Doctors happily cite alcohol as cause of death, but not smoking, for fear of stigmatization

October 24, 2011

UK doctors are willing to cite alcohol as a cause of death on death certificates, but not smoking, for fear of stigmatising the deceased, shows research published online in the Journal of Clinical Pathology.

This has implications for the true extent of the impact of smoking on health, say the researchers, who point out that the current statistical estimates of the death toll from smoking are potentially flawed.

They looked at just over 2,000 death certificates and 236 post mortem reports, issued at a large London teaching hospital between 2003 and 2009, to see what cause of death doctors had cited.

Doctors have been allowed to cite smoking and alcohol as a direct or underlying cause of death without the need to refer the case to a coroner since 1992.

Smoking was identified as the cause of death in only two certificates (0.1% of the total) and included in part II of the death certificate, which outlines other contributory conditions, in only 10 cases (0.5% of the total).

The two cases in which smoking was cited were lung cancer and chronic obstructive pulmonary disease (COPD). Yet 279 deaths included these diagnoses, and in most cases the deceased was a current (over 45%) or former (over 23%) smoker. It is well known that smoking is the primary cause of both lung cancer and COPD.

In all, 407 deaths were caused by conditions in which smoking is thought to have a substantial role. Yet smoking was cited as the cause of death in only two of these certificates and as a contributory factor in six.

The post mortem reports were no better: not a single case cited smoking as causing or contributing to death, which the authors describe as "surprising."

Yet doctors willingly cited alcohol as a direct or contributory cause of death. This was cited in over half (57.4%) of the 54 death certificates, which included diagnoses linked to alcohol use.

"Death certification is an important source of mortality data and directly captures 99.79% of all deaths in the UK," say the authors, who point out that the doctors in this study are not unique in their reluctance to cite smoking as a cause of death.

"There are many reasons why smoking is not cited as a [cause of death] by doctors in the UK," they write. "The first and frequently debated reason relates to doctors' desire not to cause relatives distress by stigmatising the deceased and their smoking habit."

They continue: "While the results of this study would support this assumption, it is interesting that the same clinicians frequently cited alcohol use as an underlying cause of death."

This may be because alcohol use is generally more accepted culturally, suggest the authors, adding that the stigma associated with smoking is well documented, and may be worsening as a result of the recent legislation, banning smoking in public places.

"Given the overwhelming evidence showing a causal link between smoking and certain terminal conditions, more effort should be made to record smoking on the death certificate. It is clear that the current arrangements fail to achieve this," they conclude.
-end-


BMJ

Related Lung Cancer Articles from Brightsurf:

State-level lung cancer screening rates not aligned with lung cancer burden in the US
A new study reports that state-level lung cancer screening rates were not aligned with lung cancer burden.

The lung microbiome may affect lung cancer pathogenesis and prognosis
Enrichment of the lungs with oral commensal microbes was associated with advanced stage disease, worse prognosis, and tumor progression in patients with lung cancer, according to results from a study published in Cancer Discovery, a journal of the American Association for Cancer Research.

New analysis finds lung cancer screening reduces rates of lung cancer-specific death
Low-dose CT screening methods may prevent one death per 250 at-risk adults screened, according to a meta-analysis of eight randomized controlled clinical trials of lung cancer screening.

'Social smokers' face disproportionate risk of death from lung disease and lung cancer
'Social smokers' are more than twice as likely to die of lung disease and more than eight times as likely to die of lung cancer than non-smokers, according to research presented at the European Respiratory Society International Congress.

Lung cancer therapy may improve outcomes of metastatic brain cancer
A medication commonly used to treat non-small cell lung cancer that has spread, or metastasized, may have benefits for patients with metastatic brain cancers, suggests a new review and analysis led by researchers at St.

Cancer mortality continues steady decline, driven by progress against lung cancer
The cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported.

Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.

Lung transplant patients face elevated lung cancer risk
In an American Journal of Transplantation study, lung cancer risk was increased after lung transplantation, especially in the native (non-transplanted) lung of single lung transplant recipients.

Proposed cancer treatment may boost lung cancer stem cells, study warns
Epigenetic therapies -- targeting enzymes that alter what genes are turned on or off in a cell -- are of growing interest in the cancer field as a way of making a cancer less aggressive or less malignant.

Are you at risk for lung cancer?
This question isn't only for people who've smoked a lot.

Read More: Lung Cancer News and Lung Cancer Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.