Smoking-attributable Mortality Research Articles

Trends in educational inequalities in smoking-attributable mortality and their impact on changes in general mortality inequalities: evidence from England and Wales, Finland, and Italy (Turin)

BackgroundSocioeconomic mortality inequalities are persistent in Europe but have been changing over time. Smoking is a known contributor to inequality levels, but knowledge about its impact on time trends in...

Impact of the use of small-area models on estimation of attributable mortality at a regional level.

The objective of this study is to assess the impact of applying prevalences derived from a small-area model at a regional level on smoking-attributable mortality (SAM). A prevalence-dependent method was used to estimate SAM. Prevalences of tobacco use were derived from a small-area model. SAM and population attributable fraction (PAF) estimates were compared against those calculated by pooling data from three national health surveys conducted in Spain (2011-2014-2017). We calculated the relative changes between the two estimates and assessed the width of the 95% CI of the PAF. Applying surveys-based prevalences, tobacco use was estimated to cause 53 825 (95% CI: 53 182-54 342) deaths in Spain in 2017, a figure 3.8% lower obtained with the small-area model prevalences. The lowest relative change was observed in the Castile-La Mancha region (1.1%) and the highest in Navarre (14.1%). The median relative change between regions was higher for women (26.1%), population aged ≥65 years (6.6%), and cardiometabolic diseases (9.0%). The differences between PAF by cause of death were never greater than 2%. Overall, the differences between estimates of SAM, PAF, and confidence interval width are small when using prevalences from both sources. Having these data available by region will allow decision-makers to implement smoking control measures based on more accurate data.

Renal Hyperfiltration as a New Mechanism of Smoking-Related Mortality.

Renal hyperfiltration (RHF), an established risk factor for mortality, is prevalent among tobacco smokers. The aim of this study was to assess the mediating role of RHF in the association between smoking and mortality. Data of this study were retrieved from the cohort of the Kuopio Ischemic Heart Disease Risk Factor Study (KIHD), including 2064 males from Finland. Study participants were followed over a 35-year period. Using classic and counterfactual mediation analysis approaches, we estimated the mediative effect of RHF in the association between smoking and each of the following outcomes: All-cause mortality, cardiovascular disease (CVD) mortality, and non-CVD mortality. The risk of all-cause mortality in smokers was twice that in nonsmokers (hazard ratio [HR], 2.06; 95% confidence interval [CI]: 1.84 to 2.31). Under the counterfactual framework the direct effect of smoking on all-cause mortality, controlled for RHF, corresponded to an HR of 2.00 (95% CI: 1.78 to 2.30). Of the effect of smoking on mortality, 5% (p-value = .016) was mediated by RHF. This finding concerned particularly non-CVD mortality. RHF mediated the effect of smoking on non-CVD and all-cause mortality, but not on CVD mortality. The generalizability of our study results is however limited by its focus on a Finnish male cohort, underscoring the need for further investigation into RHF's broader implications across diverse populations. This study elucidates the complex interplay between smoking, renal hyperfiltration (RHF), and mortality, offering novel insights into the mediating role of RHF. Our findings demonstrate that RHF significantly mediates the relationship between smoking and non-cardiovascular disease (non-CVD), but not CVD mortality. This distinction underscores the multifaceted role of RHF beyond its established association with cardiovascular events. By highlighting the specific pathways through which RHF mediates some of the smoking-attributed mortality, this research contributes to our understanding of the mechanisms linking smoking to mortality.

Equity implications of tobacco taxation: results from WHO FCTC investment cases

BackgroundAcross time, geographies and country income levels, smoking prevalence is highest among people with lower incomes. Smoking causes further impoverishment of those on the lower end of the income spectrum...

Global burden of cardiovascular disease attributable to smoking, 1990-2019: an analysis of the 2019 Global Burden of Disease Study.

