Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
Institute for Lifecourse Development, Faculty of Education, Health and Human Sciences, University of Greenwich, UK.
S Afr Med J. 2022 Sep 30;112(8b):649-661. doi: 10.7196/SAMJ.2022.v112i8b.16492.
Ongoing quantification of the disease burden attributable to smoking is important to monitor and strengthen tobacco control policies.
To estimate the attributable burden due to smoking in South Africa for 2000, 2006 and 2012.
We estimated attributable burden due to smoking for selected causes of death in South African (SA) adults aged ≥35 years for 2000, 2006 and 2012. We combined smoking prevalence results from 15 national surveys (1998 - 2017) and smoking impact ratios using national mortality rates. Relative risks between smoking and select causes of death were derived from local and international data.
Smoking prevalence declined from 25.0% in 1998 (40.5% in males, 10.9% in females) to 19.4% in 2012 (31.9% in males, 7.9% in females), but plateaued after 2010. In 2012 tobacco smoking caused an estimated 31 078 deaths (23 444 in males and 7 634 in females), accounting for 6.9% of total deaths of all ages (17.3% of deaths in adults aged ≥35 years), a 10.5% decline overall since 2000 (7% in males; 18% in females). Age-standardised mortality rates (and disability-adjusted life years (DALYs)) similarly declined in all population groups but remained high in the coloured population. Chronic obstructive pulmonary disease accounted for most tobacco-attributed deaths (6 373), followed by lung cancer (4 923), ischaemic heart disease (4 216), tuberculosis (2 326) and lower respiratory infections (1 950). The distribution of major causes of smoking-attributable deaths shows a middle- to high-income pattern in whites and Asians, and a middle- to low-income pattern in coloureds and black Africans. The role of infectious lung disease (TB and LRIs) has been underappreciated. These diseases comprised 21.0% of deaths among black Africans compared with only 4.3% among whites. It is concerning that smoking rates have plateaued since 2010.
The gains achieved in reducing smoking prevalence in SA have been eroded since 2010. An increase in excise taxes is the most effective measure for reducing smoking prevalence. The advent of serious respiratory pandemics such as COVID-19 has increased the urgency of considering the role that smoking cessation/abstinence can play in the prevention of, and post-hospital recovery from, any condition.
持续量化吸烟导致的疾病负担对于监测和加强烟草控制政策非常重要。
估计南非 2000 年、2006 年和 2012 年因吸烟导致的疾病负担。
我们估计了南非≥35 岁成年人因吸烟导致的特定死因的归因负担。我们将 15 项全国调查（1998-2017 年）的吸烟流行率结果与全国死亡率相结合，使用了吸烟影响比。吸烟与特定死因之间的相对风险来自当地和国际数据。
吸烟流行率从 1998 年的 25.0%（男性 40.5%，女性 10.9%）下降到 2012 年的 19.4%（男性 31.9%，女性 7.9%），但自 2010 年以来一直保持稳定。2012 年，烟草吸烟导致约 31078 人死亡（男性 23444 人，女性 7634 人），占所有年龄段总死亡人数的 6.9%（≥35 岁成年人死亡人数的 17.3%），与 2000 年相比总体下降了 10.5%（男性下降 7%；女性下降 18%）。标准化死亡率（和伤残调整生命年（DALY））在所有人群中也同样下降，但在有色人种中仍居高不下。慢性阻塞性肺疾病是吸烟归因死亡的主要原因（6373 人），其次是肺癌（4923 人）、缺血性心脏病（4216 人）、结核病（2326 人）和下呼吸道感染（1950 人）。吸烟归因死亡的主要原因分布在白人和亚洲人中呈现中高收入模式，在有色人和黑非洲人中呈现中低收入模式。传染性肺部疾病（结核病和下呼吸道感染）的作用被低估了。这些疾病在黑非洲人中占死亡人数的 21.0%，而在白种人中仅占 4.3%。令人担忧的是，自 2010 年以来，吸烟率一直保持稳定。
自 2010 年以来，南非降低吸烟流行率的成果已经被侵蚀。提高消费税是降低吸烟率最有效的措施。严重呼吸道传染病（如 COVID-19）的出现增加了考虑戒烟或停止吸烟在预防任何疾病以及从医院康复中的作用的紧迫性。
