Smoking and Vaping Among Adults

This topic area covers statistics and information relating to adults smoking tobacco and using e-cigarettes in Hull including local strategic need and service provision. Further information relating to Smoking in Pregnancy is given under Pregnancy, Infants and Early Years within Children and Young People, and Smoking and Vaping Among Young People is given under Lifestyle Factors within Children and Young People. Smoking information has been collected within Hull’s Health and Wellbeing Surveys and more recently information relating to the use of e-cigarettes. The full reports are available under Surveys within Tools and Resources.

This page contains information from the Office for Health Improvement & Disparities’ Fingertips. Information is taken ‘live’ from the site so uses the latest available data from Fingertips and displays it on this page. As a result, some comments on this page may relate to an earlier period of time until this page is next updated (see review dates at the end of this page).

In July 2022, Clinical Commissioning Groups (CCGs) ceased to exist and were replaced by the Integrated Care System. The sub Integrated Care Board areas which include Hull are within the Humber and North Yorkshire Integrated Care Board. In Fingertips, the sub-ICB area referenced by 03F relates to Hull (see Integrated Care Board for the codes relating to the other local sub-ICB areas). For some indicators on Fingertips, the data is still being presented at CCG level (and for Humber, Coast and Vale) and has not yet been updated for sub-ICBs. However, for Hull the geographical area for the CCG and the sub-ICB area (03F) are the same so the information can still be examined and compared to understand the health needs within Hull.

The Office for National Statistics ‘back-date’ their recent estimates of the resident population once more accurate Census data becomes available. Their revised estimates are due to be released in summer 2023. In the meantime, the Office for Health Improvement & Disparities have removed their trend data which relied on resident population estimates from Fingertips, and it will be added back in after summer 2023. Some of the statements on our website pages have been retained with the comments relating to the trend data when it was shown on Fingertips even though the trend data is not shown, and the actual values will change (in most cases slightly) once the calculations are redone using the new backdated population estimates.

