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
Marissa B Reitsma, Parkes Kendrick, Emad Ababneh, Cristiana Abbafati, Mohsen Abbasi‐Kangevari(University of Washington), Amir Abdoli(University of Washington), Aidin Abedi, E S Abhilash(University of Washington), Derrick Bary Abila(University of Washington), Victor Aboyans(University of Washington), Niveen ME Abu-Rmeileh(University of Washington), Oladimeji Adebayo(University of Washington), Shailesh M Advani(University of Washington), Mohammad Aghaali(University of Washington), Bright Opoku Ahinkorah(University of Washington), Sohail Ahmad(University of Washington), Keivan Ahmadi(University of Washington), Haroon Ahmed(University of Washington), Budi Aji(University of Washington), Chisom Joyqueenet Akunna(University of Washington), Ziyad Al‐Aly(University of Washington), Turki M Alanzi(University of Washington), Khalid F. AlHabib(University of Washington), Liaqat Ali(University of Washington), Sheikh Mohammad Alif(University of Washington), Vahid Alipour(University of Washington), Syed Mohamed Aljunid(University of Washington), François Alla(University of Washington), Peter Allebeck(University of Washington), Nelson Alvis‐Guzmán(University of Washington), Tarek Tawfik Amin(University of Washington), Saeed Amini(University of Washington), Hubert Amu(University of Washington), Gianna Gayle Herrera Amul(University of Washington), Robert Ancuceanu(University of Washington), Jason A Anderson(University of Washington), Alireza Ansari‐Moghaddam(University of Washington), Carl Abelardo T Antonio(University of Washington), Benny Antony(University of Washington), Davood Anvari(University of Washington), Jalal Arabloo(University of Washington), Nicholas Arian(University of Washington), Monika Arora(University of Washington), Malke Asaad(University of Washington), Marcel Ausloos(University of Washington), Asma Awan(University of Washington), Getinet Ayano(University of Washington), Getie Lake Aynalem(University of Washington), Samad Azari(University of Washington), B B Darshan(University of Washington), Ashish Badiye(University of Washington), Atif Amin Baig(University of Washington), Mohammad Hossein Bakhshaei(University of Washington), Maciej Banach(University of Washington), Palash Chandra Banik(University of Washington), Suzanne Barker‐Collo(University of Washington), Till Bärnighausen(University of Washington), Hiba Jawdat Barqawi(University of Washington), Sanjay Basu(University of Washington), Mohsen Bayati(University of Washington), Shahrzad Bazargan‐Hejazi(University of Washington), Masoud Behzadifar(University of Washington), Tariku Tesfaye Bekuma(University of Washington), Derrick Bennett(University of Washington), Isabela M. Benseñor(University of Washington), Kathleen S. Berfield(University of Washington), Akshaya Srikanth Bhagavathula(University of Washington), Nikha Bhardwaj(University of Washington), Pankaj Bhardwaj(University of Washington), Krittika Bhattacharyya(University of Washington), Sadia Bibi(University of Washington), Ali Bijani(University of Washington), Bagas Suryo Bintoro(University of Washington), Antonio Biondi(University of Washington), Setognal Birara(University of Washington), Dejana Braithwaite(University of Washington), Hermann Brenner(University of Washington), André R. Brunoni(University of Washington), Katrin Burkart(University of Washington), Zahid A Butt(University of Washington), Florentino Luciano Caetano dos Santos, Luis Alberto Cámera(University of Washington), Josip Car(University of Washington), Rosario Cárdenas(University of Washington), Giulia Carreras(University of Washington), Juan Jesús Carrero(University of Washington), João Maurício Castaldelli-Maia(University of Washington), Maria Sofia Cattaruzza(University of Washington), Jung‐Chen Chang(University of Washington), Simiao Chen(University of Washington), Dinh‐Toi Chu(University of Washington), Sheng‐Chia Chung(University of Washington), Massimo Círillo(University of Washington), Vera Marisa Costa(University of Washington), Rosa A S Couto(University of Washington), Omid Dadras(University of Washington), Xiaochen Dai(University of Washington), Albertino Antonio Moura