This study aims to investigate the trends in the global cardiovascular disease (CVD) burden attributable to smoking from 1990 to 2019. Global Burden of Disease Study 2019 was used to analyse the burden of CVD attributable to smoking (i.e. ischaemic heart disease, peripheral artery disease, stroke, atrial fibrillation and flutter, and aortic aneurysm). Age-standardized mortality rates (ASMRs) per 100 000 and age-standardized disability-adjusted life year rates (ASDRs) per 100 000, as well as an estimated annual percentage change (EAPC) in ASMR and ASDR, were determined by age, sex, year, socio-demographic index (SDI), regions, and countries or territories. The global ASMR of smoking-attributed CVD decreased from 57.16/100 000 [95% uncertainty interval (UI) 54.46-59.97] in 1990 to 33.03/100 000 (95% UI 30.43-35.51) in 2019 [EAPC -0.42 (95% UI -0.47 to -0.38)]. Similarly, the ASDR of smoking-attributed CVD decreased between 1990 and 2019. All CVD subcategories showed a decline in death burden between 1990 and 2019. The burden of smoking-attributed CVD was higher in men than in women. Significant geographic and regional variations existed such that Eastern Europe had the highest ASMR and Andean Latin America had the lowest ASMR in 2019. In 2019, the ASMR of smoking-attributed CVD was lowest in high SDI regions. Smoking-attributed CVD morbidity and mortality are declining globally, but significant variation persists, indicating a need for targeted interventions to reduce smoking-related CVD burden.

Estimating the return on investment of the New York Tobacco Control Programme: a synthetic control study

ObjectiveTo assess the return on investment (ROI) of the New York Tobacco Control Programme (NY TCP).SettingNew York and other states of the USA.InterventionsNY TCP.OutcomesSmoking prevalence, smoking-attributable healthcare expenditures (SAEs), smoking-attributable...

Smoking status, cadmium, and chronic kidney disease

Abstract Background Chronic kidney disease (CKD) affects 10% of the general population in Western countries. Currently, CKD cannot be cured and there are only few strategies to prevent the onset of CKD, to reverse early stages of CKD, and to prevent the progression of established CKD to end-stage kidney disease. Cigarette smoking is a preventable cause of CKD. Methods This narrative review analyses the cause–effect relationship between cigarette smoking and CKD and discusses the association of inhaled cadmium and smoking-induced kidney damage. Results Cigarette smoking places individuals at risk for incident CKD. It accelerates the progression (decline in glomerular filtration rate, aggravation of proteinuria) of CKD to end-stage kidney disease (ESKD), and is associated with shortened kidney transplant graft survival. These harmful effects on kidney function/structure are dependent on the dose and duration of cigarette smoking. Smoking abstinence decreases the higher risk for proteinuria and CKD progression. Inhaled cadmium may be the biologic link between cigarette smoking and kidney dysfunction. Recent studies indicate that accumulation of cadmium in the blood mediates progression of CKD and places smokers at higher risk for all-cause mortality. Conclusions Smoking cessation is an effective intervention to reduce the risk of onset and progression of CKD as well as to reduce smoking-attributable morbidity and mortality.

Trends of ischemic heart disease mortality attributable to smoking in the five countries with the highest number of smokers during 1990-2019: an age-period-cohort analysis.

Smoking increases the risk of various cardiovascular diseases, including ischemic heart disease (IHD). This study aimed to assess the impact of age, period, and cohort on long-term trends in IHD mortality in China, India, Indonesia, the United States, and Russia, the five countries with the highest number of smokers, from 1990 to 2019. The data were obtained from the Global Burden of Disease (GBD) Study 2019, and the age-standardized mortality rate (ASMR) was calculated. Joinpoint regression analysis was used to assess the magnitude and direction of trends in smoking-attributable mortality from IHD. Age-period-cohort (APC) studies were used to estimate net drift (estimated annual percentage change (EAPC)s), local drift (age-specific EAPCs), and independent trends in age, period, and cohort effects. The analysis revealed a significant downward trend in ASMRs attributable to IHD as a result of smoking in the United States, India, and Russia. Indonesia and China showed an upward trend. Age effects were increasing for both country and sex, with China showing the most significant increase in the older age group; period effects were decreasing in all countries except Indonesia, and cohort effects were increasing only in Indonesia and China. From 1990 to 2019, mortality from IHD caused by smoking showed a downward trend in these five countries. However, the pattern of increased mortality from IHD in women caused by smoking warrants further study.