Headlines

• Tobacco is a unique product. It is the only consumable that, when used in the intended way, kills half of its users.
• As smoking and deprivation is associated this acerbates the inequalities associated with poverty and deprivation. Smoking is the single greatest cause of inequality, and it also accounts for approximately half of the difference in life expectancy between the lowest and highest deprivation groups.
• From the local adult Health and Wellbeing Survey 2019, a high percentage of adults in Hull smoke tobacco currently one in four residents (24.9%) which is much higher than England (13.9%). This equates to 52,050 current smokers in Hull and a further 59,750 ex-smokers. Smoking prevalence is highest among those aged 25-34 years (30.5%), people living in the most deprived fifth of areas of Hull (35.7%), people who are unemployed (45.0%) or not working due to long-term illness and disability (48.1%), and among lone parents (38.8%). Overall, 28.6% were ex-smokers and 46.5% stated they have never smoked.
• From local surveys, the prevalence of smoking has decreased in Hull from 31.7% in 2014 to 24.9% in 2019. Smoking prevalence has decreased across all deprivation groups. Furthermore, around 10% of all adults in Hull smoked 20+ cigarettes per day in 2007 and 2009, but this has fallen to 4.5% in 2019.
• In the national Annual Population Survey 2021, it is estimated that 22% of people in Hull smoke compared to 13% for England. The prevalence in Hull is the highest among all upper-tier local authorities in England.
• Almost one in three people in Hull with manual and routines occupations smoke (2021), and around one-third of people with long-term mental health conditions (2019/20), although over half of those with serious mental health illness in Hull smoke (2014/15).
• Overall, in the local Health and Wellbeing Survey 2019, 29% of people were ex-smokers although this was as high as 47% among those aged 75+ years. In the national Annual Population Survey 2021, it was estimated that 24% of people were ex-smokers.
• Lung cancer registrations for 2016-18 are very high in Hull (73% higher than England and fifth highest out of the 311 lower-tier local authorities in England), and the rate of emergency admissions for chronic obstructive pulmonary disease (COPD) in Hull for 2020/21 are almost twice as high as England (around 80% of lung cancer cases and COPD are related to smoking).
• In 2019/20, it is estimated that there were 3,097 hospital admissions among Hull residents that were attributable to smoking (75% higher than England and fifth highest among 150 lower-tier local authorities in England). It was estimated that the cost of hospital admissions attributable to smoking among those aged 35+ years is £43.80 for every person aged 35+ years in Hull (cost per capita for 2016/17).
• Mortality from lung cancer and from COPD are very high in Hull (83% and 124% higher than England respectively). Whilst mortality from lung cancer has decreased slightly in Hull, mortality from oral cancer has increased, although these trends were also similar for England. Over the 17 year period between 2001-03 and 2017-19, the mortality rate from COPD decreased by 10% in England and by 9% across the Yorkshire and Humber region, but increased sharply (by 47%) in Hull. In Hull, mortality from lung cancer was second highest among 305 lower-tier local authorities in England, and mortality from COPD was the highest for both men and women, and substantially higher than the next highest local authority (13% higher for men and 9% higher for women).
• In the three year period 2017-19, it is estimated that there were 1,501 deaths to Hull residents attributable to smoking, and Hull had the highest mortality rate (420 deaths per 100,000 population aged 35+ years) among the 150 English upper-tier local authorities and the rate was more than twice as high as England (202 deaths per 100,000 population aged 35+ years). The smoking-attributable mortality rate was second highest for heart disease, highest for stroke and highest for cancer. The difference was particularly noticeable for stroke with the rate in Hull being 37% higher than the local authority which was second highest (22.2 versus 16.2 deaths per 100,000 population).
• Over the three years 2016-18, it is estimated that 8,231 potential years of life prior to the age of 75 years were lost that were attributable to smoking giving a rate of 2,399 per 100,000 population (almost twice as high as England at 1,313 per 100,000 population).
• A new provider of the Stop Smoking Services commenced at the end of 2019 and whilst services were initially disrupted due to the COVID-19 pandemic, the current service is working well with two-thirds of smokers quitting at four weeks among those who set a quit date.
• Action on Smoking and Health in their Ready Reckoner 2022 estimate that smoking costs Hull’s society a total of £120 million each year (£12 million to healthcare, £98 million to the economy, £8 million in additional social care costs, £1.6 million in house fires). In addition, they estimate that smokers in Hull spend £88 million on tobacco products.
• Overall, 13.4% of adults in the local survey used e-cigarettes which is an increase from 2014 when it was estimated that 8.4% adults in Hull used e-cigarettes. Nine in ten people who used e-cigarettes used them to stop or cut down tobacco smoking or to prevent them re-starting smoking. One quarter of daily and ex-smokers of tobacco and one-third of occasional tobacco smokers used e-cigarettes. Only 15 people in the survey used e-cigarettes who had never smoked tobacco representing fewer than 0.9% of never smokers. The majority were young males but not exclusively so. It is estimated that around 6.5% of people in England use e-cigarettes, but it is not surprising that usage is much higher in Hull when tobacco smoking prevalence is much higher in Hull and a high percentage of e-cigarette users use them as a quit aid.

The Population Affected – Why Is It Important?

The following video from The Office for Health Improvement & Disparities (previously Public Health England) explains how we can prevent ill health from both alcohol and tobacco.

https://youtu.be/dEVguE2yOj4

Tobacco is a unique product. It is the only consumable that, when used in the intended way, kills half of its users. This makes it one of the biggest causes of death and illness in the UK. Smoking causes around 80% of lung cancers, but can also cause cancer in many other parts of the body. Smoking also increases the risk of developing heart and circulation problems such as coronary heart disease, stroke, peripheral vascular disease and cerebrovascular disease. It also damages the lungs increasing the risk of bronchitis, emphysema and pneumonia, and other chronic obstructive pulmonary disease. Smoking can also cause or exacerbate numerous other health problems, and there are further risks caused by smoking in pregnancy and breathing in second hand smoke. In 2015/16, there were approximately 474,000 smoking related hospital admissions with smokers seeing their GP 35% more than non-smokers. Every year, there are around 64,000 deaths attributable to smoking in England. Smokers who die prematurely lose on average about 10 years of life.

