Mortalidade (Brazil).

Source: Argentina: ENFR 2013. MSAL-DEIS, 2012-2014 / Brazil: IBGE - PNS 2013. MS-SIM, 2012-2014 / Chile: ENS 2009-10. MINSAL-DEIS, 2009-2011 / Mexico: ENSANUT 2012. SSA-SINAIS, 2011-2013. Own research with Epidat 4.2

When analyzing the impact that these prevalence had on mortality using the YLEL methodology (see table 4), it could be observed that the most affected by mortality due to tobacco use were Argentinian men, who lost 1.77 years of life expectancy, followed by the Chilean men who lost 1.28 years of life expectancy. Mexican men lost 0.95 years of life expectancy, and Brazilian men had the lowest loss of years (0.65). Among women, the greatest loss of years of life expectancy was recorded in Argentinian women (0.65), followed by Chilean (0.53); Mexican women loss 0.31 years and Brazilian women had the lowest loss of years of life expectancy (0.28).

Table 4: Argentina, Brazil, Chile and Mexico, 2009-2013: Comparison of YLEL attributable to tobacco use in adults aged 35 and over, by gender and groups of causes of death 

Groups of causes of death Argentina 2013 - Brazil 2013 - Chile 2009-10 - Mexico 2012 -
- Men Women Men Women Men Women Men Women
Malignant neoplasms 0.82 0.28 0.25 0.09 0.59 0.23 0.25 0.08
Cardiovascular diseases 0.69 0.24 0.27 0.12 0.53 0.23 0.49 0.12
Respiratory diseases 0.26 0.12 0.13 0.07 0.16 0.08 0.21 0.10
Total causes attributable to tobacco use 1.77 0.65 0.65 0.28 1.28 0.53 0.95 0.31
Other causes not attributable to tobacco use 5.82 4.07 7.39 4.70 4.76 3.05 6.59 4.64
Total YLEL 7.59 4.72 8.04 4.99 6.04 3.58 7.53 4.95

Source: Argentina: ENFR 2013. MSAL-DEIS, 2012-2014 / Brazil: IBGE - PNS 2013. MS-SIM, 2012-2014 / Chile: ENS 2009-10. MINSAL-DEIS, 2009-2011 / Mexico: ENSANUT 2012. SSA-SINAIS, 2011-2013. Own research with Epidat (2016) 4.2

4. Discussion

The objective of this study was to compare the mortality attributable to tobacco use in selected Latin American countries between the years 2009 and 2013. We found that, between males, the most affected groups by mortality due to tobacco use were Argentinian men and, between females, were Argentinian women.

Differences in the level of mortality attributable to tobacco between the countries studied could be explained by the prevalence of tobacco use and the prevalence and incidence of NCD in each population. The first issue is related to the policies of prevention and promotion of health, and the second issue is associated with the health system in each country, in addition to epidemiologic transition and population aging in the countries studied.

Although the highest prevalence of tobacco use was recorded in Chile, both among men and women, the greatest loss of years of life expectancy was observed in Argentina. In the same way, although Mexico and Argentina have close smoking prevalence (slightly over 25% of men aged 35 and over currently smoke), the proportion of deaths attributable to this factor is higher in Argentina (14.4% versus 12.6%); and Mexican men lose less years of life expectancy (1.77 versus 0.95). The factors that can explain these facts could be found in the daily number of cigarettes smoked, the average age of the onset of smoking, the age at which former smokers quitted, among others.

