Abstract
SummaryBackgroundEnding 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.MethodsWe 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.FindingsGlobally 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.InterpretationIn 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.FundingBloomberg Philanthropies and the Bill & Melinda Gates Foundation.
Highlights
Over the past 30 years, more than 200 million deaths have been caused by smoking tobacco use, and annual economic costs due to smoking tobacco use exceed US$1 trillion.[1,2] With more than 1 billion current smokers globally in 2019, these numbers are likely to increase over the coming decades
The first international public health treaty, the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), entered into force and became an international binding law in 2005.8 Consensus on the importance of tobacco control led 182 countries to ratify the treaty, which outlines a suite of recommended demand-reduction tools
WHO has monitored the implementation of the FCTC articles using the MPOWER framework for more than a decade.[10]
Summary
Over the past 30 years, more than 200 million deaths have been caused by smoking tobacco use, and annual economic costs due to smoking tobacco use exceed US$1 trillion.[1,2] With more than 1 billion current smokers globally in 2019, these numbers are likely to increase over the coming decades. The first international public health treaty, the WHO Framework Convention on Tobacco Control (FCTC), entered into force and became an international binding law in 2005.8 Consensus on the importance of tobacco control led 182 countries to ratify the treaty, which outlines a suite of recommended demand-reduction tools. These tools include reducing affordability through taxation, passing smoke-free laws, mandating health warnings on packaging, and banning tobacco advertising, promotion, and sponsorship.[9 15] years after the FCTC entered into force, a large implementation gap remains. Progress has been made in expanding coverage of best-practice policies, www.thelancet.com Vol 397 June 19, 2021
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