There are also specific serious risks to the baby if their mother smokers during pregnancy (further specific details are given within Smoking in Pregnancy under Pregnancy and Maternal Health under Children and Young People). Second-hand smoke is very dangerous for anyone exposed to it, but it is particularly dangerous for children (further specific details are given within Smoking Among Young People under Lifestyle Factors under Children and Young People).

As smoking and deprivation are associated this acerbates the inequalities associated with poverty and deprivation. Smoking is the main contributor to health inequalities. Marmot in his original report in 2010 stated that smoking accounts for approximately half of the difference in life expectancy between the lowest and highest deprivation groups. Furthermore, as stated in Marmot’s ’10 years on’ report, it is more difficult for individuals to change unhealthy behaviours such as smoking when they are under stress caused by factors such as debt or poor housing.

Action on Smoking and Health (ASH) have produced a Ready Reckoner to calculate the cost of tobacco in a single year at local authority level. For the 2022 edition of their Ready Reckoner, for England, ASH estimate that:

• There are 6,144,703 adult (aged 18+ years) smokers in England (13.9%).
• The total cost to society is around £17.0 billion every single year.
  • Healthcare: It is estimated that the smoking-related cost to healthcare is around £2.4 billion each year.
  • Economy / productivity: It is estimated that the cost to the economy is around £13.2 billion each year in terms of lost productivity (people who are economically inactive due to smoking-related illnesses, people who die prematurely due to smoking-related illnesses, and lost productivity through smoking-related absenteeism and smoking breaks).
  • Social care: It is estimated that the additional social care costs are £1.2 billion per year (relating to additional care costs that are additional to or earlier in life, because of smoking-related conditions). Furthermore, it is estimated that smoking-related ill-health means social care is being provided informally by friends and family for over one million people and if this care was replaced with formal paid care it would cost the social care system an additional £14.1 billion.
  • House fires: It is estimated that house fires related to smoking cost £283 million per year (cost of deaths and injuries, property damage and costs to Fire and Rescue Services).
  • Littering: It is estimated cigarette butts make up the vast majority of litter items (66%) in terms of litter numbers. The majority of cigarette filters are non-biodegradable and end up in landfill sites. It is estimated that 55.9 million cigarettes consumed per day in England (47.6 million of which are filtered cigarettes) resulting in 2,972 tonnes of waste annually (1,248 tonnes discarded as street litter annually).
• In addition to the £17 billion cost per year, it is estimated that smokers in England spend around £12 billion on tobacco products each year (£1,945 per smoker).

Health benefits of quitting tobacco smoking are:

• immediate after quitting smoking;
• within 2-13 weeks circulation improves and lung function increases;
• within 1-9 months coughing and shortness of breath decreases and people start to regain lung function;
• after one year excess risk of coronary heart disease is half that of a continuing smoker’s;
• after 2-5 years stroke risk falls to that of a non-smoker’s;
• after five years the risk of cancer of the mouth, throat, oesophagus and bladder are cut in half, and cervical cancer risk falls to that of a non-smoker;
• after 10 years the risk of dying from lung cancer is about half that of a person who is still smoking, and risk of cancer of the larynx and pancreas decreases; and
• after 15 years the risk of coronary heart disease is that of a non-smoker’s.

The Hull Picture

Smoking Tobacco

Current Prevalence and Trends Over Time

Current Smokers (General Population)

From Hull’s Health and Wellbeing Survey 2019, 24.9% of adults smoked tobacco in Hull. One in five adults smoke daily and a further 4.9% smoked but not every day. The prevalence was slightly higher among men compared to women, and differed by age with 26.5% of 16-24 year olds smoking which increased to 30.5% of 25-34 year olds before falling to 28.5% among those aged 35-54 years and decreasing to 9.0% among those aged 75+ years. More than four in ten people who were unemployed or not working due to long-term illness or disability smoked tobacco, and there was a strong association with deprivation. Over one third (35.7%) of people living in the most deprived fifth of areas of Hull smoked compared to 13.2% of those who lived in the least deprived fifth of areas of Hull. Rates of smoking were also high among lone parents and people under 65 years who lived alone. Among survey responders aged under 65 years, the single person households had a higher percentage of males aged 35-64 years (42% versus 24% for all other households type where the survey responder was aged under 65 years) and females aged 55-64 years (19% versus 8% for all other households types where the survey responder was aged under 65 years). So it appears that this group could include people who are separated or divorced as well as single individuals.

