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

Smoking cessation: A genetic mutation involved in relapse

October 4, 2018
Why is it so difficult to stop smoking? Why do some people relapse months after giving up? Scientists from the Institut Pasteur and the CNRS, in collaboration with Sorbonne University and Inserm, have demonstrated that a ...

Study shows cigarillo flavors enhanced by high-intensity sweeteners

October 3, 2018
In a new study, Yale researchers found that popular brands of cigarillos are flavored with high-intensity sweeteners, potentially reducing the aversive sensation of smoking and making cigarillos more palatable. The concern ...

Leading addiction experts call for more neuroscience research on long-term recovery

September 24, 2018
September is addiction recovery month, and, in the midst of the current opioid epidemic, it's an apt moment for addiction research experts to map the future path forward for a long-term recovery strategy for substance abuse. ...

The connection between alcoholism and depression

September 21, 2018
Alcoholism and depression often go hand-in-hand.

Quitting junk food produces similar withdrawal-type symptoms as drug addiction

September 20, 2018
If you plan to try and quit junk food, expect to suffer similar withdrawal-type symptoms—at least during the initial week—like addicts experience when they attempt to quit using drugs.

Low academic achievement can lead to drug abuse decades later, research finds

September 13, 2018
A Virginia Commonwealth University researcher has found that poor academic achievement can lead to substance abuse. Data collected from Swedish participants over a period of 15 to 20 years indicate a strong correlation.

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.