Demographic ageing and the evolution of smoking-attributable mortality: the example of Germany

Objective We sought to quantify the evolution of smoking-attributable mortality (SAM) in Germany and explore the impact of demographic ageing. Methods Smoking and mortality statistics from 1992 to 2013 were obtained from the German Statistical Office, from which SAM was calculated separately for each cause of death. The impact of demographic ageing was explored by comparing actual (crude) and age-standardised SAM. In order to estimate the impact of demographic ageing on future SAM, a forward projection until 2035 was modelled (assuming continuation of recent trends in smoking rates and constant cause-specific mortality rates). Results Total SAM only slightly declined from 139 000 cases in 1992 to 125 000 cases in 2013 (-10%), despite a decrease in age-adjusted SAM by 33%. Differences between actual and age-standardised SAM were particularly striking in men. While the age-standardised SAM in men decreased nearly by half, SAM remained more or less stable in women. The forward projection of SAM suggests that demographic ageing will lead to a further steady increase in SAM within the next two decades, for both, men and women. Conclusions Especially in men, actual SAM hardly declined despite a sharp drop in age-standardised SAM, indicating that decreases were largely compensated by demographic ageing. The increasing number of deaths resulting from the ageing population will lead to a steady increase in SAM in the near future if no efforts are taken to curb smoking.