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

    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

    Fingerprint

    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 Damtew, {Solomon Abrha}",
    year = "2017",
    month = "5",
    day = "13",
    doi = "10.1016/S0140-6736(17)30819-X",
    language = "English (US)",
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    pages = "1885--1906",
    journal = "The Lancet",
    issn = "0140-6736",
    publisher = "Elsevier Limited",
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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 - Damtew, Solomon Abrha

    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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