Damasceno(University of Washington), Giovanni Damiani(University of Washington), Lalit Dandona(University of Washington), Rakhi Dandona(University of Washington), Parnaz Daneshpajouhnejad(University of Washington), Jiregna Darega Gela(University of Washington), Kairat Davletov(University of Washington), Meseret Derbew Molla, Getenet Dessie, Abebaw Alemayehu Desta, Samath Dhamminda Dharmaratne(University of Washington), Mostafa Dianatinasab(University of Washington), Daniel Díaz(University of Washington), Hoa Do(University of Washington), Abdel Douiri(University of Washington), Bruce Bartholow Duncan(University of Washington), André Rodrigues Durães(University of Washington), Arielle Wilder Eagan(University of Washington), Mohammad Ebrahimi Kalan(University of Washington), Kristina Edvardsson(University of Washington), Iffat Elbarazi(University of Washington), Maha El Tantawi(University of Washington), Saman Esmaeilnejad(University of Washington), Ibtihal Fadhil(University of Washington), Emerito Jose A Faraon(University of Washington), Carla Sofia e Sá Farinha(University of Washington), Medhat Farwati(University of Washington), Farshad Farzadfar(University of Washington), Mehdi Fazlzadeh(University of Washington), Valery L. Feigin(University of Washington), Rachel Feldman(University of Washington), Carlota Fernández Prendes(University of Washington), Pietro Ferrara(University of Washington), Irina Filip(University of Washington), Filippos T Filippidis(University of Washington), Florian Fischer(University of Washington), Luísa Sório Flor(University of Washington), Nataliya A Foigt(University of Washington), Morẹ́nikẹ́ Oluwátóyìn Foláyan(University of Washington), Masoud Foroutan(University of Washington), Mohamed M. Gad(University of Washington), Abhay Gaidhane(University of Washington), Silvano Gallus(University of Washington), Biniyam Sahiledengle Geberemariyam(University of Washington), Mansour Ghafourifard(University of Washington), Alireza Ghajar(University of Washington), Ahmad Ghashghaee(University of Washington), Simona Giampaoli(University of Washington), Paramjit Gill(University of Washington), Franklin N. Glozah(University of Washington), E. V. Gnedovskaya(University of Washington), Mahaveer Golechha(University of Washington), Sameer Vali Gopalani(University of Washington), Giuseppe Gorini(University of Washington), Houman Goudarzi(University of Washington), Alessandra C. Goulart(University of Washington), Felix Greaves(University of Washington), Avirup Guha(University of Washington), Yuming Guo(University of Washington), Bhawna Gupta(University of Washington), Rajat Das Gupta(University of Washington), Rajeev Gupta(University of Washington), Tarun Gupta(University of Washington), Vin Gupta(University of Washington), Nima Hafezi‐Nejad(University of Washington), Mohammad Rifat Haider(University of Washington), Randah R Hamadeh(University of Washington), Graeme J. Hankey(University of Washington), Arief Hargono(University of Washington), Risky Kusuma Hartono(University of Washington), Hadi Hassankhani(University of Washington), Simon I Hay(University of Washington), Golnaz Heidari(University of Washington), Claudiu Herţeliu(University of Washington), Kamal Hezam(University of Washington), Thomas R. Hird(University of Washington), Michael K. Hole(University of Washington), Ramesh Holla(University of Washington), Mehdi Hosseinzadeh(University of Washington), Sorin Hostiuc(University of Washington), Mowafa Househ(University of Washington), Thomas Hsiao(University of Washington), Junjie Huang(University of Washington), Vincent C Iannucci(University of Washington), Segun Emmanuel Ibitoye(University of Washington), Bulat Idrisov(University of Washington), Olayinka Stephen Ilesanmi(University of Washington), Irena Ilić(University of Washington), Milena Ilić(University of Washington), Leeberk Raja Inbaraj, Seyed Sina Naghibi Irvani(University of Washington), Jessica Y. Islam(University of Washington), Rakibul Islam(University of Washington), Sheikh Mohammed Shariful Islam(University of Washington), Farhad Islami(University of Washington), Hiroyasu Iso(University of Washington), Ramaiah Itumalla(University of