Rey Brandariz, JuliaSantiago Pérez, María IsolinaCandal Pedreira, CristinaVarela Lema, María LeonorRuano Raviña, AlbertoLópez Vizcaíno, María EstherGuerra Tort, CarlaAhluwalia, Jasjit S.Montes-Martínez, AgustínPérez Ríos, Mónica2024-09-242024-09-242024-06-21European Journal of Public Health, 2024, ckae1041101-1262http://hdl.handle.net/10347/34850The objective of this study is to assess the impact of applying prevalences derived from a small-area model at a regional level on smoking-attributable mortality (SAM). A prevalence-dependent method was used to estimate SAM. Prevalences of tobacco use were derived from a small-area model. SAM and population attributable fraction (PAF) estimates were compared against those calculated by pooling data from three national health surveys conducted in Spain (2011–2014–2017). We calculated the relative changes between the two estimates and assessed the width of the 95% CI of the PAF. Applying surveys-based prevalences, tobacco use was estimated to cause 53 825 (95% CI: 53 182–54 342) deaths in Spain in 2017, a figure 3.8% lower obtained with the small-area model prevalences. The lowest relative change was observed in the Castile-La Mancha region (1.1%) and the highest in Navarre (14.1%). The median relative change between regions was higher for women (26.1%), population aged ≥65 years (6.6%), and cardiometabolic diseases (9.0%). The differences between PAF by cause of death were never greater than 2%. Overall, the differences between estimates of SAM, PAF, and confidence interval width are small when using prevalences from both sources. Having these data available by region will allow decision-makers to implement smoking control measures based on more accurate dataengAtribución-NoComercial 4.0 Internacional© The Author(s) 2024. Published by Oxford University Press on behalf of the European Public Health Association. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/)http://creativecommons.org/licenses/by-nc/4.0/SmokingCause of deathHealth surveysSpainMortalityTobacco usejournal article10.1093/eurpub/ckae1041464-360Xopen access