The researchers examined 2,129 death certificates issued at University College London Hospital between 2003 and 2009. Only 0.1% cited smoking as the underlying cause of death and only 0.5% included it in the list of other contributory conditions.
Among 279 deaths from lung cancer and COPD only two certificates recorded smoking as cause of death. But 45% of these deaths occurred in current smokers and 23% in former smokers, the researchers said.
‘The almost complete absence of smoking on death certificates was most surprising in cases of lung cancer and COPD where the causal association with smoking is strongest and the prevalence of smoking among the deceased was high,’ they said.
‘This is a lost opportunity to gather important epidemiological and pathological information on smoking-related mortality.’
One reason doctors may not mention smoking was a desire not to distress relatives because of stigma surrounding smoking, the researchers said. This was not the case with alcohol, which was cited as a direct or contributory cause of death in 57% of certificates including diagnoses linked to alcohol use.
Smoking and alcohol have been citable as a direct or underlying cause of death, without coroner involvement, since 1992.