As seen from the above sections, tobacco causes a wide range of diseases and ill health. In turn, the sequelae of these diseases is widely varied. For example, the five-year survival rate for lung cancer is around 10%.(3,151) This rate has not changed in 20 years, and early detection and treatment do little to improve this poor outcome.(3) One in four heart attack victims dies before reaching hospital, and almost half will not survive a year.(152) On the other hand, those with chronic bronchitis or emphysema may suffer with their diseases for many years.(38) Those who have suffered a stroke may survive, but may require extended hospitalisation and rehabilitation, and suffer permanent disability.
Tobacco is a major cause of morbidity in the community. An Australian study estimated that in 1992, patients with tobacco caused disease experienced nearly 100,000 hospital episodes, resulting in over 800,000 hospital bed-days. Ill health and disease due to tobacco use was responsible for around 56% of all drug-caused hospital episodes, and around 51% of drug caused hospital bed-days. Tobacco use was responsible for 3.4% of total hospital episodes and 4.9% of total hospital bed-days in 1992.
Tobacco is the major cause of death due to drugs in Australia, causing over five times the number of deaths due to alcohol (see Introduction). However alcohol claims a proportionately high number of drug caused hospital episodes and admissions (Table 3.3). This is because of the chronic nature of much of the disease caused by alcohol abuse: disease caused by tobacco use is more likely to be fatal. It should also be noted that alcohol abuse is a major cause of violence and other social problems in the community.(153) As the table above provides only a measure of hospital contact, it offers a limited evaluation of the suffering caused by alcohol abuse in the community.
In general, smokers suffer poorer health than non-smokers. This may become apparent from an early age, particularly in the case of respiratory symptoms(38,58,59) (see Section 3.5 above). Australian and international studies have shown that workers who smoke also experience, on average, a greater amount absenteeism due to ill health.(61,154,155,156,157,158) See also Chapter 6, Section 8.
Smoking rates are much higher among Aborigines than the rest of the population as a whole (see also Chapter 1, Section 9). This has resulted in a proportionately greater burden of tobacco-caused illness occurring in this segment of the population.(159)
Western Australian research has shown that age standardised rates of tobacco caused hospitalisation are higher among the Aboriginal population than for the non-Aboriginal population. Aboriginal males are admitted at 2.6 times the rate of non-Aboriginal males, and Aboriginal females at 4.7 times the rate of non-Aboriginal females.(159) This burden of ill health also occurs at a younger age in the Aboriginal population. Of tobacco caused hospital admissions, among Aborigines 60% of male and 62% of female admissions occurred in those aged 55 years or younger, compared to 27% of male and 31% of female non-Aboriginal tobacco caused hospital admissions.(159)
In both the Aboriginal and the non-Aboriginal populations, the most frequent causes of hospitalisation due to tobacco smoking were chronic bronchitis and ischaemic heart disease. However Aboriginal men and women had higher rates of hospitalisation for both of these diseases: for chronic bronchitis, the rate of hospitalisation among Aboriginal males was 4.5 times higher, and among Aboriginal females 8.8 times higher than their non-Aboriginal counterparts. For ischaemic heart disease, rates were 1.7 times higher for Aboriginal men and 3.7 higher for Aboriginal women.(159)
Research from the Northern Territory has shown that respiratory problems among the Arnhem Land community now account for around 15% of medical consultations and hospital admissions. A high proportion of these are directly attributable to tobacco use.(160)
Resultant mortality among Aboriginals from tobacco caused disease is discussed in Section 3.18 below.