Smoking as the Main Factor of Preventable Mortality in Serbia

  • Ivan Marinković Demographic Research Centre, Institute of Social Sciences, Belgrade (Serbia)
Keywords: mortality, smoking, Peto-Lopez method, Serbia, life expectancy


The use of tobacco in Serbia has for many years been one of the most frequent risk factors affecting disease development. Although its impact is often neglected and the effects on health minimised, reviewing the existing literature and calculating the tobacco consumption impact on the mortality of the population in Serbia (using the Peto-Lopez method) show a clear link between smoking and health of the population. Serbian population is heavily burdened with the negative effects of tobacco on health, especially men. At the beginning of the second decade of the 21st century, mortality from the illness or cause of death associated with smoking was at about 17% of the total mortality. In men, it is estimated that even a quarter of the total mortality is associated with smoking. In the female population, the share of smokers is considerably lower, and consequently the mortality from this factor is lower, about 9% of the total mortality. Of all major disease groups, tumours are most affected by smoking. The share of tobacco-related mortality in neoplasms is high and accounts for 30% (43% in men and 14% in women). In cardiovascular diseases, the impact of smoking is much smaller and about 6,000 deaths per year are associated with the use of tobacco. Since the early 1990s, the number of smoking-attributable death has been growing. Relatively, the share of men has not changed, but for 20 years of analysis the share of women has significantly increased from 5% to 9%. In all age groups, the share of smoking-related mortality has increased in the female population, especially in the 45-69 age range where mortality has been doubled. Surveys on the health of the Serbian population also confirm the trend of increasing the share of women smokers in the population, especially in the categories of young people. Men in Serbia (35-69 years of age) have the highest smoking-attributable death rate in Europe. As much as 44% of total deaths in that age are directly related to smoking. Besides Hungary, where mortality in men is also relatively high (42%), other countries have significantly lower shares. Observed at the level of the entire continent, countries of the Balkan Peninsula (and their neighbours) have the highest shares of smoking-attributable death. Women in Serbia have a moderately high share of 9% and are among the ten most vulnerable countries in Europe. The biggest difference in smoking-related mortality by gender is observed in the Pyrenees Peninsula and in the eastern and south-eastern parts of Europe. These are also the countries with the largest absolute difference in the mortality rate of men and women, thus confirming the hypothesis that tobacco smoke, as a single mortality factor, plays the most important role in establishing a different gender mortality pattern. A high percentage of smokers in the total population limits the growth of life expectancy and affects the difference in gender mortality rate. If a certain mortality factor potentially affects the life expectancy of up to three years for men in Serbia, as shown in the paper, then it is especially important to pay attention to measures of prevention and awareness of the population regarding this issue. Moreover, it is particularly important to recognise the consequences of passive smoking the youth and children are exposed to, since in Serbia there is a great deal of tolerance for smoking indoors.


Download data is not yet available.


ARIAS, E., HERON M., & TEJADA-VERA, B. (2013) United States life tables eliminating certain causes of death, 1999–2001. National vital statistics reports 61(9). Hyattsville, MD: National Center for Health Statistics.

BELTRÁN-SÁNCHEZ, H., PRESTON, S. H., & CANUDAS-ROMO, V. (2008). An integrated approach to cause-of-death analysis: cause-deleted life tables and decompositions of life expectancy. Demographic Research 19(1): 1323–1350. doi:10.4054/DemRes.2008.19.35

BONGAARTS, J. (2014). Trends in Causes of Death in Low-Mortality Countries: Implications for Mortality Projections. Population and Development Review 40(2): 189–212. doi:10.1111/j.1728-4457.2014.00670.x

BRØNNUM-HANSEN, H., & JUEL, K. (2000). Estimating mortality due to cigarette smoking: two methods, same result. Epidemiology (Cambridge, Mass.) 11(4): 422–426.

BRØNNUM-HANSEN, H., & JUEL, K. (2001). Abstention from smoking extends life and compresses morbidity: a population based study of health expectancy among smokers and never smokers in Denmark. Tobacco Control 10(3): 273–278. doi:10.1136/tc.10.3.273

BURBANK, F. (1972). U.S. lung cancer death rates begin to rise proportionately more rapidly for females than for males: a dose-response effect? Journal of Chronic Diseases 25(8): 473–479. doi:10.1016/0021-9681(72)90211-1

DESMEULES, M., MANUEL, D., & CHO, R. (2004). Mortality: Life and health expectancy of Canadian women. BMC Women’s Health 4 (Suppl 1): S9. doi:10.1186/1472-6874-4-S1-S9

