To quantify the medical consequences of the tobacco use in the Netherlands for the past 50 years and the near future.
Theoretical study based on the national death records and published risks by cause of death of tobacco use.
Observed lung cancer mortality (1950-1999) was related to birth cohort and age by a statistical model (according to Peto), and then projected into the near future. The smoking intensity was defined as the difference between the expected lung-cancer mortality if no one smoked and the observed lung-cancer mortality. Using this smoking intensity and published risks for other smoking-related causes of death, the model provided estimates of smoking-related mortality by age, sex and cause of death.
In 1999, 18 (women) and 32 (men) of all mortality before the age of 70 was attributable to smoking. If no one had smoked, Dutch life expectancy for men and women would have been 3 years and 1 year higher, respectively. Between 1950 and 1999, 13 of all deaths were caused by smoking, the large majority (> 90) of which occurred among men. Between 2000 and 2015, slightly more deaths are to be attributed to smoking (14), 62 of which will be among men. In 2015, women will have caught up with men in terms of absolute numbers of lung-cancer mortality.
Around one quarter of premature deaths were caused by smoking. In the near future, women of the baby-boom generation will have reached middle age and the highest (relative) smoking-related risks. It is important that clinical practice takes this increased risk of disease into account among middle-aged women who smoke.