Washington), Masao Iwagami(University of Washington), Jalil Jaafari(University of Washington), Vardhmaan Jain(University of Washington), Mihajlo Jakovljević(University of Washington), Sung‐In Jang(University of Washington), Hosna Janjani(University of Washington), Shubha Jayaram(University of Washington), Panniyammakal Jeemon(University of Washington), Ravi Prakash Jha(University of Washington), Jost B Jonas(University of Washington), Tamás Joó(University of Washington), Mikk Jürisson(University of Washington), Ali Kabir(University of Washington), Zubair Kabir(University of Washington), Leila R Kalankesh(University of Washington), Tanuj Kanchan(University of Washington), Himal Kandel(University of Washington), Neeti Kapoor(University of Washington), Salah Eddin Karimi, Srinivasa Vittal Katikireddi(University of Washington), Hafte Kahsay Kebede(University of Washington), Bayew Kelkay(University of Washington), Ryan David Kennedy(University of Washington), Abdullah T Khoja(University of Washington), Jagdish Khubchandani(University of Washington), Gyu Ri Kim(University of Washington), Young‐Eun Kim(University of Washington), Ruth W Kimokoti(University of Washington), Mika Kivimäki(University of Washington), Soewarta Kosen(University of Washington), Sindhura Lakshmi Koulmane Laxminarayana, Ai Koyanagi(University of Washington), Kewal Krishan(University of Washington), Nuworza Kugbey(University of Washington), G Anil Kumar(University of Washington), Nithin Kumar(University of Washington), Om Kurmi(University of Washington), Dian Kusuma(University of Washington), Ben Lacey(University of Washington), Jennifer O. Lam(University of Washington), Iván Landires(University of Washington), Savita Lasrado(University of Washington), Paolo Lauriola(University of Washington), Doo Woong Lee(University of Washington), Yo Han Lee(University of Washington), Janni Leung(University of Washington), Shanshan Li(University of Washington), Hualiang Lin(University of Washington), Shai Linn(University of Washington), Wei Liu(University of Washington), Alan D Lopez(University of Washington), Platon D Lopukhov(University of Washington), Stefan Lorkowski(University of Washington), Alessandra Lugo(University of Washington), Azeem Majeed(University of Washington), Afshin Maleki(University of Washington), Reza Malekzadeh(University of Washington), Déborah Carvalho Malta(University of Washington), Abdullah Al Mamun(University of Washington), Narayana Manjunatha(University of Washington), Borhan Mansouri(University of Washington), Mohammad Alì Mansournia(University of Washington), José Martı́nez-Raga(University of Washington), Santi Martini(University of Washington), Manu Raj Mathur(University of Washington), Carlo Eduardo Medina‐Solís(University of Washington), Suresh Mehata(University of Washington), Walter Mendoza(University of Washington), Ritesh G. Menezes(University of Washington), Atte Meretoja(University of Washington), Tuomo J Meretoja(University of Washington), Bartosz Miazgowski(University of Washington), Irmina Maria Michałek(University of Washington), Ted R. Miller(University of Washington), Erkin М Мirrakhimov(University of Washington), Hamed Mirzaei(University of Washington), Mehdi Mirzaei-Alavijeh(University of Washington), Sanjeev Misra(University of Washington), Masoud Moghadaszadeh(University of Washington), Yousef Mohammad(University of Washington), Abdollah Mohammadian-Hafshejani(University of Washington), Shafiu Mohammed(University of Washington), Ali H. Mokdad(University of Washington), Lorenzo Monasta(University of Washington), Mohammad Ali Moni(University of Washington), Ghobad Moradi(University of Washington), Maziar Moradi‐Lakeh(University of Washington), Rahmatollah Moradzadeh(University of Washington), Shane D. Morrison(University of Washington), Tilahun Belete Mossie(University of Washington), Sumaira Mubarik(University of Washington), Erin C Mullany(University of Washington), Christopher J L Murray(University of Washington), Mohsen Naghavi(University of Washington), Behshad Naghshtabrizi(University of Washington), Sanjeev Nair(University of Washington), Mahdi Nalini(University of Washington), Vinay Nangia(University of