Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019

GBD 2019 Tobacco Collaborators

doi:10.1016/S0140-6736(21)01169-7

Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019

GBD 2019 Tobacco Collaborators

School of Public Health

Research output: Contribution to journal › Article › peer-review

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
DOIs	https://doi.org/10.1016/S0140-6736(21)01169-7
State	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. Editorial note: the Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations.

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.

Publisher Copyright:
© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

Keywords

Adult
Age Distribution
Aged
Female
Global Burden of Disease
Global Health
Humans
Male
Middle Aged
Prevalence
Quality-Adjusted Life Years
Sex Factors
Smoking/epidemiology
Socioeconomic Factors
Surveys and Questionnaires
Tobacco Use/epidemiology

ASJC Scopus subject areas

General Medicine

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10.1016/S0140-6736(21)01169-7

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@article{60bcc6d39d7c499dbca4b33ccb2ec846,

title = "Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019",

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.",

keywords = "Adult, Age Distribution, Aged, Female, Global Burden of Disease, Global Health, Humans, Male, Middle Aged, Prevalence, Quality-Adjusted Life Years, Sex Factors, Smoking/epidemiology, Socioeconomic Factors, Surveys and Questionnaires, Tobacco Use/epidemiology",

author = "{GBD 2019 Tobacco Collaborators} and Reitsma, {Marissa B.} and Kendrick, {Parkes J.} and Emad Ababneh and Cristiana Abbafati and Mohsen Abbasi-Kangevari and Amir Abdoli and Aidin Abedi and Abhilash, {E. S.} and Abila, {Derrick Bary} and Victor Aboyans and Abu-Rmeileh, {Niveen ME} and Adebayo, {Oladimeji M.} and Advani, {Shailesh M.} and Mohammad Aghaali and Ahinkorah, {Bright Opoku} and Sohail Ahmad and Keivan Ahmadi and Haroon Ahmed and Budi Aji and Akunna, {Chisom Joyqueenet} and Ziyad Al-Aly and Alanzi, {Turki M.} and Alhabib, {Khalid F.} and Liaqat Ali and Alif, {Sheikh Mohammad} and Vahid Alipour and Aljunid, {Syed Mohamed} and Fran{\c c}ois Alla and Peter Allebeck and Nelson Alvis-Guzman and Amin, {Tarek Tawfik} and Saeed Amini and Hubert Amu and Amul, {Gianna Gayle Herrera} and Robert Ancuceanu and Anderson, {Jason A.} and Alireza Ansari-Moghaddam and Antonio, {Carl Abelardo T.} and Benny Antony and Davood Anvari and Jalal Arabloo and Arian, {Nicholas D.} and Monika Arora and Malke Asaad and Marcel Ausloos and Awan, {Asma Tahir} and Getinet Ayano and Aynalem, {Getie Lake} and Samad Azari and Shai Linn",

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 Funda{\c c}{\~a}o para a Ci{\^e}ncia e Tecnologia (FCT), IP, under the Norma Transit{\'o}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{\'o}n (SNI), which is supported by the Secretar{\'i}a Nacional de Ciencia, Tecnolog{\'i}a e Innovaci{\'o}n (SENACYT), Panam{\'a}. 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{\'o}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. 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{\c c}{\~a}o para a Ci{\^e}ncia e Tecnologia (FCT), IP, under the Norma Transit{\'o}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{\'o}n (SNI), which is supported by the Secretar{\'i}a Nacional de Ciencia, Tecnolog{\'i}a e Innovaci{\'o}n (SENACYT), Panam{\'a}. 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{\'o}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. Publisher Copyright: {\textcopyright} 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license",

year = "2021",

month = jun,

day = "19",

doi = "10.1016/S0140-6736(21)01169-7",

language = "English",

volume = "397",

pages = "2337--2360",

journal = "The Lancet",

issn = "0140-6736",

publisher = "Elsevier",

number = "10292",

}

Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019. / GBD 2019 Tobacco Collaborators.
In: The Lancet, Vol. 397, No. 10292, 19.06.2021, p. 2337-2360.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019

T2 - a systematic analysis from the Global Burden of Disease Study 2019

AU - GBD 2019 Tobacco Collaborators

AU - Reitsma, Marissa B.

AU - Kendrick, Parkes J.

AU - Ababneh, Emad

AU - Abbafati, Cristiana

AU - Abbasi-Kangevari, Mohsen

AU - Abdoli, Amir

AU - Abedi, Aidin

AU - Abhilash, E. S.

AU - Abila, Derrick Bary

AU - Aboyans, Victor

AU - Abu-Rmeileh, Niveen ME

AU - Adebayo, Oladimeji M.

AU - Advani, Shailesh M.

AU - Aghaali, Mohammad

AU - Ahinkorah, Bright Opoku

AU - Ahmad, Sohail

AU - Ahmadi, Keivan

AU - Ahmed, Haroon

AU - Aji, Budi

AU - Akunna, Chisom Joyqueenet

AU - Al-Aly, Ziyad

AU - Alanzi, Turki M.

AU - Alhabib, Khalid F.

AU - Ali, Liaqat

AU - Alif, Sheikh Mohammad

AU - Alipour, Vahid

AU - Aljunid, Syed Mohamed

AU - Alla, François

AU - Allebeck, Peter

AU - Alvis-Guzman, Nelson

AU - Amin, Tarek Tawfik

AU - Amini, Saeed

AU - Amu, Hubert

AU - Amul, Gianna Gayle Herrera

AU - Ancuceanu, Robert

AU - Anderson, Jason A.

AU - Ansari-Moghaddam, Alireza

AU - Antonio, Carl Abelardo T.

AU - Antony, Benny

AU - Anvari, Davood

AU - Arabloo, Jalal

AU - Arian, Nicholas D.

AU - Arora, Monika

AU - Asaad, Malke

AU - Ausloos, Marcel

AU - Awan, Asma Tahir

AU - Ayano, Getinet

AU - Aynalem, Getie Lake

AU - Azari, Samad

AU - Linn, Shai

N1 - 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. Editorial note: the Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations. 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. Publisher Copyright: © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

PY - 2021/6/19

Y1 - 2021/6/19

N2 - 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.

AB - 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.

KW - Adult

KW - Age Distribution

KW - Aged

KW - Female

KW - Global Burden of Disease

KW - Global Health

KW - Humans

KW - Male

KW - Middle Aged

KW - Prevalence

KW - Quality-Adjusted Life Years

KW - Sex Factors

KW - Smoking/epidemiology

KW - Socioeconomic Factors

KW - Surveys and Questionnaires

KW - Tobacco Use/epidemiology

UR - http://www.scopus.com/inward/record.url?scp=85108062100&partnerID=8YFLogxK

U2 - 10.1016/S0140-6736(21)01169-7

DO - 10.1016/S0140-6736(21)01169-7

M3 - Article

C2 - 34051883

AN - SCOPUS:85108062100

SN - 0140-6736

VL - 397

SP - 2337

EP - 2360

JO - The Lancet

JF - The Lancet

IS - 10292

ER -

Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019

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