Although considerable progress has been observed in countries around the world in reducing the prevalence of smoking tobacco use, a large implementation gap remains with respect to tobacco control. Researchers estimated the prevalence of smoking tobacco and attributable disease burden as part of the Global Burden of Diseases (GBD), Injuries, and Risk Factors Study. Results of the analysis were published in The Lancet.

As smoking continues to be one of the most important risk factors for premature mortality and morbidity globally, the GBD 2019 Tobacco Collaborators sought to estimate the burden of disease attributed to the smoking of tobacco using the comparative risk assessment framework for 204 countries and territories, by age and sex, from 1990 to 2019. The researchers used direct estimation methods for 36 causally linked health outcomes that demonstrate dose-response associations among current and former smokers.

In the current analysis, key analytical steps were undertaken: (1) estimating the prevalence of former and current use of smoking tobacco; (2) modeling distributions of cigarette-equivalents of tobacco smoked per day, pack-years, and years since smoking cessation; (3) estimating dose-response curves for  the 36 health outcomes; and (4) calculating population-attributable fractions.

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Worldwide in 2019, a total of 1.14 billion (95% uncertainty interval [UI], 1.13-1.16) individuals were current smokers, consuming a total of 7.41 trillion (95% UI, 7.11-7.74) cigarette-equivalents of tobacco. This amounted to 20.3 billion (95% UI, 19.5 to 21.2) cigarette-equivalents that were consumed each day worldwide.

More than one-third of the world’s tobacco consumption was from China (2.72 trillion [95% UI, 2.47-3.01] cigarette-equivalents). The countries with the highest tobacco consumption per person in 2019 were mostly in Europe, with Montenegro, North Macedonia, Bulgaria, Slovenia, and Greece all reporting tobacco consumption that exceeded 2350 cigarette-equivalents per person. In contrast, countries with the lowest tobacco consumption per person were mostly in sub-Saharan Africa.

Since 1990, the prevalence of smoking has declined among both male (27.5% [95% UI, 26.5-28.5] reduction) and female (37.7% [95% UI, 35.4-39.9] reduction) individuals aged 15 years and older. Population growth, however, has led to a significant, steady increase in the total number of smokers globally each year since 1990, when there were 0.99 billion (95% UI, 0.98-1.00) smokers globally. The only notable exception was between 2011 and 2017, when no significant change in the numbers of smokers was reported.

Among the 204 countries and territories included in the present analysis, 113 reported a significant increase in the number of current smokers between 1999 and 2019. A total of 111 countries and territories reported a significant rise between 2005 and 2019.

In both male and female individuals, the super-regions with the largest relative increases in the number of smokers since 1990 were North Africa and the Middle East (104.1% [95% UI, 98.1%-111%] increase), and sub-Saharan Africa (74.6% [95% UI, 69.9%-79.1%] increase). The largest relative reductions in the number of smokers were reported in the Latin American and the Caribbean (19.8% [95% UI, 16.9%-22.5%] decrease), as well as in high-income super-regions (17.6% [95% UI, 16.2%-18.9%] decrease).

Globally, in 2019, smoking tobacco use was responsible for 7.69 million (95% UI, 7.16-8.20) deaths and 200 million (95% UI, 185-214) disability-adjusted life-years. Additionally, smoking tobacco use was the leading risk factor for death among male individuals (20.2% [95% UI, 19.3%-21.1%] of deaths among male individuals). Moreover, 86.9% (6.68 million of 7.69 million) of deaths attributable to smoking tobacco use were reported among current smokers.

The researchers concluded that a clear, urgent opportunity exists among countries around the world to adopt and enforce strong, evidence-based policies that will help to accelerate reductions in the prevalence of smoking, thus securing massive health benefits for their residents. This, in turn, will reduce the prevalence of smoking and prevent smoking initiation, especially among adolescents and young adults.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


GBD 2019 Tobacco Collaborators. 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. Lancet. Published online May 27, 2021. doi:10.1016/S0140-6736(21)01169-7

This article originally appeared on Pulmonology Advisor