Abstract
BACKGROUND: Ending the global tobacco epidemic is a defining challenge in global health. Timely and comprehensive estimates of the prevalence of smoking tobacco use and attributable disease burden are needed to guide tobacco control efforts nationally and globally.
METHODS: We estimated the prevalence of smoking tobacco use and attributable disease burden for 204 countries and territories, by age and sex, from 1990 to 2019 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. We modelled multiple smoking-related indicators from 3625 nationally representative surveys. We completed systematic reviews and did Bayesian meta-regressions for 36 causally linked health outcomes to estimate non-linear dose-response risk curves for current and former smokers. We used a direct estimation approach to estimate attributable burden, providing more comprehensive estimates of the health effects of smoking than previously available.
FINDINGS: Globally in 2019, 1·14 billion (95% uncertainty interval 1·13-1·16) individuals were current smokers, who consumed 7·41 trillion (7·11-7·74) cigarette-equivalents of tobacco in 2019. Although prevalence of smoking had decreased significantly since 1990 among both males (27·5% [26·5-28·5] reduction) and females (37·7% [35·4-39·9] reduction) aged 15 years and older, population growth has led to a significant increase in the total number of smokers from 0·99 billion (0·98-1·00) in 1990. Globally in 2019, smoking tobacco use accounted for 7·69 million (7·16-8·20) deaths and 200 million (185-214) disability-adjusted life-years, and was the leading risk factor for death among males (20·2% [19·3-21·1] of male deaths). 6·68 million [86·9%] of 7·69 million deaths attributable to smoking tobacco use were among current smokers.
INTERPRETATION: In the absence of intervention, the annual toll of 7·69 million deaths and 200 million disability-adjusted life-years attributable to smoking will increase over the coming decades. Substantial progress in reducing the prevalence of smoking tobacco use has been observed in countries from all regions and at all stages of development, but a large implementation gap remains for tobacco control. Countries have a clear and urgent opportunity to pass strong, evidence-based policies to accelerate reductions in the prevalence of smoking and reap massive health benefits for their citizens.
FUNDING: Bloomberg Philanthropies and the Bill & Melinda Gates Foundation.
| Original language | English |
|---|---|
| Pages (from-to) | 2337-2360 |
| Number of pages | 24 |
| Journal | The Lancet |
| Volume | 397 |
| Issue number | 10292 |
| Early online date | 27 May 2021 |
| DOIs | |
| Publication status | Published - 19 Jun 2021 |
Bibliographical note
Funding Information:SheMA acknowledges support from Monash University, VIC, Australia. SyMA would like to acknowledge the International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia and Department of Health Policy and Management, Faculty of Public Health, Kuwait University for the approval and support to participate in this research project. MarA, AdP, and CH are partially supported by a grant of the Romanian National Authority for Scientific Research and Innovation (CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084). TWB was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. SB-H was supported by National Institutes of Health (NIH) National Center for Advancing Translational Science (NCATS) UCLA (CTSI grant number UL1TR001881). DAB research receives support from the Oxford National Institute for Health Research (NIHR) Biomedical Research Centre (BRC). VMC acknowledges her grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória DL57/2016/CP1334/CT0006. AD acknowledges funding support from the NIHR Applied Research Collaboration (ARC) South London at King's College Hospital NHS Foundation Trust and the Royal College of Physicians, as well as the support from the NIHR BRC based at Guy's and St Thomas' NHS Foundation Trust and King's College London. MEK was supported by FIU University Graduate School Dissertation Year Fellowship. PSG is supported by the NIHR Applied Research Collaborations West Midland; the NIHR Global Health Research Unit on Improving Health in Slums at the University of Warwick; and the NIHR Global Health Group on Addressing Smokeless Tobacco Use & Building Research Capacity in South Asia at the University of York. CH and AdP are partially supported by a grant of the Romanian National Authority for Scientific Research and Innovation (CNDS-UEFISCDI, project number PN-III-P2-2.1-SOL-2020-2-0351). JYI is supported by UNC's Cancer Care Quality Training 2T32CA116339-11. SMSI is funded by the National Heart Foundation of Australia and NHMRC. MihJ acknowledges funding through grant OI 175 014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. PJ acknowledges the Wellcome Trust/DBT India Alliance Fellowship support (IA/CPHI/14/1/501497). HK acknowledges being the Kornhauser Research Associate at The University of Sydney, Save Sight Institute. SVK acknowledges funding from a NHS Research Scotland Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_00022/2) and the Scottish Government Chief Scientist Office (SPHSU13). SLKL acknowledges support by the Manipal Academy of Higher Education. KK is supported by the UGC Centre of Advanced Study (CAS II) awarded to the Department of Anthropology, Panjab University, Chandigarh, India. BL acknowledges support