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Smoking still kills more than 1 in 10 people around the globe

Figures show need for renewed and sustained efforts on tobacco control

Carline White

Thursday, 06 April 2017

More than 1 in 10 deaths worldwide (6.4 million) are still caused by smoking, and just four countries—China, India, USA, and Russia— account for half of these deaths, show the latest estimates from the Global Burden of Disease study* published in The Lancet today.

The new estimates, which are based on smoking habits in 195 countries and territories between 1990 and 2015, show that smoking remains a leading risk factor for death and disability. With growing and ageing populations already boosting the impact of tobacco, it will be crucial to support more smokers to quit and stop people from starting, say the researchers.

Since the implementation of the WHO Framework Convention on Tobacco Control in 2005, many countries have adopted tobacco control policies, but the war against tobacco is far from won, warn the researchers who argue that policy makers must renew and sustain their efforts to tackle the epidemic.

Worldwide, between 1990 and 2015, smoking prevalence fell by almost a third (29.4%) to 15.3% in 2015. Today, one in four men (25%) smoke, as do one in 20 women (5.4%). Despite these improvements, population growth has led to an increase in the overall number of smokers, from 870.4 million in 1990 to 933.1 million in 2015.

Deaths attributable to smoking increased by 4.7% in 2015 compared with 2005, and smoking was rated as a bigger burden on health – moving up from the third to the second highest cause of disability.

“Despite more than half a century of unequivocal evidence of the harmful effects of tobacco on health, today, one in every four men in the world is a daily smoker,” said senior author Dr Emmanuela Gakidou, Institute for Health Metrics and Evaluation at the University of Washington, USA.

“Smoking remains the second largest risk factor for early death and disability, and so to further reduce its impact we must intensify tobacco control to further reduce smoking prevalence and attributable burden,” she said.

The 10 countries with the largest number of smokers in 2015 were China, India, Indonesia, USA, Russia, Bangladesh, Japan, Brazil, Germany and the Philippines – who together accounted for nearly two-thirds of the world’s smokers (63.6%).

There were no significant reductions in the prevalence of smoking among men in Indonesia, Bangladesh or the Philippines between 1990 and 2015 (smoking rates were 46.7%, 38.0%, and 34.5%, respectively), and in Russia, smoking prevalence among women has increased from 7.9% in 1990 to 12.3% in 2015).

In contrast, Brazil, which has been a leader in tobacco control, had one of the largest reductions in smoking prevalence for men and women between 1990 and 2015— halving from 28.9% to 12.6% in men and 18.6% to 8.2% in women.

The increases in smoking prevalence among women since 1990 and consistently high levels of male smokers in Eastern Europe are associated with the tobacco industry’s targeting of the area in the 1990s, say the researchers.

They warn that a similar picture could emerge in sub-Saharan Africa, as the tobacco industry now seeks to expand its market by exploiting the region’s patchy tobacco control regulations and its limited resources to combat the industry’s marketing tactics.

“There have been some success stories, but smoking remains the leading cause of death and disability in 100 countries in 2015,” said Dr Gakidou.

“Its toll will remain substantial without more concerted policy initiatives, policy compliance and enforcement, and sustained political will to offset commercial interests.

“Despite progress in some settings, the war against tobacco is far from won, especially in countries with the highest numbers of smokers. The staggering toll of smoking on health echoes well beyond the individual, especially as tobacco threatens to exact long-term financial and operational burdens on already resource-constrained health systems.

“To markedly bend the global tobacco epidemic’s trajectory, a renewed and sustained focus is needed on comprehensive tobacco control policies around the world. Success is possible, but requires effective and aggressively enforced policies and laws,” she emphasised.

In a linked comment,** Professor John Britton, University of Nottingham, said: “Today, the smoking epidemic is being exported from the rich world to low-income and middle-income countries, slipping under the radar while apparently more immediate priorities occupy and absorb scarce available human and financial resources.

The epidemic of tobacco deaths will progress inexorably throughout the world until and unless tobacco control is recognised as an immediate priority for development, investment, and research.”


* GBD 2015 Tobacco Collaborators. Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: a systematic analysis from the Global Burden of Disease Study 2015. The Lancet, published 05 April 2017. DOI: 10.1016/S0140-6736(17)30819-X

** Britton J. Death, disease, and tobacco. The Lancet, published 05 April 2017. DOI: 10.1016/S0140-6736(17)30867-X

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