Walsh Michael, Wright Karen
Epidemiologist, Planning Funding and Outcomes, Waitemata District Health Board, Auckland.
Public Health Registrar, Planning Funding and Outcomes, Waitemata District Health Board, Auckland.
N Z Med J. 2020 Feb 7;133(1509):28-38.
To determine the contribution of smoking-related deaths to the life expectancy gap in both Māori and Pacific people compared with non-Māori/non-Pacific people in New Zealand.
Death registration and population data between 2013 and 2015 were used to calculate life expectancy. To determine the contribution of smoking to the life expectancy gap, population attributable fractions for all causes of death where smoking is a casual risk factor were calculated using age- and ethnic-specific smoking data from the 2013 New Zealand Census and relative risk estimates from the American Cancer Society Cancer Prevention Study II. Population attributable fractions were applied to all deaths registered in New Zealand for the 2013-15 period to estimate the number of deaths attributable to tobacco smoking. The life expectancy gap was decomposed using the Arriaga method. The gap was decomposed both overall and by specific smoking attributable causes of death.
Between 2013 and 2015 an estimated 12,421 (13.4% of all deaths) were attributable to smoking. Nearly one in four (22.6%) deaths among Māori were attributable to smoking (2,199 out of 9,717 deaths) and nearly one in seven (13.8%) among Pacific people (512 out of 3,720 deaths). Among non-Māori/non-Pacific people, one in eight (12.3%) deaths were attributable to smoking (9,710 out of 78,759 deaths). Higher rates of smoking attributable mortality were responsible for 2.1 years of the life expectancy gap in Māori men, 2.3 years in Māori women, 1.4 years in Pacific men and 0.3 years among Pacific women. Cancers of the trachea, bronchus and lung, chronic obstructive pulmonary disease (COPD) and ischaemic heart disease were the leading smoking attributable causes of death contributing to the gap.
Smoking is an important preventable risk factor contributing to ethnic inequities in life expectancy for Māori men and women, and Pacific men. Dramatic declines in smoking-attributable deaths can be achieved by reducing smoking prevalence rates. Preventing smoking initiation and increasing cessation rates must remain a top priority for the Ministry of Health and District Health Boards. Smokefree initiatives should be reoriented to be Tiriti o Waitangi (Treaty of Waitangi) compliant and better meet the needs of Māori and Pacific people who smoke. Addressing the residual risk in ex-smokers through equitable early diagnosis and treatment of smoking-related conditions will further assist a more rapid closing of life expectancy gaps for Māori men and women and Pacific men. The next five years provide the opportunity to demonstrate commitment to achieving a smokefree Aotearoa for all: an aspiration, based on the current trajectory, which is most probably out of reach.
确定与吸烟相关的死亡对新西兰毛利人和太平洋岛民与非毛利/非太平洋岛民预期寿命差距的影响。
利用2013年至2015年的死亡登记和人口数据计算预期寿命。为确定吸烟对预期寿命差距的影响，使用2013年新西兰人口普查中按年龄和种族划分的吸烟数据以及美国癌症协会癌症预防研究II的相对风险估计值，计算吸烟作为偶然风险因素的所有死因的人群归因分数。将人群归因分数应用于2013 - 15年在新西兰登记的所有死亡病例，以估计归因于吸烟的死亡人数。使用阿里亚加方法分解预期寿命差距。该差距按总体以及特定的吸烟归因死因进行分解。
2013年至2015年期间，估计有12421例死亡（占所有死亡人数的13.4%）可归因于吸烟。毛利人中有近四分之一（22.6%）的死亡可归因于吸烟（9717例死亡中有2199例），太平洋岛民中有近七分之一（13.8%）的死亡可归因于吸烟（3720例死亡中有512例）。在非毛利/非太平洋岛民中，八分之一（12.3%）的死亡可归因于吸烟（78759例死亡中有9710例）。吸烟归因死亡率较高导致毛利男性预期寿命差距2.1年，毛利女性2.3年，太平洋男性1.4年，太平洋女性0.3年。气管、支气管和肺癌、慢性阻塞性肺疾病（COPD）和缺血性心脏病是导致差距的主要吸烟归因死因。
吸烟是导致毛利男性和女性以及太平洋男性预期寿命存在种族不平等的一个重要可预防风险因素。通过降低吸烟流行率可大幅减少吸烟归因死亡人数。预防吸烟起始和提高戒烟率必须仍然是卫生部和地区卫生局的首要任务。无烟倡议应重新定位，以符合《怀唐伊条约》（Tiriti o Waitangi），并更好地满足吸烟的毛利人和太平洋岛民的需求。通过公平的早期诊断和治疗与吸烟相关的疾病来解决戒烟者的残余风险，将进一步有助于更快缩小毛利男性和女性以及太平洋男性的预期寿命差距。未来五年提供了一个机会，以表明致力于为所有人实现无烟的新西兰：基于当前轨迹，这一愿望很可能无法实现。
