Racial backgrounds key to shaping the face of smoking-related mortality in South Africa

Image: PD 

1. Smoking prevalence among colored (mixed black and white ancestry) individuals in South Africa is substantially higher than individuals of either white or African race. 

2. Mixed-race smokers suffer a two-fold increase in mortality as compared to white smokers. 

Evidence Rating Level: 3 (Average) 

Study Rundown: The apartheid period in South African history has had lingering effects not only on the social framework of the country but on the health of the population as well. South Africa is the only country to date that inquires about smoking history during routine death notification. The authors of this study capitalized on this unique source of data to study smoking-related mortality outcomes. Comparing mixed-race to white- and African-raced individuals, the authors found that there was a higher prevalence of smoking among mixed (men 35-39yo, 72.5%; women 35-39yo, 51.7%) as compared to whites (men 35-39yo, 45.3%; women 35-39yo, 24.5%) or Africans (men 35-39yo, 50.7%; women 35-39yo, 8.1%).  The authors also noted the increase in mortality among mixed-race smokers (as compared to non- or ex-smokers) was >50% higher than that seen in White or African smokers (as compared to their non- or ex-smoking peers). Limitations in this study included the fact that 73% of the original data set was excluded due to one or more missing pieces of information on the death notification. However, a sensitivity analysis indicated that restoration of these points would have made little difference in the final results.

Click to read the study in The Lancet

Relevant Reading: Recent trends in smoking prevalence in South Africa–some evidence from AMPS data

Lead author, Professor Debbie Bradshaw, MSc, DPhil, Director of the Burden of Disease Research Unit of the South African Medical Research Council speaks to 2 Minute Medicine: 

“There is already a high death rate from smoking in the mixed-ancestry coloured population of South Africa, and there will be major increases in tobacco-attributed mortality in many other African populations where young adults now smoke, unless there is widespread cessation.”

In-Depth [case-control study]: This study included 481,640 South African notifications of death between the ages of 35-74. Information on age, sex, province, marital status, and smoking status was gathered from these notifications. Deaths related to smoking were defined as tuberculosis, chronic obstructive pulmonary disease (COPD), other respiratory disease, stroke, cardiovascular disease, myeloid leukemia, lung cancer, upper aerodigestive tract cancer, urinary tract or female genital tract cancer, Parkinson’s disease, ulcerative colitis, and endometrial cancer. From the collected data the authors found that in men, mixed-race individuals have a relative risk (RR) of (1.55, 1.43-1.67), while whites and Africans have lower RRs of (1.37, 1.29-1.46) and (1.17, 1.15-1.19) respectively. In women, the data showed the highest RR in whites at (1.51, 1.40-1.62), followed by the mixed-race population (1.49, 1.38-1.60), and the African population (1.16, 1.13-1.20). The absolute risk per smoker was much greater in the mixed-race group compared to the white population (men 14.2% vs. 7.6%, women 11.0% vs. 7.7%).

By Devin Miller and Mimmie Kwong

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