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

October 25, 2011, British Medical Journal

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 from smoking are potentially flawed.

They looked at just over 2,000 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 and (). 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 , which included diagnoses linked to alcohol use.

"Death certification is an important source of 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 on the death certificate. It is clear that the current arrangements fail to achieve this," they conclude.

Related Stories

Recommended for you

Cannabinoids are easier on the brain than booze, study finds

February 9, 2018
Marijuana may not be as damaging to the brain as previously thought, according to new research from the University of Colorado Boulder and the CU Change Lab.

Marijuana use may not aid patients in opioid addiction treatment

December 4, 2017
Many patients who are being treated for opioid addiction in a medication-assisted treatment clinic use marijuana to help manage their pain and mood symptoms.

For opiate addiction, study finds drug-assisted treatment is more effective than detox

November 23, 2017
Say you're a publicly insured Californian with an addiction to heroin, fentanyl or prescription narcotics, and you want to quit.

Study finds medical cannabis is effective at reducing opioid addiction

November 17, 2017
A new study conducted by researchers at The University of New Mexico, involving medical cannabis and prescription opioid use among chronic pain patients, found a distinct connection between having the legal ability to use ...

Insomnia linked to alcohol-use frequency among early adolescents, says new psychology study

November 8, 2017
Insomnia is linked to frequency of alcohol use among early adolescents, according to new Rutgers University–Camden research.

Large declines seen in teen substance abuse, delinquency

October 25, 2017
More than a decade of data indicates teens have become far less likely to abuse alcohol, nicotine and illicit drugs, and they also are less likely to engage in delinquent behaviors, such as fighting and stealing, according ...

2 comments

Adjust slider to filter visible comments by rank

Display comments: newest first

dogbert
1.4 / 5 (9) Oct 25, 2011
Physicians may be expected to recognize that correlation is not causation.
rawa1
not rated yet Oct 25, 2011
It still doesn't explain, why they don't recognize it so well at the case of alcohol deaths...;-)

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.