Washington), Atta Abbas Naqvi(University of Washington), Sreenivas Narasimha Swamy(University of Washington), Muhammad Naveed(University of Washington), Smitha Nayak(University of Washington), Vinod C Nayak(University of Washington), Javad Nazari(University of Washington), Sabina O. Nduaguba(University of Washington), Sandhya Neupane Kandel(University of Washington), Cuong Tat Nguyen(University of Washington), Huong Lan Thi Nguyen(University of Washington), Son Hoang Nguyen(University of Washington), Trang Huyen Nguyen(University of Washington), Molly R Nixon(University of Washington), Chukwudi A Nnaji(University of Washington), Bo Norrving(University of Washington), Jean Jacques Noubiap(University of Washington), Christoph Nowak(University of Washington), Felix Akpojene Ogbo(University of Washington), Ayodipupo Sikiru Oguntade(University of Washington), In‐Hwan Oh(University of Washington), Andrew T Olagunju(University of Washington), Eyal Oren(University of Washington), Nikita Otstavnov(University of Washington), Stanislav S Otstavnov(University of Washington), Mayowa Owolabi(University of Washington), P A Mahesh(University of Washington), Smita Pakhalé(University of Washington), Keyvan Pakshir(University of Washington), Raffaele Palladino(University of Washington), Adrian Pană(University of Washington), Songhomitra Panda‐Jonas(University of Washington), Ashok Pandey(University of Washington), Utsav Parekh(University of Washington), Eun‐Cheol Park(University of Washington), Eun‐Kee Park(University of Washington), Fatemeh Pashazadeh Kan(University of Washington), George Patton(University of Washington), Shrikant Pawar(University of Washington), Richard G. Pestell(University of Washington), Marina Pinheiro(University of Washington), М. А. Пирадов(University of Washington), Saeed Pirouzpanah(University of Washington), Khem Narayan Pokhrel(University of Washington), Р. В. Полибин(University of Washington), Akila Prashant(University of Washington), Dimas Ria Angga Pribadi(University of Washington), Amir Radfar(University of Washington), Vafa Rahimi‐Movaghar(University of Washington), Azizur Rahman(University of Washington), Mohammad Hifz Ur Rahman(University of Washington), Muhammad Aziz Rahman(University of Washington), Amir Masoud Rahmani(University of Washington), Nazanin Rajai(University of Washington), Pradhum Ram(University of Washington), Chhabi Lal Ranabhat(University of Washington), Priya Rathi(University of Washington), Lal Rawal(University of Washington), André M. N. Renzaho(University of Washington), Luz Myriam Reynales-Shigematsu(University of Washington), Aziz Rezapour(University of Washington), Seyed Mohammad Riahi(University of Washington), Mavra A Riaz(University of Washington), Leonardo Roever(University of Washington), Luca Ronfani(University of Washington), Gholamreza Roshandel(University of Washington), Ambuj Roy(University of Washington), Bedanta Roy(University of Washington), Simona Sacco(University of Washington), Basema Saddik(University of Washington), Amirhossein Sahebkar(University of Washington), Sana Salehi(University of Washington), Hamideh Salimzadeh(University of Washington), Mehrnoosh Samaei(University of Washington), Abdallah M Samy(University of Washington), Itamar S Santos(University of Washington), Milena M Santric-Milicevic(University of Washington), Nizal Sarrafzadegan(University of Washington), Brijesh Sathian(University of Washington), Monika Sawhney(University of Washington), Mete Şaylan(University of Washington), Michael P Schaub(University of Washington), María Inês Schmidt(University of Washington), Ione Jayce Ceola Schneider(University of Washington), Aletta E. Schutte(University of Washington), Falk Schwendicke(University of Washington), Abdul-Aziz Seidu(University of Washington), Nachimuthu Senthil Kumar(University of Washington), Sadaf G Sepanlou(University of Washington), Allen Seylani(University of Washington), Omid Shafaat(University of Washington), Syed M. Shah(University of Washington), Masood Ali Shaikh(University of Washington), Ali Shalash(University of Washington), Mohammed Shannawaz(University of Washington), Kiomars Sharafi(University of Washington), Aziz