Concentrating risk: a systematic analysis of the global smoking epidemic

Abstract

BackgroundThe Global Burden of Diseases, Injuries, and Risk Factors Study 2010 revealed that smoking is the third largest risk factor for death globally and is responsible for over 6 million deaths in 2010. The complex epidemiology of tobacco, with major health effects only appearing several decades after the peak in smoking prevalence and consumption, emphasises the importance of understanding changes in exposure levels for public policy. MethodsTo develop a full-time series of daily smoking prevalence from 1980 to 2010, we compiled a database of all available surveys on population-level tobacco use prevalence. Frequency of use and type of tobacco consumed were then mapped to a consistent definition of daily tobacco smokers using linear regression. A two-stage approach of spatiotemporal modelling and Gaussian process regression were employed to generate estimates of daily tobacco smoking prevalence in each country over time. Estimates were generated by 5-year age groups for each sex. FindingsPreliminary analysis revealed that, globally, daily tobacco smoking prevalence dropped among males from 38·1% (95% CI 37·3–40·9) in 1980, to 26·6% (25·2–28·2) in 2010, while females also experienced a notable decrease, from 11·8% (11·0–12·8) to 5·4% (5·0–5·8). For males in 2010, countries with high age-standardised prevalence rates were concentrated in eastern Europe, including Armenia (41·9%, 37·7–46·4), Latvia (38·7%, 33·1–44·4), and Russia (36·5%, 30·7–42·1). For females, high-burden countries included Austria (20·7%, 15·5–26·8) and Bulgaria (18·0%, 12·4–24·8). In 2010, the age group with the highest global smoking prevalence was 40–44 years (38·6%, 31·9–45·4) for males and 45–49 years (8·2%, 6·5–10·7) for females. InterpretationIncreases in smoking prevalence have already had substantial health and economic impacts. These findings highlight the importance of allocating sufficient resources to address the rising smoking trends in high-risk populations and intensifying efforts to prevent children from starting to smoke. FundingNone.