{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T11:06:42Z","timestamp":1789556802692,"version":"build-2803163510"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2022,11,17]],"date-time":"2022-11-17T00:00:00Z","timestamp":1668643200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Carlos III Institute of Health","award":["PI19\/00288"],"award-info":[{"award-number":["PI19\/00288"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,11,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>This study sought to analyse the trend in smoking-attributable mortality (SAM) in Spain among the population aged \u226535\u2009years across the period 1990\u20132018.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>SAM was estimated by applying a prevalence-independent method, which uses lung cancer (LC) mortality as a proxy of tobacco consumption. We sourced observed mortality from the National Institute of Statistics (Spain), LC mortality rates in smokers and never smokers from the Cancer Prevention Study I\u2013II, and relative risks from 5 US cohorts. Estimates of annual SAM by cause of death, sex and age are shown, along with crude and annual standardised SAM rates. The trend in standardised all-cause and LC rates was analysed using a joinpoint regression model.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Tobacco caused 1\u2009717\u2009150 deaths in Spain in the period 1990\u20132018. Among men, cancers replaced cardiovascular diseases\u2013diabetes mellitus (CVD\u2013DM) as the leading group of tobacco-related cause of death in 1994. Among women, CVD\u2013DM remained the leading cause of death throughout the period. Trend analysis of standardised SAM rates due to all causes and LC showed a decrease in men and an increase in women.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The tobacco epidemic in Spain across the period 1990\u20132018 has had an important impact on mortality and has evolved differently in both genders. SAM is expected to increase dramatically in women in the coming years. SAM data highlight the importance of including a gender perspective in SAM analyses, in designing more effective and comprehensive public health interventions and in developing gender-specific tobacco control policies to curb tobacco consumption.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/eurpub\/ckac165","type":"journal-article","created":{"date-parts":[[2022,11,17]],"date-time":"2022-11-17T17:49:10Z","timestamp":1668707350000},"page":"919-925","source":"Crossref","is-referenced-by-count":24,"title":["Trends in smoking-attributable mortality in Spain: 1990\u20132018"],"prefix":"10.1093","volume":"32","author":[{"given":"Julia","family":"Rey-Brandariz","sequence":"first","affiliation":[{"name":"Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela , Santiago de Compostela, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00f3nica","family":"P\u00e9rez-R\u00edos","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela , Santiago de Compostela, Spain"},{"name":"Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiolog\u00eda y Salud P\u00fablica\/CIBERESP) , Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Isolina","family":"Santiago-P\u00e9rez","sequence":"additional","affiliation":[{"name":"Epidemiology Department, Directorate-General of Public Health, Galician Regional Health Authority , Santiago de Compostela, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0624-9993","authenticated-orcid":false,"given":"I\u00f1aki","family":"Gal\u00e1n","sequence":"additional","affiliation":[{"name":"National Centre for Epidemiology, Carlos III Institute of Health , Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Schiaffino","sequence":"additional","affiliation":[{"name":"Directorate-General of Health Planning, Health Department, Catalonian Regional Authority , Barcelona, Spain"},{"name":"Catalonian Institute of Oncology , Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonor","family":"Varela-Lema","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela , Santiago de Compostela, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agust\u00edn","family":"Montes","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela , Santiago de Compostela, Spain"},{"name":"Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiolog\u00eda y Salud P\u00fablica\/CIBERESP) , Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Esther","family":"L\u00f3pez-Vizca\u00edno","sequence":"additional","affiliation":[{"name":"Galician Statistics Institute , Santiago de Compostela, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Giraldo-Osorio","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela , Santiago de Compostela, Spain"},{"name":"Department of Public Health, University of Caldas , Manizales, Colombia"},{"name":"Carolina Foundation , Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Candal-Pedreira","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela , Santiago de Compostela, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Ruano-Ravina","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela , Santiago de Compostela, Spain"},{"name":"Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiolog\u00eda y Salud P\u00fablica\/CIBERESP) , Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,11,17]]},"reference":[{"key":"2023091019092505300_ckac165-B1","volume-title":"Smoking and Healht: Report of the Advisory Committee to the Surgeon General of the Public Health Service","author":"National Center for Chronic Disease Prevention and Health Promotion","year":"1964"},{"key":"2023091019092505300_ckac165-B2","volume-title":"The Health Consequences of Smoking: 50 Years of Progress. 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