Oxidative stress and inflammation: elucidating mechanisms of smoking-attributable pathology for therapeutic targeting

Abstract Background Tobacco smoking remains a major preventable cause of disease and death worldwide. Combustible cigarettes release thousands of chemicals that can initiate inflammatory pathways leading to smoking-related illness. This review aims to synthesize current scientific knowledge on mechanisms of smoking-induced disease, epidemiological trends, and clinical strategies from recent literature. Main body of the abstract At the cellular level, cigarette smoke triggers oxidative stress through reactive oxygen species (ROS), causing DNA damage. This provokes inflammatory signaling cascades mediated by damage-associated molecular patterns (DAMPs), receptors like RAGE and TLRs, and downstream cytokines. Smoking also disrupts apoptosis and autophagy. In the lungs, oxidative stress and inflammation from smoking play central roles in COPD pathogenesis. Smoking-induced oxidative DNA damage, chronic inflammation, and impaired immunity combine to promote lung carcinogenesis. For cardiovascular disease, smoking triggers endothelial dysfunction, platelet activation, and atherogenesis through oxidized LDL and effects on nitric oxide and adhesion molecules. Short conclusion Given the unequivocal evidence of health risks, smoking cessation is critical to reducing preventable death and disability. Both counseling and pharmacotherapy have proven efficacy for quitting, but efficacy remains limited long-term. Emerging nicotine products like e-cigarettes have unknown impacts on cessation and population health. Comprehensive efforts encompassing prevention, screening, treatment innovation, harm reduction, and policy reform focused on curbing smoking-attributable morbidity and mortality are warranted.

Estimating smoking-attributable lung cancer mortality in Chinese adults from 2000 to 2020: a comparison of three methods

BackgroundSmoking is a significant public health concern in China and a leading cause of lung cancer deaths among adults. This study aims to employ three methods to estimate smoking-attributable lung cancer mortality among Chinese adults from 2000 to 2020.MethodsPopulation attributable fractions (PAFs) of lung cancer deaths caused by smoking were estimated using lagged smoking prevalence, Peto-Lopez, and dose–response relationship methods, separately. Smoking exposure was obtained from national tobacco surveys in China, and relative risks (RR) were derived from a meta-analysis of state-of-the-art studies among the Chinese population. Finally, we estimated the sex- and age-stratified smoking-attributable lung cancer deaths in Chinese population in 2000, 2005, 2010, 2015, and 2020.ResultsThe PAFs estimated using 5- and 10-year lagged smoking prevalence method (45–47%) and Peto-Lopez method (46–47%) were similar, while PAFs calculated using the dose–response method were highest (47–58%). The PAFs were consistently higher in males than in females. Age-specific PAFs estimated by lagged smoking prevalence method (54–60%) and the Peto-Lopez method (57–61%) in males were similar and relatively stable, with slight decreases in older populations, while the dose–response relationship-based PAFs increased with age and fluctuated by year. By using the above methods, smoking-attributable lung cancer deaths were estimated to be 134,100, 134,600, 136,600, and 155,300 in 2000 increasing to 310,300, 301,100, 306,000, and 314,700 in 2020, respectively.ConclusionThe estimation from dose–response methods could better reflect the smoking effect, however, high-quality data and accurate estimation of parameters are necessary.

New Estimates of Smoking-Attributable Mortality in the U.S. From 2020 Through 2035

Introduction: The often-cited CDC estimate of 480,000 annual US smoking-attributable deaths (SADs), including 439,000 first-hand smoke deaths, derives from 2005-2009 data. Since then, adult smoking prevalence has decreased by 40%, while the population has grown and the smoking population aged. An updated estimate is presented to determine whether the CDC figure remains accurate or has changed substantially. In addition, the likely annual smoking-related mortality toll is projected through 2035. Methods: A well-established model of smoking prevalence and health effects is employed to estimate annual SADs among individuals exposed to first-hand smoke in the US for two distinct periods: 2005-2009 and 2020-2035. The estimate for 2005-2009 serves as a benchmark to evaluate the reliability of the model's estimate in comparison to CDC's. The projections for 2020-2035 provide up-to-date figures for SADs, predicting how annual SADs are likely to change in the coming years. Data were collected between 2005 and 2020. The analysis was conducted in 2023. Results: This study's estimate of 420,000 first-hand smoke deaths over 2005-2009 is 95.7% of CDC's estimate during the same period. The model projections indicate that SADs among individuals who currently smoke or formerly smoked have increased modestly since 2005-2009. Beginning in 2020, annual SADs will remain relatively stable at approximately 450,000 before starting to decline around 2030. Conclusions: These findings suggest that the CDC estimate of the annual mortality burden of smoking remains valid. Despite US population growth and the ageing of the smoking population, substantial reductions in smoking will finally produce a steady, if gradual, decline in SADs beginning around 2030.

