Dai Xiaochen, Gakidou Emmanuela, Lopez Alan D
Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA.
Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
Tob Control. 2022 Mar;31(2):129-137. doi: 10.1136/tobaccocontrol-2021-056535.
Despite compelling evidence on the health hazards of tobacco products accumulated over the past 70 years, smoking remains a leading cause of death worldwide. Policy action to control smoking requires timely, comprehensive, and comparable evidence on smoking levels within and across countries. This study provides a recent assessment of that evidence based on the methods used in the Global Burden of Disease (GBD) Study.
We estimated annual prevalence of, and mortality attributable to smoking any form of tobacco from 1970 to 2020 and 1990-2020, respectively, using the methods and data sources (including 3431 surveys and studies) from the GBD collaboration. We modelled annual prevalence of current and former smoking, distributions of cigarette-equivalents per smoker per day, pack-years for current smoking, years since cessation for former smokers and estimated population-attributable fractions due to smoking.
Globally, adult smoking prevalence in 2020 was 32.6% (32.2% to 33.1%) and 6.5% (6.3% to 6.7%) among men and women, respectively. 1.18 (0.94 to 1.47) billion people regularly smoke tobacco, causing 7.0 (2.0 to 11.2) million deaths in 2020. Smoking prevalence has declined by 27.2% (26.0% to 28.3%) for men since 1990, and by 37.9% (35.3% to 40.1%) for women. Declines have been largest in the higher sociodemographic countries, falling by more than 40% in some high-income countries, and also in several Latin American countries, notably Brazil, where prevalence has fallen by 70% since 1990. Smoking prevalence for women has declined substantially in some countries, including Nepal, the Netherlands and Denmark, and remains low throughout Asia and Africa. Conversely, there has been little decline in smoking in most low- and middle-income countries (LMICs) with over half of all men continuing to smoke in large populations in Asia (China, Indonesia), as well as the Pacific Islands.
While global smoking prevalence has fallen, smoking is still common and causes a significant health burden worldwide. The unequal pace of declines across the globe is shifting the epidemic progressively to LMICs. Smoking is likely to remain a leading cause of preventable death throughout this century unless smoking cessation efforts can significantly and rapidly reduce the number of smokers, particularly in Asia.
XD and EG received funding through grant projects from Bloomberg Philanthropies (funding no. 66-9468) and the Bill & Melinda Gates Foundation (funding no. 63-3452).
尽管在过去70年里积累了大量关于烟草制品对健康危害的确凿证据，但吸烟仍是全球主要死因。控制吸烟的政策行动需要有关国家内部和国家之间吸烟水平的及时、全面且可比的证据。本研究基于全球疾病负担（GBD）研究中使用的方法，对该证据进行了最新评估。
我们分别使用GBD合作项目的方法和数据源（包括3431项调查和研究），估算了1970年至2020年以及1990年至2020年期间任何形式烟草吸烟的年度患病率和归因死亡率。我们对当前和既往吸烟的年度患病率、每位吸烟者每天的香烟当量分布、当前吸烟的包年数、既往吸烟者戒烟后的年数进行了建模，并估算了吸烟导致的人群归因分数。
2020年全球成年人吸烟率男性为32.6%（32.2%至33.1%），女性为6.5%（6.3%至6.7%）。2020年有11.8亿（9400万至1.47亿）人经常吸烟，导致700万（200万至1120万）人死亡。自1990年以来，男性吸烟率下降了27.2%（26.0%至28.3%），女性下降了37.9%（35.3%至40.1%）。社会人口统计学水平较高的国家下降幅度最大，一些高收入国家下降超过40%，几个拉丁美洲国家也是如此，尤其是巴西，自1990年以来吸烟率下降了70%。在一些国家，包括尼泊尔、荷兰和丹麦，女性吸烟率大幅下降，亚洲和非洲整体吸烟率仍然较低。相反，大多数低收入和中等收入国家（LMICs）吸烟率下降甚微，亚洲（中国、印度尼西亚）以及太平洋岛屿的大量男性中，超过一半的人仍在吸烟。
虽然全球吸烟率有所下降，但吸烟仍然普遍，在全球造成了重大的健康负担。全球下降速度不均衡，使得这一流行趋势逐渐转向低收入和中等收入国家。除非戒烟努力能够显著且迅速地减少吸烟者数量，特别是在亚洲，否则吸烟在整个本世纪可能仍将是可预防死亡的主要原因。
XD和EG通过彭博慈善基金会（资助编号66 - 9468）和比尔及梅琳达·盖茨基金会（资助编号63 - 3452）的资助项目获得资金。
