Tobacco-related and tobacco-attributable cancer mortality in Spain, 1999–2023: Trends and gender inequalities

Abstract

Background

Tobacco is the leading risk factor for multiple cancers. Changes in smoking patterns make it essential to assess trends in mortality from tobacco-related cancers in Spain between 1999 and 2023, by sex, age and autonomous community, as well as to estimate tobacco-attributable cancer mortality in individuals aged ≥ 35 years and explore gender inequalities.

Methods

Deaths from cancers strongly associated with tobacco use (ICD-10: C00-15; C32-34; C67) were analyzed for the period 1999−2023. Age-adjusted mortality rates were calculated and trends were assessed using joinpoint regression models. Tobacco-attributable mortality was estimated by combining smoking prevalence, relative risks for current and former smokers, and the number of deaths, obtaining population attributable fractions in individuals aged ≥ 35 years.

Results

Between 1999 and 2023, mortality decreased among men for all studied cancers (−27.9% for lung cancer; −56.4% for laryngeal cancer). In women, mortality increased for lung cancer (+104.1%), lip-oral cavity-pharynx cancer (+30.0%) and laryngeal cancer (+16.3%), with the greatest increase observed among women aged 55–69 years (+219.1% in lung cancer). Across autonomous communities, men showed widespread declines, whereas increases were observed in most regions among women. Between 2000 and 2023, tobacco use caused more than 600,000 cancer deaths (two-thirds due to lung cancer).

Conclusions

Mortality from tobacco-related cancers shows divergent trends by sex, highlighting the need to strengthen tobacco control and prevention policies with a gender perspective, and to continue monitoring smoking patterns and related mortality.