Background
Tobacco use is a public health problem, responsible for approximately six million deaths annually worldwide. It is a risk factor for many diseases including cancers, respiratory and cardiovascular diseases. In low-and middle-income countries, respiratory and cardiovascular diseases are important causes of death. Tobacco use is prevalent in Ghana, but no study had examined the relationship between tobacco use and deaths from respiratory and cardiovascular diseases in the Upper East Region of Northern Ghana. Hence the paper assessed the association between tobacco use and deaths from respiratory and cardiovascular diseases in that region.

Methods
The study used verbal autopsy data collected from the Kassena-Nankana East and West districts of the Upper East Region of Northern Ghana. Data from deceased individuals aged 15 to 59 years whose deaths occurred between January 1, 2004 and December 31, 2011 and with a known cause as well as smoking status were analyzed. Two binary outcome variables were generated from the cause of death data; whether an individual died from respiratory diseases or not, and from cardiovascular diseases or not. Multiple logistic regression models were used to assess the relationship between tobacco use and deaths from respiratory and cardiovascular diseases.

Results
Out of 3,492 deaths with a known cause of death and smoking status, a third of them smoked. About 16.6% of smokers and 8.1% of non-smokers died from respiratory diseases. Approximately, 10.7% of smokers died from cardiovascular diseases compared to 10.6% of non-smokers. In multivariate analyses, individuals with a history of smoking had two-fold increased odds [OR=2.18, 95% CI (1.6-2.9)] of dying from respiratory diseases. Besides, the number of years of smoking as well as the frequency of smoking is significantly associated with deaths from respiratory diseases. No association existed between tobacco use and deaths from cardiovascular diseases.

Conclusions
Within our study we identified a strong relationship between tobacco use and deaths from respiratory diseases, but not an association with deaths from cardiovascular diseases. Our findings highlight the need to make appropriate health interventions to control tobacco use and thus help reduce premature deaths from respiratory and other tobacco linked diseases.