Smoking-attributable burden of lung cancer in the Philippines: a comparative risk assessment

• Published in: The Lancet (British edition) 2013-06, Vol.381 (S2), p.S15-S15
• Main Authors: Bilano, Ver Luanni F, MS, Borja, Maridel P, Prof, Cruz, Eduardo L, MS, Tan, Alvin G, MS, Mortera, Lalaine L, MD, Reganit, Paul Ferdinand M, MD
• Format: Article
• Language: English
• Subjects: comparative risk assessment; disability-adjusted life year; Epidemiology; expert opinion; Internal Medicine; issues and policy; Lung cancer; lung neoplasms; males; monitoring; Monte Carlo method; Monte Carlo simulation; Mortality; Risk assessment; risk assessment process; sales; Smoking; Taxation; taxes; tobacco; uncertainty analysis; World Health Organization
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(13)61269-6

Abstract Background Smoking is highly prevalent in the Philippines. Tobacco control policies fail to fully implement the WHO Framework Convention on Tobacco Control provisions, especially with respect to taxation, smoking bans, sales and marketing restrictions, and cessation support. To aid in policy change and intervention implementation, monitoring, and evaluation, this study aimed to provide the most recent (2008) estimates for the Philippines of: (1) disability-adjusted life-years (DALYs) lost due to lung cancer; (2) population-attributable fractions (PAFs) for smoking; and (3) smoking-attributable lung cancer DALYs. Methods This study applied the Global Burden of Disease and Comparative Risk Assessment frameworks to secondary data, supplemented by local expert opinion. A comprehensive internally consistent assessment of disease epidemiology was conducted using the DisMod II model, and disease impact was quantified in the form of DALYs. PAFs were calculated using the smoking impact ratio, which indirectly estimates accumulated smoking exposure. Uncertainty analyses to obtain intervals were conducted per age–sex group via Monte Carlo simulations. Findings For the 2008 Philippine population, aggregated lung cancer incidence and mortality estimates were 10 871 cases and 9871 deaths, respectively. Lung cancer accounted for the loss of an aggregated estimate of 104 442 DALYs, 99% of which were due to years of life lost. Overall, the aggregated PAF for smoking was 62%, and an aggregated total of 64 913 DALYs were attributable to smoking. There were increasing trends in incidence, mortality, and DALY losses with age, the majority of which occurred among males, who also had higher PAF estimates. Interpretation Considerable health gains could be achieved if smoking exposure were eliminated or reduced in the Philippines. Prevention of initiation and support for cessation of smoking through strong enforcement of measures, such as increasing taxation to the WHO-endorsed rate, more stringent sales and marketing restrictions, and development and scaling up of smoking cessation programmes is recommended. Funding None.