In addition, highest loss of years of life expectancy observed in Argentina could be explained by policies applied against tobacco, related specially with protecting people from tobacco smoke. In this sense, in Chile, like Brazil and Mexico, the highest level of application of the MPOWER package was achieved, particularly in relation to tobacco monitoring and the application of control policies, and health warnings about tobacco hazards between three and six years earlier than in Argentina (Organización Panamericana de la Salud [OPS], 2016). Brazil, along with Uruguay and Panama, has been a continental leader in tobacco control; it has implemented progressively stronger tobacco control policies to more than halve smoking prevalence since 1980. In Argentina smoking rates are falling, but the country has yet ratify the WHO FCTC, and cigarettes are extremely affordable (Burki, 2017). In fact, in the group of 65 years and more the prevalence of ex-smokers in both sexes in almost every country is almost double that of smokers. What would be reflecting success in awareness are campaigns to stop smoking, combined with the abandonment of habit due to health complications.

Another explanation is related to incidence and treatment of illness associated to tobacco, and health system in each country. In Argentina and Chile, the main cause is neoplasms, especially cancer of the trachea, lung or bronchus with a 5-year survival rate of 49% (American Cancer Society, 2016), in Mexico and Brazil, it is the COPD, with a 5-year survival rate of 74% (Solanes & Casan, 2010).

Compared with figures from other countries, it is observed that, while Brazil and Mexico have an incidence of deaths caused by tobacco use lower than other countries, Argentina and Chile show values similar to those recorded in Spain (Gutiérrez-Abejón et al., 2015) and Uruguay (Sandoya & Bianco, 2011) and slightly higher than those observed in Paraguay (Sánchez & San Martín, 2010).

Estimates of the number of deaths attributable to tobacco use are lower than those achieved by other studies such as those carried out by the Institute for Clinical Effectiveness and Health Policy (IECS) work team (Instituto de Efectividad Clínica y Sanitaria [IECS], 2017a, 2017b, 2017c; Pinto et al., 2017), by Argentine Observatory on Drugs (Observatorio Argentino de Drogas, 2016), and by Guerrero López, Munos-Hernandez, Saenz De Miera-Juarez, & Reynales-Shigematsu (2013), particularly in Brazil and Mexico. Nevertheless, these differences can be possibly explained by the application of different methodologies, the selection of sources of information and the incorporation of parameters2

This paper has some limitations. One limitation of our study was related to the source of data of the Brazilian National Health Survey, because a person who smokes daily or occasionally is considered a smoker, and it did not inquire whether the person had smoked 100 or more cigarettes in their lifetime, like other sources of data. This fact could affect the prevalence of smoking in Brazil.

Another limitation was related to the quality of mortality data, with an underreporting of mortality of about 1% in Chile and of up to 9% in Brazil in 2009. Moreover, wrongly defined causes are high in Argentina and Brazil (around 8%) (Comisión Económica para América Latina y el Caribe [CEPAL], 2014). In addition, garbage codes are high in these countries: in average, in the period 1998-2011 about 22% in Argentina, 21% in Brazil, 6% in Mexico and 11% in Chile (World Health Organization, 2013). Both, underreporting of mortality and garbage codes could affect the prevalence of mortality related to tobacco, especially in Argentina and Brazil.

Finally, it is important to clarify that tobacco use is just one cause of disease, and non-communicable diseases are associated with the effects of multiple causes: genetic, lifestyle and environmental factors. In this sense, differences in mortality attributable to tobacco between these countries could reflect other factors not studied in this paper. For example, Mexican women had higher loss of years of life expectancy than Brazilian women due to respiratory diseases; despite Brazilian women had a higher prevalence of tobacco use than Mexican women. One possible explanation is that women in Mexico are more exposed to other risk factors to respiratory diseases (for example, occupational and environmental air pollution).

Financiamiento

Esta investigación fue financiada por Fondo para la Investigación Científica y Tecnológica (FONCyT), Proyectos de Investigación Científica y Tecnológica (PICT) N° 3238.