Smoking-attributable mortality among Korean adults in 2019.

Tobacco use ranks among the leading preventable causes of death worldwide. This study was conducted to calculate the mortality rate attributable to smoking in Korea for 2019 and to highlight the importance of tracking and monitoring smoking-related deaths for public health purposes. Population attributable risk (PAR) was used to estimate the number of deaths related to smoking in 2019. PAR percentages were applied to the estimated mortality figures for various diseases, with PAR determined based on relative risk (RR). Levin's formula was used to calculate PAR, and RR was adjusted for age and alcohol consumption using Cox proportional hazards regression model to derive disease-specific regression coefficients. The analysis incorporated previously determined smoking rates from 1985, and use rates of novel tobacco products were not considered. The findings revealed a total of 67,982 smoking-attributable deaths in Korea in 2019, 56,993 of which occurred in men and 11,049 in women. The PAR of smoking for various causes of death in adult men was highest for lung cancer at 74.9%, followed by pneumonia (29.4%), ischemic heart disease (42.3%), and stroke (30.2%). For women, the PAR for smoking-related death was highest for lung cancer (19.9%), followed by stroke (7.6%), pneumonia (5.7%), and ischemic heart disease (9.1%). In countries experiencing rapid fluctuations in smoking rates, including Korea, regular studies on smoking-related mortality is imperative. Furthermore, it is necessary to investigate smoking-related deaths, including the prevalence of novel tobacco product use, to accurately gauge the risks associated with emerging tobacco products.

Gender differences in smoking-attributable mortality (SAM) by region in Portugal

Gender differences in smoking-attributable mortality (SAM) by region in Portugal

Smoking-attributable mortality in Portugal and its regions in 2019

Introduction and objectivesTimely regional-specific estimates of smoking-attributable mortality (SAM) are crucial for healthcare planning and tobacco control advocacy. Currently, this information is lacking in Portugal. The aim of this study was to estimate SAM by region in 2019 among the Portuguese population aged ≥35 years. MethodsSAM was estimated using an independent-prevalence method. Observed mortality was obtained from Portugal Statistics; lung cancer mortality rates in smokers and never-smokers from the Cancer Prevention Study I-II and updated relative risks from five contemporary US cohort studies. SAM was estimated for each NUTS-II region by sex, age, and cause of death. Crude SAM rates, sex and age-specific rates, and age-adjusted rates were calculated using the direct method. ResultsIn 2019, tobacco consumption caused 13,847 deaths, representing 12.3% of total mortality among the Portuguese population aged ≥35 years. Of the total SAM, 71.2% occurred in men and 22.2% in those under 65 years; 42.5% was due to cancer, 35.4% to cardiovascular and metabolic diseases, and 22.2% to respiratory diseases. SAM greatly varied among regions from 2.1% in Madeira to 36.2% in the North region. In men, cancer was the leading cause of death in all regions, while in women it was cardiovascular and metabolic diseases. ConclusionIn Portugal, tobacco-mortality burden is high and varies significantly by region, sex and age. Therefore, estimates disaggregated by sociodemographic data and region may better support decision-makers while tailoring and implementing tobacco control policies addressing health population needs. The apparent lower tobacco burden among women and in some Portuguese regions may dramatically rise in the near future. This and the high SAM in Portugal, particularly in some regions, highlights the need to accelerate tobacco control both at national and regional levels.

