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Original Article Smoking-attributable Mortality in Korea, 2020: A Meta-analysis of Four Databases
Eunsil Cheon1orcid , Yeun Soo Yang2orcid , Suyoung Jo1orcid , Jieun Hwang3orcid , Keum Ji Jung2orcid , Sunmi Lee4orcid , Seong Yong Park5,6orcid , Kyoungin Na7orcid , Soyeon Kim7orcid , Sun Ha Jee2corresp_iconorcid , Sung-il Cho1,8corresp_iconorcid

DOI: https://doi.org/10.3961/jpmph.23.471 [Accepted]
Published online: July 3, 2024
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1Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Korea
2Department of Epidemiology and Health Promotion, Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea
3College of Health and Welfare, Department of Health Administration, Dankook University, Cheonan, Korea
4Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, Korea
5Department of Big Data Management, National Health Insurance Service, Wonju, Korea
6Department of Health Administration, Yonsei University Graduate School, Wonju, Korea
7Division of Health Hazard Response, Korea Disease Control and Prevention Agency, Osong, Korea
8Institute of Health and Environment, Graduate School of Public Health, Seoul National University, Seoul, Korea
Corresponding author:  Sun Ha Jee,
Email: persontime@hotmail.com
Sung-il Cho,
Email: persontime@hotmail.com
Received: 23 October 2023   • Revised: 1 May 2024   • Accepted: 3 May 2024

Objectives
Estimating the number of deaths caused by smoking is crucial for developing and evaluating tobacco control and smoking cessation policies. This study aimed to determine smoking-attributable mortality (SAM) in Korea in 2020.
Methods
Four large-scale cohorts from Korea were analyzed. A Cox proportional-hazards model was used to determine the hazard ratios (HRs) of smoking-related death. By conducting a meta-analysis of these HRs, the pooled HRs of smoking-related death for 41 diseases were estimated. Population-attributable fractions (PAFs) were calculated based on the smoking prevalence for 1995 in conjunction with the pooled HRs. Subsequently, SAM was derived using the PAF and the number of deaths recorded for each disease in 2020.
Results
The pooled HR for all-cause mortality attributable to smoking was 1.73 for current male smokers (95% CI, 1.532-1.954) and 1.631 for current female smokers (95% CI, 1.371-1.94). Smoking accounted for 33.2% of all-cause deaths in men and 4.6% in women. Additionally, it was a factor in 71.8% of male lung cancer deaths and 11.9% of female lung cancer deaths. In 2020, smoking was responsible for 53,930 male deaths and 6,283 female deaths, totaling 60,213 deaths.
Conclusions
Cigarette smoking was responsible for a significant number of deaths in Korea in 2020. Monitoring the impact and societal burden of smoking is essential for effective tobacco control and harm prevention policies.

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JPMPH : Journal of Preventive Medicine and Public Health