from UK Biobank, the NIHR Oxford BRC, and the BHF Oxford Centre of Research Excellence. IL is member of the Sistema Nacional de Investigación (SNI), which is supported by the Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT), Panamá. StL acknowledges institutional support from the Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig (Germany; German Federal Ministry of Education and Research; grant agreement number 01EA1808A). RGP is supported in part by funding from the NIH National Cancer Institute (R01CA132115, R21CA235139-01) and the Breast Cancer Research Program (W81XWH1810605, Breakthrough Award) from the Department of Defense. PriR acknowledges the Manipal Academy of Higher Education, Manipal. AMS acknowledges the support from a fellowship from the Egyptian Fulbright Mission Program. MMS-M acknowledges the support of the Ministry of Education, Science and Technological Development of the Republic of Serbia (contract number 175087). AzS acknowledges support from the HDRUK BREATHE Hub. JPS acknowledges support from Applied Molecular Biosciences Unit (UCIBIO; grant number UIDB/04378/2020), supported through Portuguese national funds via FCT/MCTES. AmbS is supported by the International Graduate Research Scholarship, University of Tasmania. JBS is part of the Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. SKT acknowledges support from an NHMRC Early Career Fellowship. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.
Funding Information:
ViA reports personal fees from Bayer Healthcare, Boehringer Ingelheim/Lilly alliance, Bristol Myers Squibb/Pfizer alliance, and Novo Nordisk outside of the submitted work. RA reports consultancy and speakers' fees from UCB, Sandoz, AbbVie, Zentiva, Teva, Laropharm, CEGEDIM, Angelini, Biessen Pharma, Hofigal, AstraZeneca, and Stada outside of the submitted work. BeA reports personal fees from Australian Institute of Sports; non-financial support from Zydus Cadila; and grants and non-financial support from Natural Remedies outside of the submitted work. FG was employed by Public Health England during the conduct of the study, which does not necessarily endorse this study. GJH reports personal fees from the American Heart Association outside of the submitted work. SMSI reports grants from National Heart Foundation of Australia and from the Australian National Health and Medical Research Council (NHMRC) outside of the submitted work. SVK reports grants from Chief Scientist Office and UK Medical Research Council during the conduct of the study. KK reports non-financial support from UGC Centre of Advanced Study (CAS II), Department of Anthropology, Panjab University, Chandigarh, India, outside of the submitted work. StL reports personal fees from Akcea Therapeutics, Amedes, AMGEN, Berlin-Chemie, Boehringer Ingelheim Pharma, Daiichi Sankyo, Lilly, MSD Sharp & Dohme, Novo Nordisk, Sanofi-Aventis, Synlab, Unilever, and Upfield, and non-financial support from Preventicus outside of the submitted work. WM is Program Analyst in Population and Development at the UN Population Fund-UNFPA Country Office in Peru, which does not necessarily endorse this study. TRM reports contracts from Gov't Plaintiff Lawyers, JUUL, outside of the submitted work. BoN reports personal fees from AstraZeneca and Bayer, outside of the submitted work. SimS reports grants, personal fees, and non-financial support from Abbott and Novartis; personal fees and non-financial support from Allergan-Abbvie, AstraZeneca, and Teva; and personal fees from Eli Lilly and Novo Nordisk outside of the submitted work. AES reports personal fees from Takeda, Novartis, Servier, and Omron Healthcare outside of the submitted work. JAS reports consultancy fees from Crealta/Horizon, Medisys, Fidia, Two Labs Inc, Adept Field Solutions, Clinical Care options, Clearview Healthcare Partners, Putnam Associates, Focus Forward, Navigant Consulting, Spherix, MedIQ, UBM, Trio Health, Medscape, WebMD, Practice Point communications, the National Institutes of Health, and the American College of Rheumatology; payment for lectures including service on Simply Speaking speaker's bureau; and stock ownership in TPT Global Tech, Vaxart pharmaceuticals, and Charlotte's Web Holdings. JAS previously owned stock options in Amarin, Viking, and Moderna pharmaceuticals; held placement on the steering committee of OMERACT, an international organisation that develops measures for clinical trials and receives arm's length funding from 12 pharmaceutical companies; serves on the US Food and Drug Administration Arthritis Advisory Committee; is a member of the Veterans Affairs Rheumatology Field Advisory Committee; and is the editor and the director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis. DJS reports personal fees from Lundbeck, Takeda, Johnson & Johnson, and Servier outside of the submitted work. StS reports grants from Edwards Lifesciences, Medtronic, Boston Scientific, and Abbott; and personal fees from Boston Scientific, Teleflex, and BTG outside of the submitted work. JS reports ownership in companies providing services to Itrim, Amgen, Janssen, Novo Nordisk, Eli Lilly, Boehringer, Bayer, Pfizer, and AstraZeneca outside of the submitted work. FT reports grants and personal fees from Novartis, Thea, Alcon, Pfizer, and Bayer; grants from Bausch & Lomb; and personal fees from Allergan, Omikron, and Santen outside of the submitted work. All other authors declare no competing interests.