It is estimated that there are 52,050 current smokers in Hull with 41,700 smoking daily and 10,300 smoking but not every day. There are a further 59,750 people who are ex-smokers.

There were large difference in the prevalence of smoking across Hull’s 21 wards ranging from 9.9% in Kingswood to 41.7% in St Andrew’s and Docklands. The prevalence of smoking was strongly linked to deprivation. St Andrew’s & Docklands was the most deprived ward in Hull followed by Orchard Park, Central, Marfleet, North Carr, and Newington & Gipsyville. The prevalence of smoking was surprisingly low in the survey for North Carr, but all the other wards had high levels of current smokers. In contrast, Kingswood is the least deprived ward, followed by Holderness, Bricknell, and Boothferry, and these four wards has the lowest prevalence of smoking.

Health and Wellbeing Surveys have been completed in Hull for a number of years, and it is possible to compare the prevalence of smoking over time among survey responders. The prevalence has been consistently higher than 30% but fell in 2019 to just under one-quarter. The recent decrease occurred for both men and women, and across all deprivation groups particularly people living in the most deprived areas of Hull. The estimate for 2019 differs slightly to the figure quoted above as the percentages in the trend chart have been adjusted for age.

The Office for Health Improvement & Disparities’ Fingertips also presents the prevalence of smoking from the Annual Population Survey (ASP) for local authorities in England, although a couple of local authorities do not have data because of recent boundary changes, and the numbers are too small for two local authorities (City of London and Isles of Scilly). They also present smoking prevalence from the GP Patient Survey (GGPS) as well as the prevalence from the Quality and Outcomes Framework (QOF) which is the primary care payment system where practices’ funding is based on achieving specific indicators around care (e.g. recording patients who have specific diseases and medical conditions and the care those patients receive). Within the Quality and Outcomes Framework, there is an indicator relating to recording smoking prevalence, and the prevalence of smoking can be estimated from this at practice level and at Clinical Commissioning Group level. Both measures from the GP Patient Survey and Quality and Outcomes Framework will be based on a slightly different population compared to the Annual Population Survey as the former two are based on patients registered with Hull GPs whereas the latter is based on the resident population.

The local surveys have involved a much larger number of people (at least 4,000) and are much more representative of Hull’s population, whereas the national Annual Population Survey involve far fewer people who participate in Hull (often around 500 people) and due to the way they are approached or selected to participate in the survey, they are not necessarily representative of Hull’s population. So prevalence estimates from the local survey have been used and are the best ones to use when estimating smoking prevalence in Hull. For instance, the GP Patient Survey in 2021 involved sending out 12,458 questionnaires with 4,224 returned (34%) so a much higher sample, but it is possible that there were differences between those that did and did not respond, and it is not known how representative the sample is of Hull’s overall population. The Quality and Outcomes Framework data is recorded for all patients registered with Hull GPs, but this does not necessarily mean the data is accurate. It is possible that the smoking status may not be recorded for all patients, and for some patients their smoking status could have changed and the change has not been reflected in their GP record (especially if the patient has not attended the practice for some time and/or their GP did not ask or was not told if there had been a change to the patient’s smoking status).

From the Annual Population Survey 2021, it was estimated that 22% of people aged 18+ years in Hull smoked compared to 13% for England. The rate in Hull was highest across the Yorkshire & Humber region, as well as highest among the 147 upper-tier local authorities in England (Blackpool has an estimated prevalence of 20.6% and all other local authorities have a prevalence below 20%).

For 2021/22, it is estimated that the prevalence of smoking is 20% for patients registered with Hull GPs compared to 14% for England from the GP Patient Survey, and 23% for Hull and 15% for England from the Quality and Outcomes Framework.

