Estimates of burden of disease due to SHS
Two major reports about the burden of disease due to SHS have been published in the past 10 years in Europe: the ‘Analysis of the Science and Policy in Europe for the Control of Tobacco’ (ASPECT) report in 2005; and ‘Lifting the Smokescreen: 10 Reasons for a Smoke Free Europe’ by the Smoke Free Partnership (SFP) in 2006. Both dealt with the extent of SHS health effects in European countries and with economic considerations. The SFP report estimated that 79 449 adults died because of SHS exposure in the European Union in 2002 and also estimated mortality for each separate member state. In March 2010, the Royal College of Physicians issued a report entitled ‘Passive Smoking and Children’. It focused on the UK but also presented evidence from the world literature on the harmful effects of passive smoking on fetal and reproductive health. The report’s authors estimated that in the UK, SHS causes 121 400 new cases of middle ear disease, 20 500 new lower respiratory tract infections and 22 600 new cases of wheeze, as well as 40 cases of SIDS each year.
According to the 1992 EPA report, ETS is estimated to cause around 3000 lung cancer deaths per year among nonsmokers (never-smokers and former smokers) of both sexes in the USA. While there are statistical and modelling uncertainties in this estimate, and the true number may be higher or lower, the overall confidence in this estimate is medium to high, and the assumptions used when calculating it would tend to underestimate the actual population risk.
The ETS exposure of young children and particularly infants from parental (and especially maternal) smoking is causally associated with an increased risk of lower respiratory tract infections (pneumonia, bronchitis, and bronchiolitis). The EPA report estimated, with high confidence, that exposure to ETS in the USA causes 150 000–300 000 of these infections annually in infants and children less than 18 months old, resulting in 7500–15 000 hospital admissions. Children up to 3 years of age were at increased risk of lower respiratory tract infections, but no estimated figures were derived for children over 18 months old.
The report also estimated that ETS exposure exacerbates symptoms in approximately 20% of the 2–5 million asthmatic children in the USA, and is a major aggravating factor in approximately 10%.