Evolution of smoking-attributable cardiovascular mortality in Germany 1992-2020

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Marga and Walter Boll Foundation, Kerpen, Germany. Background Despite comparatively weak tobacco control, smoking has steadily declined in Germany over the last 30 years. At the same time, while cardiovascular mortality rates have generally been decreasing in recent decades, population ageing leads to increasing numbers of deaths. Purpose To explore the impact of smoking prevalence on cardiovascular mortality against the background of these different trends at a population level, this study sought to quantify trends in smoking-attributable cardiovascular mortality (SACVM) in Germany over the past three decades. Methods Smoking and mortality statistics from 1992 to 2020 were obtained from the German Statistical Office, from which absolute and relative SACVM was calculated separately for each cardiovascular cause of death causally associated with smoking. The impact of population ageing was explored by comparing crude and age-standardized SACVM, respectively. To estimate the impact of population ageing on future SACVM, a forward projection until 2035 was modelled assuming constant mortality rates and a continuation of smoking trends. Results Results show that total absolute SACVM strongly declined over time, from about 71,900 cases in 1992 to about 42,000 cases in 2020, with a stronger drop in men (from about 51,200 to 26,400 cases) than in women (from about 20,700 to 15,600 cases). Somewhat stronger declines were seen for age-adjusted SACVM, with differences between crude and age-standardized SACVM being somewhat more distinct in men. Relative SACVM decreased overall, from 17.3% in 1992 to 14.6% in 2020. Sex-specific relative SACVM however showed differing trends: a strong decrease in men (from 29.3% to 18.8%) and a slight increase in women (8.6% to 10.6%). The forward projection of SACVM indicates a slight decline among men and a marked increase in women. Conclusions Results indicate that SACVM has strongly declined over the past three decades, even though being partly compensated by opposing trends in population ageing. The marked decrease in absolute SACVM seems to be mostly due to the general drop in cardiovascular mortality rates, and only partly due to declining smoking rates, particularly in women, where relative SACVM has even slightly increased. Over the next 15 years, population ageing and the increasing trend in relative SACVM among women might halt the recent declining trend in absolute SACVM. Hence, there is tremendous potential to curb the smoking-associated public health burden by implementing a comprehensive set of evidence-based tobacco control polices. Additionally, given still significant smoking rates in middle and old age, smoking cessation programs should be intensified.

Smoking: Quit to win.

The Winners of ‘Quit to Win’ Smoke-free Community Campaign organized by the Hong Kong Council on Smoking and Health. Translation of banner text: ‘13th Quit to Win Smoke-free Community Campaign Prize Presentation Ceremony’. (Image source: Hong Kong Council on Smoking and Health, with permission). In 2019, there were 1.14 billion current smokers globally, and they consumed 7.41 trillion cigarette-equivalents of tobacco (https://www.sciencedirect.com/science/article/pii/S0140673621011697). Smoking rates are high in some parts of Asia. China, India and Indonesia comprised 46% of the world's smokers in 2020 (https://www.statista.com/chart/24965/share-of-smokers-and-world-population-by-country/). Since early 1960, the detrimental impact of smoking on physical health and well-being has been reported worldwide. Smoking can damage nearly every human organ and lead to various diseases and disabilities, including cancer, heart disease, stroke, diabetes and chronic obstructive pulmonary disease. Smoking is harmful not only to the human body, but also the society and the economy. In 2012, the cost of diseases caused by smoking equated to 5.7% of global health expenditure and 1.8% of global gross domestic product (GPD; https://tobaccocontrol.bmj.com/content/27/1/58.long). Globally, 7.69 million deaths and 200 million disability-adjusted life-years (DALY) were related to smoking tobacco in 2019 (https://www.sciencedirect.com/science/article/pii/S0140673621011697). The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) opened for signature in 2003, and this treaty has been signed by 182 countries, covering more than 90% of the world population, making it one of the most widely embraced treaties in the United Nations' history. Various strategies have been advocated for tobacco control, and examples are price and tax measures to reduce the demand for tobacco and non-price measures, such as packaging and labelling of tobacco products; education, communication, training and public awareness; policies on tobacco advertising, promotion and sponsorship. Comprehensive tobacco control policies effectively reduce smoking prevalence, and the positive effects are amplified when multiple measures are implemented simultaneously at the same place (https://www.nature.com/articles/s41591-020-01210-8). With the substantial effort on tobacco control, from 1990 to 2019, there was a decline in the smoking-attributable mortality for both males and females in some countries such as China, Japan, the UK and the US (https://www.ssph-journal.org/articles/10.3389/ijph.2022.1605147/full). The effort to curtail the tobacco epidemic should be continued. At the regional level, the Asia Pacific Society of Respirology has recently added a new section on ‘Tobacco Control’ under the Environmental & Occupational Health and Epidemiology Assembly. It is anticipated that this can help to drive concerted efforts in the region on tobacco control. In my local community in Hong Kong, there is a recent 31% tax hike in tobacco smoking sales. It is gratifying to see the local effort for education and encouragement of smoking cessation. When attending the local campaign on tobacco control, I was touched by the stories shared by the quitters as their behavioural change positively impacts their community, family and personal life. None declared.

Genetic Associations with Smoking Relapse and Proportion of Follow-up in Smoking Relapse throughout Adulthood in Pre- and Postmenopausal Women.

