TY - JOUR
T1 - Smoking prevalence and attributable disease burden in 195 countries and territories, 1990-2015
T2 - A systematic analysis from the global burden of disease study 2015
AU - GBD 2015 Tobacco Collaborators
AU - Reitsma, Marissa B.
AU - Fullman, Nancy
AU - Ng, Marie
AU - Salama, Joseph S.
AU - Abajobir, Amanuel
AU - Abate, Kalkidan Hassen
AU - Abbafati, Cristiana
AU - Abera, Semaw Ferede
AU - Abraham, Biju
AU - Abyu, Gebre Yitayih
AU - Adebiyi, Akindele Olupelumi
AU - Al-Aly, Ziyad
AU - Aleman, Alicia V.
AU - Ali, Raghib
AU - Alkerwi, Ala'a Al
AU - Allebeck, Peter
AU - Al-Raddadi, Rajaa Mohammad
AU - Amare, Azmeraw T.
AU - Amberbir, Alemayehu
AU - Ammar, Walid
AU - Amrock, Stephen Marc
AU - Antonio, Carl Abelardo T.
AU - Asayesh, Hamid
AU - Atnafu, Niguse Tadela
AU - Azzopardi, Peter
AU - Banerjee, Amitava
AU - Barac, Aleksandra
AU - Barrientos-Gutierrez, Tonatiuh
AU - Basto-Abreu, Ana Cristina
AU - Bazargan-Hejazi, Shahrzad
AU - Bedi, Neeraj
AU - Bell, Brent
AU - Bello, Aminu K.
AU - Bensenor, Isabela M.
AU - Beyene, Addisu Shunu
AU - Bhala, Neeraj
AU - Biryukov, Stan
AU - Bolt, Kaylin
AU - Brenner, Hermann
AU - Butt, Zahid
AU - Cavalleri, Fiorella
AU - Cercy, Kelly
AU - Chen, Honglei
AU - Christopher, Devasahayam Jesudas
AU - Ciobanu, Liliana G.
AU - Colistro, Valentina
AU - Colomar, Mercedes
AU - Cornaby, Leslie
AU - Dai, Xiaochen
AU - Damtew, Solomon Abrha
N1 - Publisher Copyright:
© 2017 The Author(s). Published by Elsevier Ltd.
PY - 2017/5/13
Y1 - 2017/5/13
N2 - Background The scale-up of tobacco control, especially after the adoption of the Framework Convention for Tobacco Control, is a major public health success story. Nonetheless, smoking remains a leading risk for early death and disability worldwide, and therefore continues to require sustained political commitment. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) offers a robust platform through which global, regional, and national progress toward achieving smoking-related targets can be assessed. Methods We synthesised 2818 data sources with spatiotemporal Gaussian process regression and produced estimates of daily smoking prevalence by sex, age group, and year for 195 countries and territories from 1990 to 2015. We analysed 38 risk-outcome pairs to generate estimates of smoking-attributable mortality and disease burden, as measured by disability-adjusted life-years (DALYs). We then performed a cohort analysis of smoking prevalence by birth-year cohort to better understand temporal age patterns in smoking. We also did a decomposition analysis, in which we parsed out changes in all-cause smoking-attributable DALYs due to changes in population growth, population ageing, smoking prevalence, and risk-deleted DALY rates. Finally, we explored results by level of development using the Socio-demographic Index (SDI). Findings Worldwide, the age-standardised prevalence of daily smoking was 25·0% (95% uncertainty interval [UI] 24·2-25·7) for men and 5·4% (5·1-5·7) for women, representing 28·4% (25·8-31·1) and 34·4% (29·4-38·6) reductions, respectively, since 1990. A greater percentage of countries and territories achieved significant annualised rates of decline in smoking prevalence from 1990 to 2005 than in between 2005 and 2015; however, only four countries had significant annualised increases in smoking prevalence between 2005 and 2015 (Congo [Brazzaville] and Azerbaijan for men and Kuwait and Timor-Leste for women). In 2015, 11·5% of global deaths (6·4 million [95% UI 5·7-7·0 million]) were attributable to smoking worldwide, of which 52·2% took place in four countries (China, India, the USA, and Russia). Smoking was ranked among the five leading risk factors by DALYs in 109 countries and territories in 2015, rising from 88 geographies in 1990. In terms of birth cohorts, male smoking prevalence followed similar age patterns across levels of SDI, whereas much more heterogeneity was found in age patterns for female smokers by level of development. While smoking prevalence and risk-deleted DALY rates mostly decreased by sex and SDI quintile, population growth, population ageing, or a combination of both, drove rises in overall smoking attributable DALYs in low-SDI to middle-SDI geographies between 2005 and 2015. Interpretation The pace of progress in reducing smoking prevalence has been heterogeneous across geographies, development status, and sex, and as highlighted by more recent trends, maintaining past rates of decline should not be taken for granted, especially in women and in low-SDI to middle-SDI countries. Beyond the effect of the tobacco industry and societal mores, a crucial challenge facing tobacco control initiatives is that demographic forces are poised to heighten smoking's global toll, unless progress in preventing initiation and promoting cessation can be substantially accelerated. Greater success in tobacco control is possible but requires effective, comprehensive, and adequately implemented and enforced policies, which might in turn require global and national levels of political commitment beyond what has been achieved during the past 25 years.