5. Conclusion

We found that the groups most affected by mortality due to tobacco use were Argentinian men and women, and this fact is according to incipient policy against tobacco in that country; while in Brazil, México and Chile tobacco policy control was implemented early. Despite this, tobacco use is still an important cause of death in these countries. The results of this study indicate the importance of considering tobacco consumption as a public health issue in these countries. Efforts to reduce tobacco use have been significant, but they are far from being sufficient. The Political Declaration of the High-level Meeting of the United Nations General Assembly on the Prevention and Control of Non-Communicable Diseases, adopted in September 2011, recognize that effective non-communicable disease prevention and control require leadership and multisectoral approaches for health at the government level, including, as appropriate, health in all policies and whole-of-government approaches across such sectors as health, education, energy, agriculture, sports, transport, communication, urban planning, environment, labour, employment, industry and trade, finance, and social and economic development (World Health Organization, 2014a).

References

Ahluwalia, I., Arrazola, R., & Graffunder, C. (2017). Measuring progress in tobacco prevention and control: the role of the surveillance. Salud Pública de México, 59(1), S10-S11. doi: http://dx.doi.org/10.21149/8209 [ Links ]

American Cancer Society (2016). Non-Small Cell Lung Cancer Survival Rates, by Stage. Atlanta: American Cancer Society, Inc. Retrived from https://www.cancer.org/cancer/non-small-cell-lung-cancer/detection-diagnosis-staging/survival-rates.htmlLinks ]

Arriaga, E. (2014). Análisis demográfico de la mortalidad. Córdoba, Argentina: Centro de Investigaciones y Estudios sobre Cultura y Sociedad. [ Links ]

Blanco, A., Sandoval. R., Martínez-López, L., & Caixeta, R. (2017). Diez años del Convenio Marco de la OMS para el Control del Tabaco: avances en las Américas. Salud Pública de México , 59(1), S117-S125. doi: http://dx.doi.org/10.21149/8682 [ Links ]

Burki, T. K. (2017). Latin America makes progress on tobacco control. The Lancet, 5 (6), 470. [ Links ]

Comisión Económica para América Latina y el Caribe (2014). Los datos demográficos. Alcances, limitaciones y métodos de evaluación. Santiago de Chile, Chile: Naciones Unidas. [ Links ]

Epidat. (2016). análisis epidemiológico de datos (Versión 4.2) [Software]. Consellería de Sanidade, Xunta de Galicia, España; Organización Panamericana de la salud (OPS-OMS); Universidad CES. [ Links ]

Ezzati, M., Vander Hoornm, S., Lopez, A., Danaei, G., Rodgers, A., Mathers, C., & Murray, C. (2006). Chapter 4: Comparative quantification of mortality and burden of disease attributable to selected risk factors. In A.Lopez, C. Mathers, M. Ezzati, D. Jamison, and C. Murray (Eds.), Global Burden of Disease and Risk Factors (pp. 241-268). Washington, DC: The International Bank for Reconstruction and Development/The World Bank and Oxford University Press. [ Links ]

Guerrero-Lopez, C. M., Munos-Hernandez, J. A., Saenz De Miera-Juarez, B., & Reynales-Shigematsu, L. M. (2013). Consumo de tabaco, mortalidad y política fiscal en México. Salud Pública de México , 55(suppl.2), S276-S281. [ Links ]

Gutiérrez-Abejón, E., Rejas-Gutiérrez, J., Criado-Espejel, P., Campo-Ortega, E., Breñas-Villalon, M., & Martín-Sobrino, N. (2015). Impacto del consumo de tabaco sobre la mortalidad en España en el año 2012. Medicina Clínica, 45(12), 532-533. doi: 10.1016/j.medcli.2015.03.013 [ Links ]

Instituto de Efectividad Clínica y Sanitaria. (2017a). El tabaquismo en Argentina. Buenos Aires, Argentina: Autor. Retrived from http://www.iecs.org.ar/wp-content/uploads/resumen-Infografi%C2%A6%C3%BCa.pdfLinks ]

Instituto de Efectividad Clínica y Sanitaria. (2017b). El tabaquismo en Chile. Buenos Aires, Argentina: Autor . Retrived from http://www.iecs.org.ar/wp-content/uploads/Flyer_tabaquismo_CHILE.pdfLinks ]