So whilst all these surveys are slightly different, there is not too much difference between the different measures of smoking prevalence for Hull although the prevalence from the GP Patient Survey is slightly lower.

From the national survey, the prevalence of smoking in Hull has decreased from 31% in 2011 to 22% in 2019 which is a 27% decrease which is slightly lower than the decrease for England over the same time period (30%). Whilst the prevalence reduced in 2020, it has increased in 2021 to a similar level to that observed in 2019.

There has also been a fall in prevalence as measured by the GP Patient Survey falling from 25% in 2013/14 to 20% in 2021/22.

A similar decrease in smoking prevalence among Hull patients has occurred as measured by Quality and Outcomes Framework falling from 27% in 2013/14 to 23% in 2021/22.

Current Smokers (People Working in Routine or Manual Occupations)

From the Annual Population Survey 2020, the prevalence of smoking among people who work in routine and manual occupations is estimated to be 29% in Hull compared to 25% for England, although not statistically significantly higher.

The prevalence of smoking among people who work in manual and routine occupations has been decreasing in Hull although there has been some year-on-year variability. The prevalence was estimated to be around 42% for 2011 and 2012, and has fallen to 29% for 2020.

Current Smokers (People With Mental Health Conditions)

The prevalence of smoking is also given on Fingertips for different groups who have mental health conditions which tend to have a higher prevalence of smoking.

From the GP Patient Surveys, in Hull, it was estimated that 38% of people with a long-term mental health condition smoked in 2021/22 and 32% of people with anxiety or depression smoked in 2016/17, both of which are statistically significantly higher than England (26%). The GP Patient Surveys are regularly undertaken and are mainly used to collect information relating to patient satisfaction. The information relating to medical conditions from this survey is self-reported, so those who report they have a long-term mental health condition or that they have anxiety or depression.

From the Quality and Outcomes Framework, in 2014/15, it was estimated that over half (52%) of people with a serious mental illness registered with Hull GPs smoked which was statistically significantly higher than England (41%). This included patients identified as having schizophrenia, bipolar affective disorder or other psychoses in their electronic health record (and their latest mental health diagnosis was not in remission).

Both the GP Patient Surveys and information collected as part of the Quality and Outcomes Framework are collected through GP practices. Around 10% of patients registered with Hull GPs live in East Riding of Yorkshire, and the smoking prevalence estimates relating to mental health will include these patients. The prevalence of smoking is generally much lower in East Riding of Yorkshire (particularly in the villages to the west of Hull where many of these patients will live) and thus it is likely that the prevalence would be slightly higher if only patients who live in Hull were to be included.

It was estimated that almost half of adults with a long-term mental health condition smoked in 2013/14, but this has steadily fallen to a low of 32% in 2019/20. However, the prevalence has increased slightly for 2020/21 and increased more sharply for 2021/22.

In 2014/15, there were 2,487 patients registered with Hull GPs with a serious mental health illness. There were 924 patients with a serious mental health illness who smoked and with the prevalence being 52.3%, this works out to be out of 1,767 patients (presumably this means that smoking status was not recorded for all 2,487 patients and perhaps this is why the indicator has not been updated since 2014/15).

The prevalence of smoking among adults who have anxiety or depression has also been decreasing in Hull from 41% in 2013/14 to 32% in 2016/17. The rate of decrease in Hull has been greater than England (-23% versus -10%) but similar to the decrease across the Yorkshire and Humber region (-21%). So the inequalities gap between Hull and England has decreased over time.

Current Smokers (People in Drug Misuse Treatment Services)

Over 80% of people admitted to substance misuse treatment services in 2019/20 smoked.

The number of adults admitted to services who smoked has increased over time in Hull, but it is possible that this increase is due to better recording of smoking status.

Heavy Smokers – 20+ Cigarettes Per Day

From Hull’s Health and Wellbeing Survey 2019, 4.5% of Hull’s total adult population smoked the equivalent of 20 or more cigarettes per day (or equivalent), and this was highest among people aged 45-64 years, people living in the most deprived areas of Hull and people who were unemployed or not working due to long-term illness and disability. It is estimated that across all of Hull, around 9,300 adults usually smoke 20+ cigarettes per day.