AB - Background The scale-up of tobacco control, especially after the adoption of the Framework Convention for Tobacco Control, is a major public health success story. Nonetheless, smoking remains a leading risk for early death and disability worldwide, and therefore continues to require sustained political commitment. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) offers a robust platform through which global, regional, and national progress toward achieving smoking-related targets can be assessed. Methods We synthesised 2818 data sources with spatiotemporal Gaussian process regression and produced estimates of daily smoking prevalence by sex, age group, and year for 195 countries and territories from 1990 to 2015. We analysed 38 risk-outcome pairs to generate estimates of smoking-attributable mortality and disease burden, as measured by disability-adjusted life-years (DALYs). We then performed a cohort analysis of smoking prevalence by birth-year cohort to better understand temporal age patterns in smoking. We also did a decomposition analysis, in which we parsed out changes in all-cause smoking-attributable DALYs due to changes in population growth, population ageing, smoking prevalence, and risk-deleted DALY rates. Finally, we explored results by level of development using the Socio-demographic Index (SDI). Findings Worldwide, the age-standardised prevalence of daily smoking was 25·0% (95% uncertainty interval [UI] 24·2-25·7) for men and 5·4% (5·1-5·7) for women, representing 28·4% (25·8-31·1) and 34·4% (29·4-38·6) reductions, respectively, since 1990. A greater percentage of countries and territories achieved significant annualised rates of decline in smoking prevalence from 1990 to 2005 than in between 2005 and 2015; however, only four countries had significant annualised increases in smoking prevalence between 2005 and 2015 (Congo [Brazzaville] and Azerbaijan for men and Kuwait and Timor-Leste for women). In 2015, 11·5% of global deaths (6·4 million [95% UI 5·7-7·0 million]) were attributable to smoking worldwide, of which 52·2% took place in four countries (China, India, the USA, and Russia). Smoking was ranked among the five leading risk factors by DALYs in 109 countries and territories in 2015, rising from 88 geographies in 1990. In terms of birth cohorts, male smoking prevalence followed similar age patterns across levels of SDI, whereas much more heterogeneity was found in age patterns for female smokers by level of development. While smoking prevalence and risk-deleted DALY rates mostly decreased by sex and SDI quintile, population growth, population ageing, or a combination of both, drove rises in overall smoking attributable DALYs in low-SDI to middle-SDI geographies between 2005 and 2015. Interpretation The pace of progress in reducing smoking prevalence has been heterogeneous across geographies, development status, and sex, and as highlighted by more recent trends, maintaining past rates of decline should not be taken for granted, especially in women and in low-SDI to middle-SDI countries. Beyond the effect of the tobacco industry and societal mores, a crucial challenge facing tobacco control initiatives is that demographic forces are poised to heighten smoking's global toll, unless progress in preventing initiation and promoting cessation can be substantially accelerated. Greater success in tobacco control is possible but requires effective, comprehensive, and adequately implemented and enforced policies, which might in turn require global and national levels of political commitment beyond what has been achieved during the past 25 years.
UR - http://www.scopus.com/inward/record.url?scp=85017146418&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85017146418&partnerID=8YFLogxK
U2 - 10.1016/S0140-6736(17)30819-X
DO - 10.1016/S0140-6736(17)30819-X
M3 - Article
C2 - 28390697
AN - SCOPUS:85017146418
SN - 0140-6736
VL - 389
SP - 1885
EP - 1906
JO - The Lancet
JF - The Lancet
IS - 10082
ER -