Smoking- attributable mortality in Spain: A systematic review

Smoking-attributable mortality (SAM) is an indicator that reflects the evolution of the tobacco epidemic at the population level. The objective of this study is to identify and to describe published studies that have estimated SAM in Spain. A search in PubMed and EMBASE databases was performed, limited to studies published until April 15th, 2021. Studies that estimated SAM in Spain or its constituent regions were included. Of the 146 studies identified, 22 met eligibility criteria. The first estimate of SAM in Spain dates from 1978 and the last from 2017. Twelve of the studies found estimated SAM at national level, 8 in regions, 1 in a province and 1 in a city. Most estimates were made for adults aged over 34, categorized as smokers, ex-smokers and never smokers. Observed mortality derived, in all studies, from official records, and relative risks mostly from Cancer Prevention Study II. In the period analyzed, a decrease in the burden of SAM was observed. In Spain, different SAM estimates are available globally, but they do not have regular periodicity, and such estimates are infrequently made by region. Due to variations in methodology and data sources, it is difficult to assess changes in SAM. Having global and regional periodic estimates would be necessary to correctly monitor the tobacco epidemic in Spain.