DOLL, R., PETO, R., BOREHAM, J., & SUTHERLAND, I. (2004). Mortality in relation to smoking: 50 years’ observations on male British doctors. British Medical Journal 328: 1519–1528. doi: 10.1136/bmj.38142.554479.AE

EZZATI, M., & LOPEZ, A. D. (2003). Measuring the accumulated hazards of smoking: global and regional estimates for 2000. Tobacco Control 12(1): 79–85. doi:10.1136/tc.12.1.79

EZZATI, M., HENLEY, S. J., THUN, M. J., & LOPEZ, A. D. (2005). Role of Smoking in Global and Regional Cardiovascular Mortality. Circulation 112: 489–497. doi:10.1161/CIRCULATIONAHA.104.521708

FENELON, A., & PRESTON, S. H. (2012). Estimating Smoking‒Attributable Mortality in the United States. Demography 49(3): 797–818. doi:10.1007/s13524-012-0108-x

GUTTERMAN, S. (2015). Mortality of Smoking by Gender. North American Actuarial Journal 19(3): 200–223. doi:10.1080/10920277.2015.1018389

IZJZS-BATUT (2014). Rezultati istraživanja zdravlja stanovništva Srbije: 2013. godina. Beograd: Institut za javno zdravlje Srbije „Dr Milan Jovanović Batut” i Ministarstvo zdravlja Republike Srbije.

IZJZS-BATUT (2015). Rezultati Istraživanja o efektima i stavovima u vezi sa Zakonom o zaštiti stanovništva od izloženosti duvanskom dimu. Beograd: Institut za javno zdravlje Srbije „Dr Milan Jovanović Batut”.

KRSTEV, S. (2014). Globalno istraživanje upotrebe duvana među mladima 13-15 godina u Srbiji 2013. godine. Beograd: Ministarstvo zdravlja Republike Srbije, Institut za javno zdravlje Srbije „Dr Milan Jovanović Batut”.

LUY, M. (2012). Estimating mortality differences in developed countries from survey information on maternal and paternal orphanhood. Demography 49(2): 607–627. doi:10.1007/s13524-012-0101-4

MARINKOVIĆ, I. (2012). Uzroci smrti u Srbiji od sredine 20. veka. Stanovništvo 50(1): 89-106.

MZRS (2007). Istraživanje zdravlja stanovnika Republike Srbije, 2006. godina. Beograd: Ministarstvo zdravlja Republike Srbije.

OZA, S., THUN, M. J., HENLEY, S. J., LOPEZ, A. D., & EZZATI, M. (2011). How many deaths are attributable to smoking in the United States? Comparison of methods for estimating smoking-attributable mortality when smoking prevalence changes. Preventive Medicine 52(6): 428–33. doi:10.1016/j.ypmed.2011.04.007

PAMPEL, F. C. (2002). Cigarette use and the narrowing sex differential in mortality. Population and Development Review 28(1): 77–104. doi: 10.1111/j.1728-4457.2002.00077.x/abstract

PETO, R., LOPEZ, A. D., BOREHAM, J., THUN, M., & HEATH, C. (1992). Mortality from tobacco in developed countries: indirect estimation from national vital statistics. Lancet 339(8804): 1268–1278. doi:10.1016/0140-6736(92)91600-D

PETO, R., LOPEZ, A. D., PAN, H., BOREHAM, J., & THUN, M. (2012). Мortality from smoking in developed countries 1950-2020.

STAETSKY, L. (2009). Diverging trends in female old-age mortality: a reappraisal. Demographic Research 2: 885–914. doi:10.4054/DemRes.2009.21.30

THUN, M. J., DAY-LALLY, C., MYERS, D. G., CALLE, E. E., FLANDERS, W., ZHU, B. P. ... & HEATH, C. W. (1997). Trends in tobacco smoking and mortality from cigarette use in Cancer Prevention Studies I (1959 through 1965) and II (1982 through 1988). Changes in cigarette-related disease risks and their implication for prevention and control: smoking and tobacco control monograph, 8.

THUN, M. J., CARTER, B. D., FESKANICH, D., FREEDMAN, N. D., PRENTICE, R., LOPEZ, A. D., … GAPSTUR, S. M. (2013). 50-Year Trends in Smoking-Related Mortality in the United States. New England Journal of Medicine 368(4): 351–364. doi:10.1056/NEJMsa1211127

WALDRON, I. (1985) What do we know about causes of sex differences in mortality? A review of the literature. Population Bulletin of the United Nations 18: 59–76.

WHO (2007). Protection from exposure to second-hand tobacco smoke. Policy recommendations. Geneva: World Health Organization.

How to Cite
Marinković, I. (2017). Smoking as the Main Factor of Preventable Mortality in Serbia. Stanovnistvo, 55(1), 87-106.