Ezzati M, Lopez A D
Harvard School of Public Health, Population and International Health, 665 Huntington Avenue, Boston, Massachusetts 02115, USA.
Tob Control. 2004 Dec;13(4):388-95. doi: 10.1136/tc.2003.005215.
Smoking has been causally associated with increased mortality from several diseases, and has increased considerably in many developing countries in the past few decades. Mortality attributable to smoking in the year 2000 was estimated for adult males and females, including estimates by age and for specific diseases in 14 epidemiological subregions of the world.
Lung cancer mortality was used as an indirect marker of the accumulated hazard of smoking. Never-smoker lung cancer mortality was estimated based on the household use of coal with poor ventilation. Estimates of mortality caused by smoking were made for lung cancer, upper aerodigestive cancer, all other cancers, chronic obstructive pulmonary disease (COPD), other respiratory diseases, cardiovascular diseases, and selected other medical causes. Estimates were limited to ages 30 years and above.
In 2000, an estimated 4.83 million premature deaths in the world were attributable to smoking, 2.41 million in developing countries and 2.43 million in industrialised countries. There were 3.84 million male deaths and 1.00 million female deaths attributable to smoking. 2.69 million smoking attributable deaths were between the ages of 30-69 years, and 2.14 million were 70 years of age and above. The leading causes of death from smoking in industrialised regions were cardiovascular diseases (1.02 million deaths), lung cancer (0.52 million deaths), and COPD (0.31 million deaths), and in the developing world cardiovascular diseases (0.67 million deaths), COPD (0.65 million deaths), and lung cancer (0.33 million deaths). The share of male and female deaths and younger and older adult deaths, and of various diseases in total smoking attributable deaths exhibited large inter-regional heterogeneity, especially in the developing world.
Smoking was an important cause of global mortality in 2000, affecting a large number of diseases. Age, sex, and disease patterns of smoking-caused mortality varied greatly across regions, due to both historical and current smoking patterns, and the presence of other risk factors that affect background mortality from specific diseases.
吸烟与多种疾病导致的死亡率上升存在因果关系，且在过去几十年中，许多发展中国家的吸烟率大幅上升。对2000年成年男性和女性因吸烟导致的死亡率进行了估算，包括按年龄以及世界14个流行病学分区的特定疾病进行的估算。
肺癌死亡率被用作吸烟累积危害的间接指标。从不吸烟者的肺癌死亡率是根据通风不良的家庭燃煤使用情况估算的。对肺癌、上呼吸道消化道癌症、所有其他癌症、慢性阻塞性肺疾病（COPD）、其他呼吸道疾病、心血管疾病以及选定的其他医学原因导致的死亡率进行了估算。估算仅限于30岁及以上人群。
2000年，全球估计有483万例过早死亡归因于吸烟，其中发展中国家为241万例，工业化国家为243万例。归因于吸烟的男性死亡384万例，女性死亡100万例。269万例归因于吸烟的死亡发生在30 - 69岁之间，214万例发生在70岁及以上。工业化地区因吸烟导致的主要死亡原因是心血管疾病（102万例死亡）、肺癌（52万例死亡）和COPD（31万例死亡），而在发展中世界则是心血管疾病（67万例死亡）、COPD（65万例死亡）和肺癌（33万例死亡）。男性和女性死亡、年轻和老年成年人死亡以及各种疾病在归因于吸烟的总死亡中所占比例存在很大的区域间差异，尤其是在发展中世界。
吸烟是2000年全球死亡率的一个重要原因，影响多种疾病。由于历史和当前的吸烟模式以及影响特定疾病背景死亡率的其他风险因素的存在，吸烟导致的死亡率的年龄、性别和疾病模式在各地区差异很大。