Instituto de Efectividad Clínica y Sanitaria. (2017c). El tabaquismo en México. Buenos Aires, Argentina: Autor . Retrived from http://www.iecs.org.ar/wp-content/uploads/Flyer_tabaquismo_MEXICO.pdfLinks ]

Mathers, C., Vos, T., Lopez, A., Salomon, J., & Ezzati, M. (Eds.) (2001). National Burden of Disease Studies: A Practical Guide. Edition 2.0. Geneva: Global Program on Evidence for Health Policy/World Health Organization. [ Links ]

Öberg, M., Jaakkola Maritta, S., Woodward, A, Peruga, A., & Prüss-Ustün, A. (2011). Worldwide Burden of disease from exposure to second hand smoke: a retrospective analysis of data from 192 countries. The Lancet , 377(9760), 8-14. doi: https://doi.org/10.1016/S0140-6736(10)61388-8 [ Links ]

Observatorio Argentino de Drogas (2016). Informe epidemiológico sobre el consumo de tabaco en Argentina. Buenos Aires, Argentina: SEDRONAR. [ Links ]

Organización Panamericana de la Salud (2016). Informe sobre el Control del Tabaco en la Región de las Américas. A los 10 años del Convenio Marco de la Organización Mundial de la Salud para el Control del Tabaco. Washington, DC: Autor. [ Links ]

Palloni, A., Novak, B., & Pinto-Aguirre, G. (2015). The Enduring Effects of Smoking in Latin America. American Journal of Public Health, 105(6), 1246-1253. doi: 10.2105/AJPH.2014.302420 [ Links ]

Pinto, M., Bardach, A., Palacios, A, Biz, A., Alcaraz, A., Rodríguez, B., Augustovski, F., & Pichon-Riviere, A. (2017) Carga de doença atribuível ao uso do tabaco no Brasil e potencial impacto do aumento de preços por meio de impostos. Buenos Aires, Argentina: IECS. [ Links ]

Sánchez, C., & San Martín, V. (2010). Mortalidad atribuible al tabaquismo durante los años 2001-2007 en Paraguay. Revista Paraguaya de Epidemiología, 1(1), 27-32. [ Links ]

Sandoya, E., & Bianco, E. (2011). Mortalidad por tabaquismo y por humo de segunda mano en Uruguay. Revista Uruguaya de Cardiología, 26(3), 201-206. [ Links ]

Solanes, I., & Casan, P. (2010). Causes of Death and Prediction of Mortality in COPD. Archivos de Bronconeumología, 46(7), 343-346. [ Links ]

United States Department of Health and Human Services (2014). The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, United States of America: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. [ Links ]

World Health Organization (2013). WHO methods and data sources for global causes of death 2000-2011. Geneva: Autor; Department of Health Statistics and Information Systems. [ Links ]

World Health Organization (2014a). Global status report on noncommunicable diseases 2014. Geneva: Autor. [ Links ]

World Health Organization (2014b). World health statistics 2014. Geneva: Autor . [ Links ]

World Health Organization (2016). Non-communicable diseases. Geneva: Autor . Retrived from http://www.who.int/mediacentre/factsheets/fs355/en/Links ]

World Health Organization (2017). WHO report on the global tobacco epidemic, 2017: monitoring tobacco use and prevention policies. Geneva: Autor . [ Links ]

Yamaguchi, N., Pilnik, N., De La Garza, J., Ashton, L., Garcia, A., Bianco, E., & Kevorkof, G. (2017). Tobacco Control Policies in Latin America. Journal of Thoracic Oncology, 12(1S), S56-S57. [ Links ]

12

Received: September 05, 2018; Revised: December 04, 2018; Accepted: December 15, 2018

Creative Commons License This is an open-access article distributed under the terms of the Creative Commons Attribution License