Smoking attributable hospital admissions and deaths
Scotland 2024

About this release

This annual release by Public Health Scotland (PHS) covers smoking attributable hospital admissions and deaths in Scotland from 2003 to 2024 (calendar year). Smoking increases the risk of developing certain cancers, respiratory diseases, circulatory diseases, mental health and other conditions and remains a leading cause of preventable disease and premature death. While it is not possible to class any hospital admission or death as wholly attributable to smoking, it is possible to estimate what fraction of admissions or deaths can be attributed to smoking using estimated prevalence rates of smoking and associated risk of disease. As smoking attributable conditions can take many years to develop the likelihood of younger individuals being admitted to hospital or dying from smoking is generally low and so only admissions and death estimates for Scottish residents aged 35 years and older are included.

Previously smoking attributable hospital admissions and deaths were published on the Scottish Public Health Observatory (ScotPHO) website. Currently updates to ScotPHO are paused (see the ScotPHO website notice) while they undertake a review of the content, structure and hosting of the site. To ensure the continued release of these statistics this publication has been released on the PHS site as a new annual report series. Additionally, these statistics have been produced through an improved methodology, which includes revision of previously published estimates for 2003 - 2022. Therefore, the statistics presented here supersede, and are not comparable, to those previously published via ScotPHO.

Main points

Hospital Admissions

In 2024, for those aged 35 and over, and where the smoking-attributable condition was recorded as the primary diagnosis:

• There were an estimated 1,107 smoking‑attributable hospital admissions per 100,000 population (38,675 admissions). This is a 36% decrease since 2008 (1,735 per 100,000).
• Men had a higher rate of admissions (1,224 per 100,000) than women (1,006 per 100,000).
• As measured by the Scottish Index of Multiple Deprivation (SIMD), those living in the 20% most deprived areas had a rate of admissions (2,247 per 100,000) 4.4 times higher compared to those living in the 20% least deprived areas (505 per 100,000).

Deaths

In 2024, for those aged 35 and over:

• There were an estimated 204 smoking‑attributable deaths per 100,000 population (7,085 deaths). This is a 39% decrease since 2008 (334 per 100,000).
• Men had a higher rate of deaths (236 per 1000,000) than women (178 per 100,000).
• Those living in the 20% most deprived areas had a rate of deaths (412 per 100,000) 4.7 times higher compared to those living in the 20% least deprived areas (87 per 100,000).

Trend chart from 2008 to 2024 showing the age standardised rates of smoking attributable deaths for males, females and overall figures. There has been a general decline over the time period across all categories.

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Age standardised rate of smoking attributed deaths, 2008-2024, by sex¹

1. For more information on chart data, including the break in continuity for 2020, see Background.

Background

Smoking attributable fractions (SAFs) are estimates of the number of hospital admissions and deaths for a range of conditions where smoking is a known risk factor. For each condition the fraction of hospital admissions or deaths are calculated using the prevalence of smoking within the population coupled with the evidence based relative risks of developing those conditions due to smoking. Further information on how SAFs are calculated can be found in Appendix 1 of the main report.

Smoking prevalence rates used from the Scottish Health Survey were only published annually from 2008, so data is presented from that year. As a result of the COVID-19 pandemic the prevalence data collected in 2020 was published as experimental statistics and was not comparable to previous surveys. Additionally with the disruption to usual hospital activity the decision was made to not calculate estimates for that year.

Previously, the method used for calculating smoking attributable hospital admissions and deaths was based on relative risks published in The Health Consequences of Smoking: A Report of the Surgeon General published in 2004 using data from 1982 to 1988. PHS has updated our methodology to use the relative risks from the 2018 Royal College of Physicians (RCP) report, which incorporates more recent research and meta-analyses on the effects of smoking. Using this method for calculating smoking attributable hospital admissions and deaths is more accurate and reliable as it is based on an updated understanding of clinical risk and is also more readily comparable with other UK nations which are using the same methodology. More information on the differences between methodologies and the impact on previously published statistics is available in the technical document.

Further information

The next release of this publication will be March 2027.