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Background  To establish the impact of tobacco smoking on mortality is essential to define and monitor public health interventions in developing countries.    Methods  The Smoking-Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software was used to estimate the smoking attributable mortality (SAM) in 15 Brazilian State Capitals and the Federal District for the year 2003. Smoking prevalence and mortality data of people aged 35 years or older were obtained for each city from the Brazilian Household Survey on Non Communicable Diseases Risk Factors (2002–2003) and from the Brazilian Mortality System (2003), respectively.    Results  In 2003, of the 177,543 deaths of persons aged 35 years and older 24,222 (13.64%) were attributable to cigarette smoking. This total represents 18.08% of all male deaths (n = 16,896) and 8.71% (n = 7,326) of all female deaths in these cities. The four leading causes of smoking-attributable death were chronic airways obstruction (4,419 deaths), ischemic heart disease (4,417 deaths), lung cancer (3,682 deaths), and cerebrovascular disease (3,202 deaths). Cigarette smoking accounted for 419,935 years of potential life lost (YPLL) (279,990 YPLL for men and 139,945 YPLL for women) in the same period.    Conclusion  Tobacco use caused one out of five male deaths and one out of ten female deaths in the sixteen cities in 2003. Four leading causes of smoking attributable deaths (ischemic heart disease, chronic airways obstruction, lung cancer and cerebrovascular disease) accounted for 64.9% of SAM. Effective and comprehensive actions must be taken in order to slow this epidemic in Brazil.

Smoking-attributable mortality and years of potential life lost in 16 Brazilian capitals, 2003: a prevalence-based study