People living in Newington and Gipsyville had the highest prevalence of smoking 20+ cigarettes per day with 8.4% of all adults doing so. In contrast, fewer than 1% of all adults participating in the survey who lived in Kingswood usually smoked 20+ cigarettes per day.

The percentage of heavy smokers who usually smoke 20+ cigarettes per day has shown a large decrease over time. In 2007 and 2009, around one in ten of all adults in Hull usually smoked 20+ cigarettes per day, but this has decreased gradually over time and currently around 4.5% of Hull’s total adult population aged 16+ years usually smoke 20+ cigarettes per day.

It is useful to examine the percentage of people who smoke 20+ cigarettes per day out of those people who were current smokers. Among all current smokers surveyed, 17.9% stated that they usually smoked 20+ cigarettes per day, but this was over one-quarter of those aged 55-64 years and who were not working due to long-term illness or disability. People aged 16-24 years who smoked were the least likely to smoke heavily and as a consequence the percentage was also low among students.

Around one-third of current smokers who lived in Longhill & Bilton Grange, and Pickering wards smoked 20+ cigarettes per day. Fewer than 7% of current smokers in Kingswood were heavy smokers.

Ex-Smokers

From the local survey, 28.6% of adults aged 16+ years are ex-smokers. Perhaps unsurprisingly, as age increases the percentage of ex-smokers increases sharply. Almost a half of survey responders aged 75+ years stated they were ex-smokers. There were only small differences in the percentage of men and women who were ex-smokers, and perhaps surprisingly there were only small differences by local deprivation fifth. The differences in the percentage of ex-smokers by working status and household composition were those expected given that there were considerable differences in age among the survey responders by working status. However, the exception to this was the very low prevalence of ex-smokers among those who were unemployed, and this may be because such a higher percentage of people were unemployed still smoked (45%). This was not the case for people who were not working due to long-term illness and disability though which had an even higher prevalence of current smokers (48%) because 30% of this group were also ex-smokers. So the differences here also lie within the differences in the percentages who had never smoked which differs between people who are unemployed and people who are not working due to long-term illness or disability (see below for information in the percentages who have never smoked).

Survey responders living in Pickering (38%), Derringham (38%), Longhill & Bilton Grange (36%), Marfleet (33%), Orchard Park (33%), Bricknell (32%), Avenue (32%) and Boothferry (31%) had the highest percentage of ex-smokers.

The length of time the person had quit smoking was not collected in the 2019 survey so it is difficult to assess the level of risk to health previous smoking may have on the estimated 60,000 adults aged 16+ years who are ex-smokers. It is also complex as the level of risk reduces over time at different rates depending on the disease or medical condition, and will be dependent on other factors such as the length of time the person was a smoker and the quantity they smoked. It is possible that some, or even most or many, of the people who were 75+ years in the survey, quit smoking a long time ago.

From local Health and Wellbeing Surveys, approximately one-quarter of survey responders stated they were ex-smokers (25.7% in 2007, 22.2% in 2009 and 26.3% in 2011) although this was slightly higher in 2014 (27.1%) and in 2019 (28.6%) perhaps due to slightly fewer people being current smokers in those particular surveys.

The Annual Population Survey and GP Patient Survey also includes information on the prevalence of ex-smokers, and this prevalence is similar for Hull and England, but slightly lower for Hull than the local estimated prevalence for 2019 particularly in relation to the Annual Population Survey.

From the Annual Population Survey, the percentage of ex-smokers was around a third between 2011 and 2015 in Hull but fell to around one-quarter between 2016 and 2021 with a slight temporary increase in 2020 perhaps due to the COVID-19 pandemic.

The percentage of ex-smokers from the GP Patient Survey has remained relatively constant between 2013/14 and 2020/21 at around 27-28% for Hull.

Never Smoked

Within the local adult Health and Wellbeing Survey 2019, the percentage of survey responders who had never smoked was 46.5% although it was considerably higher among those aged 16-24 years (60.0%) and students (69.6%). There was a strong association with deprivation with 37% of people living in most deprived fifth of areas of Hull having never smoked compared to 59% among people living in the least deprived fifth of areas of Hull. Only around one in five people who were not working due to long-term illness or disability had never smoked.

