1. Tobacco attributable hospitalizations in BC; geographic variations, temporal trends and burden relative to alcohol and illicit drugs Jane Buxton jane.buxton@bccdc.ca jane.buxton@bccdc.ca Andrew Tu & Tim Stockwell

2. Harms of tobacco Tobacco kills 47,000 Canadians every year Tobacco is the leading cause of preventable deaths; Doll and Hill BMJ 1950 Harms include Cancer Reproductive effects Respiratory & cardiovascular disease Highly addictive to many consumers Harms not just to those who choose to consume, but to others exposed including children

3. Aggressively promoted by powerful industry

4. Rehm et al Cost of substance abuse in Canada 2002 Included law enforcement, loss of productivity from premature death and disability and overall social cost –Tobacco $17.0 B (42.7%) –Alcohol $14.6 B (36.6%) –Illegal drugs $ 8.3 B (20.7%) Productivity losses $24.3B Health care $8.8B Law enforcement $5.4B

5. Objective To calculate standardized rates of hospital separations attributable to tobacco, alcohol and illicit dugs in BC using aetiologic fractions To allow comparisons by region,sex,age groups and time for each/btw substance AOD

6. Methods Ministry of Health, hospital separation data – Discharge Abstract Data base Methods developed by English in Australia 1995 to derive attributable (aetiologic) fractions using relative risks & prevalence exposure Combine into overall categories of substance related harm (tobacco, alcohol and illicit drugs) to estimate burden related to each

7. Disease categories attributable to tobacco

8. Disease categories attributable to tobacco continued

10. Hospital discharges attributable to tobacco

11. Age standardized rates of tobacco attributable hospitalizations by gender

12. Age & sex standardized rates of hospital discharges attributable to tobacco by HA 2002-05 Smoking rates in BC 2006 (BC Stats) Northern 26% Interior – 21% Fraser – 16% BC = 18% Vancouver Island 20% Vancouver Coastal 14%

14. Age & sex standardized rates of hospital discharges attributable to illicit drugs by HA

15. Number of 2005 hospital discharges attributable to AOD Tobacco = 27,622 (36% female) Alcohol = 14,790 (37% female) Illicit drugs = 4,817 (43% female)

16. Number of 2005 hospital discharges attributable to AOD by sex & HA

17. 2005 age & sex standardized rates hospital discharges attributable to AOD /100,000 AlcoholIllicit DrugsTobacco Interior Health394127721 Fraser Health30196631 Vancouver Coastal26179478 Vancouver Island357116560 Northern Health554130881 BC338114611

18. Where next? Requested DAD 2006 (+ before) by HSDA Ongoing reports, improve prevalence data Share methods and lessons learned with other provinces to ensure consistency & comparability of data Vital stats arrived

19. ≤ 90.0 Number of Deaths in 2006 Attributable to Tobacco per 100,000 People for the 16 Health Service Districts in British Columbia Central Vancouver Island42Northeast53 East Kootenay11Northern Interior52 Fraser East21Northwest51 Fraser North22Okanagan13 Fraser South23Richmond31 Kootenay Boundary12South Vancouver Island41 North Shore/Coast Garibaldi 33 Thompson Cariboo Shuswap 14 North Vancouver Island43Vancouver32

20. Conclusions Tobacco accounts for 5X hospital admissions attributable to illicit drugs Tobacco rates stable, variation btw HA may reflecting smoking rates, alcohol slight increase but persistent increase illicit drugs Ongoing analysis of morbidity data will inform health authorities and policy makers; and help to evaluate interventions and policies.

21. Acknowledgement for assistance and support Jurgen Rehm and team; CAMH, Toronto Tanya Chikritzhs; National Drug Research Institute, Australia THANK YOU!

22. Burden of Disease Relative risk method AF= [ ∑ k i=1 P i (RR i - 1)] / [ ∑ k i=0 P i (RR i - 1) +1 ] where K = total levels of exposure i: exposure category with baseline exposure or no exposure i = 0 RR i : relative risk at exposure level i vs. no consumption (mb different by sex/age) P i : prevalence of the ith category of exposure (mb different consumption level) Overall attributable fraction for the population is: the product of the attributable fraction among the exposed and the proportion of exposed cases The AF is then multiplied with the total mortality to get the burden of disease