Funding Information:
SheMA acknowledges support from Monash University, VIC, Australia. SyMA would like to acknowledge the International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia and Department of Health Policy and Management, Faculty of Public Health, Kuwait University for the approval and support to participate in this research project. MarA, AdP, and CH are partially supported by a grant of the Romanian National Authority for Scientific Research and Innovation (CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084). TWB was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. SB-H was supported by National Institutes of Health (NIH) National Center for Advancing Translational Science (NCATS) UCLA (CTSI grant number UL1TR001881). DAB research receives support from the Oxford National Institute for Health Research (NIHR) Biomedical Research Centre (BRC). VMC acknowledges her grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Funda??o para a Ci?ncia e Tecnologia (FCT), IP, under the Norma Transit?ria DL57/2016/CP1334/CT0006. AD acknowledges funding support from the NIHR Applied Research Collaboration (ARC) South London at King's College Hospital NHS Foundation Trust and the Royal College of Physicians, as well as the support from the NIHR BRC based at Guy's and St Thomas' NHS Foundation Trust and King's College London. MEK was supported by FIU University Graduate School Dissertation Year Fellowship. PSG is supported by the NIHR Applied Research Collaborations West Midland; the NIHR Global Health Research Unit on Improving Health in Slums at the University of Warwick; and the NIHR Global Health Group on Addressing Smokeless Tobacco Use & Building Research Capacity in South Asia at the University of York. CH and AdP are partially supported by a grant of the Romanian National Authority for Scientific Research and Innovation (CNDS-UEFISCDI, project number PN-III-P2-2.1-SOL-2020-2-0351). JYI is supported by UNC's Cancer Care Quality Training 2T32CA116339-11. SMSI is funded by the National Heart Foundation of Australia and NHMRC. MihJ acknowledges funding through grant OI 175 014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. PJ acknowledges the Wellcome Trust/DBT India Alliance Fellowship support (IA/CPHI/14/1/501497). HK acknowledges being the Kornhauser Research Associate at The University of Sydney, Save Sight Institute. SVK acknowledges funding from a NHS Research Scotland Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_00022/2) and the Scottish Government Chief Scientist Office (SPHSU13). SLKL acknowledges support by the Manipal Academy of Higher Education. KK is supported by the UGC Centre of Advanced Study (CAS II) awarded to the Department of Anthropology, Panjab University, Chandigarh, India. BL acknowledges support from UK Biobank, the NIHR Oxford BRC, and the BHF Oxford Centre of Research Excellence. IL is member of the Sistema Nacional de Investigaci?n (SNI), which is supported by the Secretar?a Nacional de Ciencia, Tecnolog?a e Innovaci?n (SENACYT), Panam?. StL acknowledges institutional support from the Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig (Germany; German Federal Ministry of Education and Research; grant agreement number 01EA1808A). RGP is supported in part by funding from the NIH National Cancer Institute (R01CA132115, R21CA235139-01) and the Breast Cancer Research Program (W81XWH1810605, Breakthrough Award) from the Department of Defense. PriR acknowledges the Manipal Academy of Higher Education, Manipal. AMS acknowledges the support from a fellowship from the Egyptian Fulbright Mission Program. MMS-M acknowledges the support of the Ministry of Education, Science and Technological Development of the Republic of Serbia (contract number 175087). AzS acknowledges support from the HDRUK BREATHE Hub. JPS acknowledges support from Applied Molecular Biosciences Unit (UCIBIO; grant number UIDB/04378/2020), supported through Portuguese national funds via FCT/MCTES. AmbS is supported by the International Graduate Research Scholarship, University of Tasmania. JBS is part of the Centro de Investigaci?n en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. SKT acknowledges support from an NHMRC Early Career Fellowship. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. Editorial note: the Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations.
Publisher Copyright:
© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
ASJC Scopus subject areas
- General Medicine