Sheikh(University of Washington), Sara Sheikhbahaei(University of Washington), Mika Shigematsu(University of Washington), Rahman Shiri(University of Washington), Kawkab Shishani(University of Washington), K. M. Shivakumar(University of Washington), Siddharudha Shivalli(University of Washington), Roman Shrestha(University of Washington), Soraya Siabani(University of Washington), Negussie Boti Sidemo(University of Washington), Inga Dóra Sigfúsdóttir(University of Washington), Rannveig Sigurvinsdóttir(University of Washington), Diego Augusto Santos Silva(University of Washington), João Pedro Silva(University of Washington), Ambrish Singh(University of Washington), Jasvinder A. Singh(University of Washington), Virendra Singh(University of Washington), Dhirendra Narain Sinha(University of Washington), Freddy Sitas(University of Washington), Valentin Yurievich Skryabin(University of Washington), Anna Aleksandrovna Skryabina(University of Washington), Matiwos Soboka(University of Washington), Joan B. Soriano(University of Washington), Ali Soroush(University of Washington), Sergey Soshnikov(University of Washington), Ireneous N Soyiri(University of Washington), Emma Elizabeth Spurlock(University of Washington), Chandrashekhar T Sreeramareddy(University of Washington), Dan J. Stein(University of Washington), Paschalis Steiropoulos(University of Washington), Stefan Stortecky(University of Washington), Kurt Straif(University of Washington), Rizwan Suliankatchi Abdulkader(University of Washington), Gerhard Sulo(University of Washington), Johan Sundström(University of Washington), Takahiro Tabuchi(University of Washington), Santosh Kumar Tadakamadla, Biruk Wogayehu Taddele(University of Washington), Eyayou Girma Tadesse(University of Washington), Animut Tagele Tamiru(University of Washington), Minale Tareke(University of Washington), Md. Ismail Tareque(University of Washington), Ingan Ukur Tarigan(University of Washington), Mohamad‐Hani Temsah(University of Washington), Kavumpurathu Raman Thankappan(University of Washington), Rekha Thapar(University of Washington), Aleš Tichopád(University of Washington), Musliu Adetola Tolani(University of Washington), Fotis Topouzis(University of Washington), Marcos Roberto Tovani‐Palone, Bach Xuan Tran(University of Washington), Jaya Prasad Tripathy, Gebiyaw Wudie Tsegaye(University of Washington), Nikolaos Tsilimparis(University of Washington), Hayley Tymeson(University of Washington), Anayat Ullah(University of Washington), Saif Ullah(University of Washington), Brigid Unim(University of Washington), Rachel L Updike(University of Washington), Marco Vacante(University of Washington), Pascual Valdéz(University of Washington), Constantine Vardavas(University of Washington), Patricia Varona Pérez(University of Washington), Tommi Vasankari(University of Washington), Narayanaswamy Venketasubramanian(University of Washington), Madhur Verma(University of Washington), Marina Vetrova(University of Washington), Bay Vo(University of Washington), Giang Thu Vu(University of Washington), Yasir Waheed(University of Washington), Yanzhong Wang(University of Washington), Kevin Welding(University of Washington), Andrea Werdecker(University of Washington), Joanna L Whisnant(University of Washington), Nuwan Darshana Wickramasinghe(University of Washington), Kazumasa Yamagishi(University of Washington), Srikanth Yandrapalli(University of Washington), Hiroshi Yatsuya(University of Washington), Vahid Yazdi‐Feyzabadi(University of Washington), Yigizie Yeshaw, Mohammed Zewdu Yimmer, Naohiro Yonemoto, Chuanhua Yu(University of Washington), Ismaeel Yunusa, Hasan Yusefzadeh, Telma Zahirian Moghadam, Muhammed Shahriar Zaman, Maryam Zamanian, Hamed Zandian(University of Washington), Heather J. Zar(University of Washington), Михаил Сергеевич Застрожин, Anasthasia Zastrozhina, Luis Zavala‐Arciniega(University of Washington), Jianrong Zhang, Zhi-Jiang Zhang, Chenwen Zhong(University of Washington), Yves Miel H Zuñiga, Emmanuela Gakidou(University of Washington)
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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.
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