1990 年和 2017 年归因于吸烟的流行趋势和死亡负担在巴西和联邦单位中的变化。

Trends in prevalence and mortality burden attributable to smoking, Brazil and federated units, 1990 and 2017.

机构信息

Department of Maternal and Child Nursing and Public Health, Nursing School, Universidade Federal de Minas Gerais, Avenida Alfredo Balena, n.° 190, Santa Efigênia, Belo Horizonte, MG, CEP: 30130-100, Brazil.

Postgraduate Program in Nursing, Nursing School, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

出版信息

Popul Health Metr. 2020 Sep 30;18(Suppl 1):24. doi: 10.1186/s12963-020-00215-2.

BACKGROUND

The present study sought to analyze smoking prevalence and smoking-attributable mortality estimates produced by the 2017 Global Burden of Disease Study for Brazil, 26 states, and the Federal District.

METHODS

Prevalence of current smokers from 1990 to 2017 by sex and age was estimated using spatiotemporal Gaussian process regression. Population-attributable fractions were calculated for different risk-outcome pairs to generate estimates of smoking-attributable mortality. A cohort analysis of smoking prevalence by birth-year cohort was performed to better understand temporal age patterns in smoking. Smoking-attributable mortality rates were described and analyzed by development at state levels, using the Socio-Demographic Index (SDI). Finally, a decomposition analysis was conducted to evaluate the contribution of different factors to the changes in the number of deaths attributable to smoking between 1990 and 2017.

RESULTS

Between 1990 and 2017, prevalence of smoking in the population (≥ 20 years old) decreased from 35.3 to 11.3% in Brazil. This downward trend was seen for both sexes and in all states, with a marked reduction in exposure to this risk factor in younger cohorts. Smoking-attributable mortality rates decreased by 57.8% (95% UI - 61.2, - 54.1) between 1990 and 2017. Overall, larger reductions were observed in states with higher SDI (Pearson correlation 0.637; p < 0.01). In Brazil, smoking remains responsible for a considerable amount of deaths, especially due to cardiovascular diseases and neoplasms.

CONCLUSIONS

Brazil has adopted a set of regulatory measures and implemented anti-tobacco policies that, along with improvements in socioeconomic conditions, have contributed to the results presented in the present study. Other regulatory measures need to be implemented to boost a reduction in smoking in order to reach the goals established in the scope of the 2030 United Nations Agenda for Sustainable Development.

背景

本研究旨在分析 2017 年全球疾病负担研究为巴西、26 个州和联邦区提供的吸烟流行率和归因于吸烟的死亡率估计。

方法

使用时空高斯过程回归估计 1990 年至 2017 年按性别和年龄划分的当前吸烟者流行率。为不同的风险-结果组合计算人群归因分数，以生成归因于吸烟的死亡率估计。对出生年份队列的吸烟流行率进行队列分析，以更好地了解吸烟的时间年龄模式。使用社会人口指数（SDI）在州一级描述和分析归因于吸烟的死亡率。最后，进行分解分析以评估不同因素对 1990 年至 2017 年归因于吸烟的死亡人数变化的贡献。

结果

1990 年至 2017 年，巴西≥20 岁人群的吸烟流行率从 35.3%下降到 11.3%。这种下降趋势在男女和所有州都可见，年轻人群接触这种风险因素的程度明显降低。1990 年至 2017 年，归因于吸烟的死亡率下降了 57.8%（95%置信区间为-61.2，-54.1）。总体而言，SDI 较高的州下降幅度更大（皮尔逊相关系数 0.637；p < 0.01）。在巴西，吸烟仍然导致大量死亡，特别是心血管疾病和肿瘤。