Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015

a systematic analysis from the Global Burden of Disease Study 2015

GBD 2015 Tobacco Collaborators

Research output: Contribution to journalArticle

257 Citations (Scopus)

Abstract

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. Funding Bill & Melinda Gates Foundation and Bloomberg Philanthropies.

Original languageEnglish (US)
Pages (from-to)1885-1906
Number of pages22
JournalThe Lancet
Volume389
Issue number10082
DOIs
StatePublished - May 13 2017

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Smoking
Quality-Adjusted Life Years
Demography
Geography
Tobacco
Population Growth
Global Burden of Disease
Uncertainty
Azerbaijan
Tobacco Industry
Term Birth
Congo
Kuwait
Sexual Development
Information Storage and Retrieval
Russia
Population
India
China
Cohort Studies

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015 : a systematic analysis from the Global Burden of Disease Study 2015. / GBD 2015 Tobacco Collaborators.

In: The Lancet, Vol. 389, No. 10082, 13.05.2017, p. 1885-1906.

Research output: Contribution to journalArticle

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title = "Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: a systematic analysis from the Global Burden of Disease Study 2015",
abstract = "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. Funding Bill & Melinda Gates Foundation and Bloomberg Philanthropies.",
author = "{GBD 2015 Tobacco Collaborators} and Reitsma, {Marissa B.} and Nancy Fullman and Marie Ng and Salama, {Joseph S.} and Amanuel Abajobir and Abate, {Kalkidan Hassen} and Cristiana Abbafati and Abera, {Semaw Ferede} and Biju Abraham and Abyu, {Gebre Yitayih} and Adebiyi, {Akindele Olupelumi} and Ziyad Al-Aly and Aleman, {Alicia V.} and Raghib Ali and {Al Alkerwi}, Ala'a and Peter Allebeck and Al-Raddadi, {Rajaa Mohammad} and Amare, {Azmeraw T.} and Alemayehu Amberbir and Walid Ammar and Amrock, {Stephen Marc} and Antonio, {Carl Abelardo T.} and Hamid Asayesh and Atnafu, {Niguse Tadela} and Peter Azzopardi and Amitava Banerjee and Aleksandra Barac and Tonatiuh Barrientos-Gutierrez and Basto-Abreu, {Ana Cristina} and Shahrzad Bazargan-Hejazi and Neeraj Bedi and Brent Bell and Bello, {Aminu K.} and Bensenor, {Isabela M.} and Beyene, {Addisu Shunu} and Neeraj Bhala and Stan Biryukov and Kaylin Bolt and Hermann Brenner and Zahid Butt and Fiorella Cavalleri and Kelly Cercy and Honglei Chen and Christopher, {Devasahayam Jesudas} and Ciobanu, {Liliana G.} and Valentina Colistro and Mercedes Colomar and Leslie Cornaby and Xiaochen Dai and Hosgood, {Howard D.}",
year = "2017",
month = "5",
day = "13",
doi = "10.1016/S0140-6736(17)30819-X",
language = "English (US)",
volume = "389",
pages = "1885--1906",
journal = "The Lancet",
issn = "0140-6736",
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number = "10082",

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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 - Al Alkerwi, Ala'a

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 - Hosgood, Howard D.

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. Funding Bill & Melinda Gates Foundation and Bloomberg Philanthropies.

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. Funding Bill & Melinda Gates Foundation and Bloomberg Philanthropies.

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