There were also considerable differences in the percentages who had never smoked across Hull’s 21 electoral wards which ranged from 68% in Kingswood to 33% in St Andrew’s & Docklands.

From local Health and Wellbeing Surveys, the percentage who had never smoked was relatively consistent over time (42.6% in 2007, 44.4% in 2009, 39.7% in 2011 and 42.3% in 2014 although this was slightly higher in 2019 at 46.6%).

The Annual Population Survey and GP Patient Survey also includes information on the percentage who have never smoked. The percentage who have never smoked is around 10 percentage points lower in Hull (around 50% in Hull compared to around 60% for England).

From the Annual Population Survey, the percentage of adults who have never smoked was around 40% between 2011 and 2015, but has increased to around 50% between 2016 and 2019, and has further increased to 54% for 2021.

The percentage of adults who have never smoked from the GP Patient Survey is also around 50% but has been relatively unchanged in Hull between 2013/14 and 2020/21.

Smoking Related Cancer Registrations

The Office for Health Improvement & Disparities’ Fingertips also provides information on the number of cancer registrations from lung and oral cancers, a high percentages of which are due to smoking.

The Office for Health Improvement & Disparities (formerly Public Health England) state that “In England in 2017/18, 47% of hospital admissions for cancers that can be caused by smoking, and 39% of admissions for respiratory diseases that can be caused by smoking, were estimated to be attributable to smoking in persons aged 35 and over. Lung cancer registration is therefore a direct measure of smoking-related harm.”

The rate of lung and oral cancer registrations is given as the directly age-standardised registration rate for lung and oral cancer per 100,000 population standardised to the European Standard Population.

During 2017-19, the rate of lung cancer registration for Hull was 72% higher than England (132 versus 77 per 100,000 population), and the highest across the Yorkshire and Humber region.

The rate of oral cancer registration for Hull was 12% higher than England, and the rate of cancer registrations for oesophageal cancer is 22% higher than England and the highest across the region.

The rate of lung cancer registration declined slightly in Hull from 148 registrations per 100,000 population in 2007-09 to 124 registrations per 100,000 population in 2010-12, but has gradually increased to 139 per 100,000 population for 2014-16 before decreasing slightly to 132 registrations per 100,000 population during 2017-19. The rate in England has remained relatively unchanged over this period, and has decreased marginally across the Yorkshire and Humber.

In the latest three year period 2017-19, there were 802 cancer registrations for lung cancers in Hull.

The rate of oral cancer registrations in Hull has been relatively variable but the rates appear to have increased between 2007-09 and 2015-17, and although there has been a fall between 2015-17 and 2017-19, but the latest rate in 2017-19 is considerably higher than the rate in 2007-09. The increase over time is not unique to Hull as the rates across both England and the region have increased between 2007-09 and 2017-19.

In the latest three year period 2017-19, there were 113 cancer registrations for oral cancers in Hull.

There has been relatively large year-on-year variation in the rate of cancer registrations for oesophageal cancer, but for the six of the 11 periods the rate has been statistically significantly higher in Hull compared to England.

Further information relating to cancer incidence can be found in Cancer under Health Factors within Adults.

Hospital Admissions Due to Smoking

Around 80% of cases of chronic obstructive pulmonary disease (COPD) are caused by smoking, and given Hull’s high prevalence of smoking, the emergency admission rate for COPD are around twice as high in Hull compared to England (259 versus 134 emergency hospital admissions per 100,000 population).

The rate is given as a directly age-standardised admission rate per 100,000 population standardised to the European Standard Population.

The number of emergency hospital admissions for COPD in Hull steadily increased from 400 admissions per 100,000 population in 2013/14 to a high of 525 admissions per 100,000 population during 2017/18. Whilst the rate decreased between 2017/18 to 2019/20, the rate in Hull is twice as high as England.

The rate fell sharply in 2020/21 with admissions halving due to the COVID-19 pandemic, although given the very high rates in Hull, it is likely that the number of emergency hospital admissions for COPD will increase in 2021/22.

