Lancet Public Health. 2025 Jun;10(6):e442-e455. doi: 10.1016/S2468-2667(24)00326-8.
Tobacco smoking has long been a regional health priority for the Association of Southeast Asian Nations (ASEAN). Despite decades of commitment to implementing tobacco control measures, the ASEAN region continues to face substantial challenges in reversing the epidemic. We aimed to analyse longitudinal data on smoking prevalence and attributable disease burden to understand the trajectory of the smoking epidemic, inform priority setting, and enable effective policy planning.
We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 to evaluate the prevalence of tobacco smoking and its attributable disease burden in the ten ASEAN member states by age and sex, from 1990 to 2021. Current smoking prevalence was estimated using spatiotemporal Gaussian process regression models, which synthesised data from 159 distinctive data sources specific to the ASEAN region in addition to 2646 data sources from other GBD countries. Dose-response risks for 36 health outcomes were derived using the latest burden of proof approach. Population attributable fractions were subsequently calculated and applied to determine the burden in terms of mortality, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) attributable to tobacco smoking in these countries.
In 2021, there were approximately 137 million (95% uncertainty interval 134-139) current smokers aged 15 years and older in the ASEAN region, with an estimated age-standardised prevalence of 48·4% (47·5-49·2) among males and 4·47% (4·09-4·92) among females. Tobacco smoking accounted for 10·8% (8·86-12·9) of all-cause mortality across the region. The total number of deaths and DALYs attributed to smoking were 526 000 deaths (433 000-622 000) and 15·7 million (12·9-18·5) DALYs. Death rates varied considerably across the region, especially among males, ranging from 68·9 (55·8-84·2) per 100 000 males in Singapore to 364 (279-463) per 100 000 males in Cambodia. Although smoking prevalence declined substantially in most ASEAN countries between 1990 and 2021, the absolute number of smokers increased by 63·3% (59·0-67·8), and the number of smokers aged 10 years and older increased by 53·0 million (50·2-56·2).
Tobacco smoking remains a persistent public health threat in the ASEAN region. Considerable disparities exist across the region: while some countries have made remarkable progress in tobacco control, others lag behind. As a modifiable risk factor heavily influenced by commercial determinants, smoking can be controlled through effective policy changes. As a geopolitical and economic collaboration network, ASEAN countries must work together to overcome barriers hindering anti-tobacco efforts and collectively devise strategies to strengthen tobacco control across the region.
Bloomberg Philanthropies and the Bill & Melinda Gates Foundation.
长期以来，吸烟一直是东南亚国家联盟（东盟）区域卫生工作的重点。尽管数十年来致力于实施烟草控制措施，但东盟地区在扭转这一流行趋势方面仍面临重大挑战。我们旨在分析吸烟流行率和可归因疾病负担的纵向数据，以了解吸烟流行的轨迹，为确定优先事项提供信息，并实现有效的政策规划。
我们使用了《2021年全球疾病、伤害和风险因素负担研究》（GBD 2021）的数据，以评估1990年至2021年期间东盟十个成员国按年龄和性别的吸烟流行率及其可归因疾病负担。当前吸烟流行率采用时空高斯过程回归模型进行估计，该模型综合了东盟地区159个独特数据源以及其他GBD国家的2646个数据源的数据。使用最新的证据负担方法得出36种健康结局的剂量反应风险。随后计算人群归因分数，并应用于确定这些国家因吸烟导致的死亡率、寿命损失年数、带病生存年数和伤残调整生命年（DALY）负担。
2021年，东盟地区15岁及以上的当前吸烟者约有1.37亿（95%不确定区间为1.34 - 1.39亿），估计年龄标准化患病率在男性中为48.4%（47.5 - 49.2），在女性中为4.47%（4.09 - 4.92）。吸烟占该地区全因死亡率的10.8%（8.86 - 12.9）。归因于吸烟的死亡总数和DALY分别为52.6万例（43.3万 - 62.2万）和1570万（1290万 - 1850万）。该地区的死亡率差异很大，尤其是男性，从新加坡每10万男性中的68.9例（55.8 - 84.2）到柬埔寨每10万男性中的364例（279 - 463）不等。尽管1990年至2021年期间大多数东盟国家的吸烟流行率大幅下降，但吸烟者的绝对数量增加了{63.3%}（59.0 - 67.8），10岁及以上吸烟者的数量增加了5300万（5020万 - 5620万）。
吸烟在东盟地区仍然是持续存在的公共卫生威胁。该地区存在相当大的差异：虽然一些国家在烟草控制方面取得了显著进展，但其他国家则滞后。作为一个受商业因素严重影响的可改变风险因素，吸烟可以通过有效的政策变革加以控制。作为一个地缘政治和经济合作网络，东盟国家必须共同努力克服阻碍控烟工作的障碍，并共同制定加强该地区烟草控制的战略。
彭博慈善基金会和比尔及梅琳达·盖茨基金会。
