TY  - JOUR
TI  - Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: a systematic analysis from the Global Burden of Disease Study 2015
AU  - Marissa B Reitsma
AU  - Nancy Fullman
AU  - Marie Ng
AU  - Joseph S Salama
AU  - Amanuel Alemu Abajobir
AU  - Kalkidan Hassen Abate
AU  - Cristiana Abbafati
AU  - Semaw Ferede Abera
AU  - Biju Abraham
AU  - Gebre Yitayih Abyu
AU  - Akindele O. Adebiyi
AU  - Ziyad Al‐Aly
AU  - Alicia V Aleman
AU  - Raghib Ali
AU  - Ala’a Alkerwi
AU  - Peter Allebeck
AU  - Rajaa Al‐Raddadi
AU  - Azmeraw T. Amare
AU  - Alemayehu Amberbir
AU  - Walid Ammar
AU  - Stephen M. Amrock
AU  - Carl Abelardo T. Antonio
AU  - Hamid Asayesh
AU  - Niguse Tadela Atnafu
AU  - Peter Azzopardi
AU  - Amitava Banerjee
AU  - Aleksandra Barać
AU  - Tonatiuh Barrientos‐Gutiérrez
AU  - Ana Basto‐Abreu
AU  - Shahrzad Bazargan‐Hejazi
AU  - Neeraj Bedi
AU  - Brent Bell
AU  - Aminu K. Bello
AU  - Isabela M. Benseñor
AU  - Addisu Shunu Beyene
AU  - Neeraj Bhala
AU  - Stan Biryukov
AU  - Kaylin Bolt
AU  - Hermann Brenner
AU  - Zahid A Butt
AU  - Fiorella Cavalleri
AU  - Kelly Cercy
AU  - Honglei Chen
AU  - Devasahayam Jesudas Christopher
AU  - Liliana G Ciobanu
AU  - Valentina Colistro
AU  - Mercedes Colomar
AU  - Leslie Cornaby
AU  - Xiaochen Dai
AU  - Solomon Abrha Damtew
AU  - Lalit Dandona
AU  - Rakhi Dandona
AU  - Emily Dansereau
AU  - Kairat Davletov
AU  - Anand Dayama
AU  - Tizta Tilahun Degfie
AU  - Amare Deribew
AU  - Samath Dhamminda Dharmaratne
AU  - Balem Dimtsu
AU  - Kerrie Doyle
AU  - Aman Yesuf Endries
AU  - Sergey Petrovich Ermakov
AU  - Kara Estep
AU  - Emerito Jose A Faraon
AU  - Farshad Farzadfar
AU  - Valery L. Feigin
AU  - Andrea B Feigl
AU  - Florian Fischer
AU  - Joseph Friedman
AU  - Tsegaye Tewelde G/hiwot
AU  - Seana Gall
AU  - Wayne Gao
AU  - Richard F Gillum
AU  - Audra L Gold
AU  - Sameer Vali Gopalani
AU  - Carolyn Gotay
AU  - Rahul Gupta
AU  - Rajeev Gupta
AU  - Vipin Gupta
AU  - Randah R Hamadeh
AU  - Graeme J. Hankey
AU  - Hilda L Harb
AU  - Simon I Hay
AU  - Masako Horino
AU  - Nobuyuki Horita
AU  - Hung Chak Ho
AU  - Abdullatif Husseini
AU  - Bogdan Vasile Ileanu
AU  - Farhad Islami
AU  - Guohong Jiang
AU  - Ying Jiang
AU  - Jost B. Jonas
AU  - Zubair Kabir
AU  - Ritul Kamal
AU  - Amir Kasaeian
AU  - Chandrasekharan Nair Kesavachandran
AU  - Yousef Khader
AU  - Ibrahim Khalil
AU  - Young‐Ho Khang
AU  - Sahil Khera
PY  - 2017
JO  - The Lancet
DO  - 10.1016/s0140-6736(17)30819-x
UR  - https://doi.org/10.1016/s0140-6736(17)30819-x
AB  - BACKGROUND: The scale-up of tobacco control, especially after the adoption of the Framework Convention for Tobacco Control, is a major public health success story. Nonetheless, smoking remains a leading risk for early death and disability worldwide, and therefore continues to require sustained political commitment. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) offers a robust platform through which global, regional, and national progress toward achieving smoking-related targets can be assessed. METHODS: We synthesised 2818 data sources with spatiotemporal Gaussian process regression and produced estimates of daily smoking prevalence by sex, age group, and year for 195 countries and territories from 1990 to 2015. We analysed 38 risk-outcome pairs to generate estimates of smoking-attributable mortality and disease burden, as measured by disability-adjusted life-years (DALYs). We then performed a cohort analysis of smoking prevalence by birth-year cohort to better understand temporal age patterns in smoking. We also did a decomposition analysis, in which we parsed out changes in all-cause smoking-attributable DALYs due to changes in population growth, population ageing, smoking prevalence, and risk-deleted DALY rates. Finally, we explored results by level of development using the Socio-demographic Index (SDI). FINDINGS: Worldwide, the age-standardised prevalence of daily smoking was 25·0% (95% uncertainty interval [UI] 24·2-25·7) for men and 5·4% (5·1-5·7) for women, representing 28·4% (25·8-31·1) and 34·4% (29·4-38·6) reductions, respectively, since 1990. A greater percentage of countries and territories achieved significant annualised rates of decline in smoking prevalence from 1990 to 2005 than in between 2005 and 2015; however, only four countries had significant annualised increases in smoking prevalence between 2005 and 2015 (Congo [Brazzaville] and Azerbaijan for men and Kuwait and Timor-Leste for women). In 2015, 11·5% of global deaths (6·4 million [95% UI 5·7-7·0 million]) were attributable to smoking worldwide, of which 52·2% took place in four countries (China, India, the USA, and Russia). Smoking was ranked among the five leading risk factors by DALYs in 109 countries and territories in 2015, rising from 88 geographies in 1990. In terms of birth cohorts, male smoking prevalence followed similar age patterns across levels of SDI, whereas much more heterogeneity was found in age patterns for female smokers by level of development. While smoking prevalence and risk-deleted DALY rates mostly decreased by sex and SDI quintile, population growth, population ageing, or a combination of both, drove rises in overall smoking-attributable DALYs in low-SDI to middle-SDI geographies between 2005 and 2015. INTERPRETATION: The pace of progress in reducing smoking prevalence has been heterogeneous across geographies, development status, and sex, and as highlighted by more recent trends, maintaining past rates of decline should not be taken for granted, especially in women and in low-SDI to middle-SDI countries. Beyond the effect of the tobacco industry and societal mores, a crucial challenge facing tobacco control initiatives is that demographic forces are poised to heighten smoking's global toll, unless progress in preventing initiation and promoting cessation can be substantially accelerated. Greater success in tobacco control is possible but requires effective, comprehensive, and adequately implemented and enforced policies, which might in turn require global and national levels of political commitment beyond what has been achieved during the past 25 years. FUNDING: Bill & Melinda Gates Foundation and Bloomberg Philanthropies.
ER  -