Proposed changes to how smoking-attributable risk is calculated

Smoking remains the biggest single cause of preventable mortality and morbidity in the world and accounts for 1 in 6 deaths in England. There are well-documented links between smoking and a number of diseases such as a variety of cancers, respiratory diseases, heart disease and mental ill-health.

For these diseases, it is possible to calculate the ratio of the probability of them occurring in the exposed group (smokers or ex-smokers) versus the probability them occurring in the non-exposed group (never smoked). This is called the extent to which each of the diseases can be attributed to smoking and is calculated using a relative risk (a fraction between 0 and 1) and is specific to each disease, age group and sex, in some cases differs for smokers and ex-smokers. These relative risks are combined with smoking prevalence information in order to create a smoking-attributable fraction, which is the proportion of a disease that can be attributed to smoking. These are used to calculate various indicators for smoking-attributable mortality and hospital admissions.

The current relative risks calculation of smoking-attributable fractions are based on data from ‘The Health Consequences of Smoking: A Report of the Surgeon General’ using data from 1982 to 1988. We propose to update the list of relative risks to a subset of those in the report published by the Royal College of Physicians in 2018.

The consultation document outlines our proposal, why we propose the changes and the methodology we propose to use.

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