Stroke mortality and morbidity attributable to passive smoking in Germany.

BACKGROUND Passive smoking is an established risk factor for coronary heart disease (CHD). Epidemiological studies suggest that passive smoking may also be associated with an increased risk of stroke. We estimate the burden of stroke due to passive smoking in Germany. METHODS Frequency of passive smoking was derived from the German national health survey. Nonsmokers who reported exposure to environmental tobacco smoke (ETS) at home were considered for analyses. The relative risk for stroke and passive smoking was derived by means of a meta-analysis from available cohort studies. We computed attributable risks for passive smoking and used data from official statistics to estimate stroke mortality due to ETS. Attributable stroke morbidity was calculated using the WHO-Global-Burden-of-Disease approach. RESULTS Passive smoking may account for 774 stroke-related deaths and 1837 incident first ever strokes in Germany every year. More strokes owing to passive smoking occur among women (1248) than among men (589). The majority of strokes attributable to ETS happen at the age of 65-84 years. CONCLUSION ETS is a common exposure and stroke is a frequent disease. Though the relative risk of passive smoking on stroke mortality and morbidity is small, the impact on population health is substantial.