Kliniken &… Institute Heidelberger Institut… Groups & Projects Working Groups Research Cancer… Smoking in Africa

Estimating the number of death from causes related to smoking in countries with insufficient vital statistics data - theory and application

Project team: Heiko Becher, Volker Winkler

External collaborators

Dr. Nawi Ng, Epidemiology and Public Health Sciences

Public Health and Clinical Medicine, Umeå University, Sweden  

Funding: own funds

Funding period: DFG 2008-2012

Status: ongoing

Tobacco is the major cause of cancer and a relevant risk factor for several other chronic diseases. Due to the epidemiological transition in developing countries with overall increasing life expectancy there is an increasing relevance of chronic diseases to the total burden of disease. Furthermore, there are indications for a rise in the consumption of tobacco products in those countries. Reliable estimation on chronic disease burden can provide essential guidance for the core elements of cancer prevention and control. 

Since in developing countries data on cause of death are scarce and valid mortality statistics rarely exist we will develop new methods and extend a method that we have developed previously to estimate the number of deaths from diseases which are caused by smoking. The method does not use data from regional registries or similar sources, but rather data on smoking prevalence. The methods shall be applicable to diseases for which smoking is the major risk factor such as lung cancer.

We apply those methods to data from various developing countries. For some of those countries relevant data are already available (Indonesia, Vietnam, Ethiopia). For others it will be available shortly.

First results show that WHO estimates significantly underestimate the lung cancer death burden in Africa, but not in Asia.


Winkler V. (2004) Schätzung der tabakassoziierten Lungenkrebsfälle in afrikanischen Entwicklungsländern. Diplomarbeit, Fakultät für Biowissenschaften der Ruprecht-Karls-Universität Heidelberg.

Winkler V, Gbangou A, Kouyaté B, Becher H. (2006) A simple method to estimate tobacco related lung cancer deaths in sub-Saharan Africa. Methods of Information in Medicine 45: 397-403.

Winkler V, Becher H. (2010) Global Cancer cases and Lung cancer in Sub-Saharan Africa. BMJ. rapid response 27/7/10

Winkler V, Becher H. (2010) Lung cancer in Sub-Saharan Africa. Gesundheitswesen 72 - V224. DOI: 10.1055/s-0030-1266416. Abstract

Winkler V1, Becher H1. (2011) Lung cancer mortality in Sub-Saharan Africa. Int J Cancer. 129:1537-9. letter to the Editor

Winkler V, Ng N, Tesfaye F, Becher H. (2011) Predicting lung cancer deaths from smoking prevalence data. Lung Cancer. 74:170-7.

Winkler V1, Ott JJ1, Cowan M, Becher H. (2013) Smoking prevalence and its impacts on lung cancer mortality in Sub-Saharan Africa: An epidemiological study. Preventive Medicine 57:634–640.

Winkler V, Lan Y, Becher H. (2015) Smoking prevention policies in West African countries and their effects on smoking prevalence. BMC Public Health 15:1216.

Winkler V, Mangolo NJ, Becher H. (2015) Lung cancer in South Africa: A forecast to 2025 based on smoking prevalence data. BMJ Open 5:e006993.