Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: a systematic analysis from the Global Burden of Disease Study 2015
Authors: Marissa B Reitsma, Nancy Fullman, Marie Ng, Joseph S Salama, Amanuel Abajobir, Kalkidan Hassen Abate, Cristiana Abbafati, Semaw Ferede Abera, Biju Abraham, Gebre Yitayih Abyu, Akindele Olupelumi Adebiyi, Ziyad Al-Aly, Alicia V Aleman, Raghib Ali, Ala'a Al Alkerwi, Peter Allebeck, Rajaa Mohammad Al-Raddadi, Azmeraw T Amare, Alemayehu Amberbir, Walid Ammar, Stephen Marc Amrock, Carl Abelardo T Antonio, Hamid Asayesh, Niguse Tadela Atnafu, Peter Azzopardi, Amitava Banerjee, Aleksandra Barac, Tonatiuh Barrientos-Gutierrez, Ana Cristina Basto-Abreu, Shahrzad Bazargan-Hejazi, Neeraj Bedi, Brent Bell, Aminu K Bello, Isabela M Bensenor, Addisu Shunu Beyene, Neeraj Bhala, Stan Biryukov, Kaylin Bolt, Hermann Brenner, Zahid Butt, Fiorella Cavalleri, Kelly Cercy, Honglei Chen, Devasahayam Jesudas Christopher, Liliana G Ciobanu, Valentina Colistro, Mercedes Colomar, Leslie Cornaby, Xiaochen Dai, Solomon Abrha Damtew, Lalit Dandona, Rakhi Dandona, Emily Dansereau, Kairat Davletov, Anand Dayama, Tizta Tilahun Degfie, Amare Deribew, Samath D Dharmaratne, Balem Demtsu Dimtsu, Kerrie E Doyle, Aman Yesuf Endries, Sergey Petrovich Ermakov, Kara Estep, Emerito Jose Aquino Faraon, Farshad Farzadfar, Valery L Feigin, Andrea B Feigl, Florian Fischer, Joseph Friedman, Tsegaye Tewelde G/hiwot, Seana L Gall, Wayne Gao, Richard F Gillum, Audra L Gold, Sameer Vali Gopalani, Carolyn C Gotay, Rahul Gupta, Rajeev Gupta, Vipin Gupta, Randah Ribhi Hamadeh, Graeme Hankey, Hilda L Harb, Simon I Hay, Masako Horino, Nobuyuki Horita, H Dean Hosgood, Abdullatif Husseini, Bogdan Vasile Ileanu, Farhad Islami, Guohong Jiang, Ying Jiang, Jost B Jonas, Zubair Kabir, Ritul Kamal, Amir Kasaeian, Chandrasekharan Nair Kesavachandran, Yousef S Khader, Ibrahim Khalil, Young-Ho Khang, Sahil Khera, Jagdish Khubchandani, Daniel Kim, Yun Jin Kim, Ruth W Kimokoti, Yohannes Kinfu, Luke D Knibbs, Yoshihiro Kokubo, Dhaval Kolte, Jacek Kopec, Soewarta Kosen, Georgios A Kotsakis, Parvaiz A Koul, Ai Koyanagi, Kristopher J Krohn, Hans Krueger, Barthelemy Kuate Defo, Burcu Kucuk Bicer, Chanda Kulkarni, G Anil Kumar, Janet L Leasher, Alexander Lee, Mall Leinsalu, Tong Li, Shai Linn, Patrick Liu, Shiwei Liu, Loon-Tzian Lo, Alan D Lopez, Stefan Ma, Hassan Magdy Abd El Razek, Azeem Majeed, Reza Malekzadeh, Deborah Carvalho Malta, Wondimu Ayele Manamo, Jose Martinez-Raga, Alemayehu Berhane Mekonnen, Walter Mendoza, Ted R Miller, Karzan Abdulmuhsin Mohammad, Lidia Morawska, Kamarul Imran Musa, Gabriele Nagel, Sudan Prasad Neupane, Quyen Nguyen, Grant Nguyen, In-Hwan Oh, Abayomi Samuel Oyekale, Mahesh PA, Adrian Pana, Eun-Kee Park, Snehal T Patil, George C Patton, Joao Pedro, Mostafa Qorbani, Anwar Rafay, Mahfuzar Rahman, Rajesh Kumar Rai, Usha Ram, Chhabi Lal Ranabhat, Amany H Refaat, Nickolas Reinig, Hirbo Shore Roba, Alina Rodriguez, Yesenia Roman, Gregory Roth, Ambuj Roy, Rajesh Sagar, Joshua A Salomon, Juan Sanabria, Itamar de Souza Santos, Benn Sartorius, Maheswar Satpathy, Monika Sawhney, Susan Sawyer, Mete Saylan, Michael P Schaub, Neil Schluger, Aletta Elisabeth Schutte, Sadaf G Sepanlou, Berrin Serdar, Masood Ali Shaikh, Jun She, Min-Jeong Shin, Rahman Shiri, Kawkab Shishani, Ivy Shiue, Inga Dora Sigfusdottir, Jonathan I Silverberg, Jasvinder Singh, Virendra Singh, Erica Leigh Slepak, Samir Soneji, Joan B Soriano, Sergey Soshnikov, Chandrashekhar T Sreeramareddy, Dan J Stein, Saverio Stranges, Michelle L Subart, Soumya Swaminathan, Cassandra E I Szoeke, Worku Mekonnen Tefera, Roman Topor-Madry, Bach Tran, Nikolaos Tsilimparis, Hayley Tymeson, Kingsley Nnanna Ukwaja, Rachel Updike, Olalekan A Uthman, Francesco Saverio Violante, Sergey K Vladimirov, Vasiliy Vlassov, Stein Emil Vollset, Theo Vos, Elisabete Weiderpass, Chi-Pan Wen, Andrea Werdecker, Shelley Wilson, Mamo Wubshet, Lin Xiao, Bereket Yakob, Yuichiro Yano, Penpeng Ye, Naohiro Yonemoto, Seok-Jun Yoon, Mustafa Z Younis, Chuanhua Yu, Zoubida Zaidi, Maysaa El Sayed Zaki, Anthony Lin Zhang, Ben Zipkin, Christopher J L Murray, Mohammad H Forouzanfar, Emmanuela Gakidou
Journal: The Lancet (2017)

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.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).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.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.Bill & Melinda Gates Foundation and Bloomberg Philanthropies.