This study is the first to quantify genetic associations with smoking relapse among female smokers throughout adulthood. These findings could inform precision medicine approaches to improve long-term smoking relapse prevention to reduce smoking attributable cancer morbidity and mortality.

Estimations of smoking-attributable mortality in Spain at a regional level: comparison of two methods

PurposeTo estimate and discuss smoking-attributable mortality (SAM) for the 17 regions in Spain among the population aged ≥35 years in 2017, using two methods. MethodsA descriptive analysis of SAM was conducted using two methods, the prevalence-independent method (PIM) and the prevalence-dependent method (PDM). Observed mortality was obtained from the National Institute of Statistics; smoking prevalence from three National Health Surveys; lung cancer mortality rates from the Cancer Prevention Study-II; and relative risks from five US cohorts. SAM and percentages of change were estimated for each region overall, by sex, age and cause of death. ResultsIn 2017, tobacco caused 56,203 deaths in Spain applying the PIM. Using the PDM the number of deaths was 4.4% (95% CI: 3.4–5.5) lower (53,825 deaths). Except in four regions, the PIM estimated a higher overall SAM and the maximum percentage of change was 18.6%. Overall percentages of change were higher for women (15.7% 95% CI: 12.6–19.0) and for cardiovascular diseases–diabetes mellitus (13.8%; 95% CI: 11.5–16.2). ConclusionsAt the national level, both methods estimate similar figures for SAM. However, the difference in estimates appears at the subnational level. Differences were higher in subgroups with lower smoking prevalence and for causes of death with periods of induction shorter than those for lung cancer.

Effect of tobacco taxation on smoking prevalence and smoking-attributable deaths in India.

Higher taxes are the single most effective way to encourage tobacco users to quit tobacco use and prevent youth from initiation. The present study aims to estimate the effect of raising the tax on smoked tobacco products on its consumption and smoking-attributable deaths in India. A mathematical model was developed which used the projected population of India, taxation rates on smoked tobacco products, smoking prevalence, and price elasticity of demand of cigarette and bidi from 2017 to 2025. Four scenarios of tax increment (0%, 25%, 50%, and 100%) on smoked tobacco products were created which were modeled to calculate smoking prevalence and smoking-attributable deaths due to respiratory diseases, heart diseases, stroke tuberculosis, and cancer in country till 2025. A relative decrease of 6.2% in the prevalence of smoking was observed between the existing tax rates and its increment to 100% over the last increment of 6%. Similarly, smoking-attributable deaths (SAD) decreased by 6.04% on increasing the tax rates to 100% of the existing taxation rates. There has been a steady increase in SAD in scenario 1 which decreases effectively in scenario 4, which in turn leads to the saving of around 33,000 lives due to tobacco-related diseases by 2025. The consumption of cigarettes and bidis can be reduced by raising the price of these products. The model will help policymakers in deciding to fix the tax and ultimately the price of cigarettes and bidi to reduce its consumption and smoking-attributable mortality.

Mortalidad atribuida al consumo de tabaco en Brasil, 1996-2019

ObjectiveTo analyze the burden of tobacco consumption on mortality and years of life expectancy lost in population ≥35 years in Brazil in the period 1996-2019 and to identify trend changes in smoking-attributable mortality. MethodAn independent prevalence method using the lung cancer mortality rate as a proxy for cumulative smoking risk was used to estimate smoking-attributable mortality. Smoking-attributable mortality is estimated from the lung cancer mortality rate and applying relative risks from 5 US cohorts. Smoking-attributable mortality, crude and standardized attributed mortality rates are presented overall, by sex, age and causes of death. Trend analysis was performed by applying joinpoint regression models. Years of life expectancy lost due to tobacco were calculated. ResultsTobacco consumption caused 2,389,831 deaths in Brazil between 1996-2019. Cardiometabolic diseases were the leading cause of death in women throughout the period and in men until 2015. Since 2006, smoking-attributable mortality rates in men, regardless of age, show a decreasing trend while in females the evolution is different. The years of life expectancy lost show a slight decrease since the first triennia and are higher in men. ConclusionsIn Brazil, the 8.5% of total mortality between 1996-2019 is attributed to tobacco consumption. It is important to monitor the burden of the tobacco consumption on mortality in order to strengthen or implement interventions against smoking in Brazil.