Overall, in 2019/20 there were 1,125 emergency admissions for COPD which decreased to 645 during 2020/21.

Further information relating to hospital admissions from chronic obstructive pulmonary disease can be found under Respiratory Diseases under Health Factors within Adults.

Fingertips also provides information on hospital admissions attributable to smoking. Each hospital admission is assigned a primary diagnosis code using the International Classification of Diseases which relates to the main reason or cause for the hospital admission. The Office for Health Improvement & Disparities (formerly Public Health England) have assigned a smoking attributable fraction for each diagnosis code based on research. Each smoking attributable fraction is between 0 and 1. Most smoking attributable fractions will be zero in that smoking is not implicated in any way for that specific primary diagnosis of admission, but admissions with a primary diagnosis for a smoking-related condition will have a smoking attributable fraction higher than zero and that fraction is likely to differ for men and women, and for different age groups.

For instance, a hospital admission would be assigned a smoking attributable fraction of 0.7 if it has been found that 70% of admissions with that primary diagnosis code were related to smoking among men or women of a specific age.

Every admission in Hull for the specified period has been assigned a smoking attributable fraction, and then these have been summed over all admissions to estimate the total number of hospital admissions that are attributable to smoking.

In 2019/20, it is estimated that there were 2,440 hospital admissions attributable to smoking in Hull per 100,000 population which is 75% higher than England, and the highest across the Yorkshire and Humber region. The rate in Hull is also fifth highest across all upper-tier local authorities in England behind Blackpool (3,071 per 100,000 population), Sunderland (2,868), Stoke-on-Trent (2,593) and South Tyneside (2,511).

The rate is given as a directly age-standardised admission rate per 100,000 population standardised to the European Standard Population.

It is estimated among people aged 35+ years in Hull that there were 3,097 admissions to hospital during 2019/20 that were attributable to smoking. There has been some year-on-year variability in Hull over time, but the rate has remained relatively unchanged between 2015/16 and 2019/20 at around 2,500 per 100,000 population. In contrast, the rate for England and across the Yorkshire and Humber region has decreased over this time.

Information relating to the cost of hospital admissions attributable to smoking is given below in the section entitled Cost of Smoking in Hull.

Deaths from Smoking

Information relating to deaths attributable to smoking is also available from Fingertips as well as mortality rates from diseases where a high percentage of the cases are due to smoking. Action on Smoking and Health (ASH) estimated in their May 2021 Smoking Statistics Factsheet that 85% of male lung cancer deaths and 69% of female lung cancer deaths were due to smoking, and that 88% and 81% of chronic obstructive pulmonary disease (COPD) deaths among men and women respectively were due to smoking. These are the two diseases where more than three-quarters of the deaths from these causes are attributable to smoking, although similar conditions such as cancer of the larynx (79% for men and 71% for women) and chronic airway obstruction (77% for men and 74% for women) also have high rates of mortality linked to smoking. The figures for cancer of the upper respiratory sites are 69% for men and 44% for women, and presumably covers oral cancers.

Further information on individual diseases such as COPD, cancer, heart disease and stroke is available within Health Factors under Adults.

The mortality rate from oral cancer, lung cancer and from COPD is high in Hull due the current and historically high levels of smoking in Hull.

The mortality rate from oral cancer in Hull for 2017-19 is the highest across the Yorkshire and the Humber region, although due to the relatively small number of deaths in total from this cause, the difference is not statistically significantly different from England.

Mortality rates from lung cancer in Hull re the highest in England and almost twice as high as the England average for 2021. There were 94.7 lung cancer deaths per 100,000 population in Hull in 2021 compare to 48.5 deaths per 100,000 population for England.

Mortality from COPD was the second highest in Hull across the region, and 13th highest across England for 2021 (Knowsley had the highest rate with 92.9 deaths per 100,000 population). The rate in Hull was 61% higher than England for 2021.

There were 37 deaths from oral cancer among Hull residents over the three year period 2017-19. As the numbers are relatively small there has been year-on-year variability, but despite this variation there is an increasing trend in the mortality rate over time. There has also been an increase across England and the region.