Estimates of global mortality attributable to smoking in 2000
Abstract
Background Smoking is a risk factor for several diseases and has been increasing in many developing countries. Our aim was to estimate global and regional mortality in 2000 caused by smoking, including an analysis of uncertainty.Methods Following the methods of Peto and colleagues, we used lung-cancer mortality as an indirect marker for accumulated smoking risk. Never-smoker lung-cancer mortality was estimated based on the household use of coal with poor ventilation. Relative risks were taken from the American Cancer Society Cancer Prevention Study, phase II, and the retrospective proportional mortality analysis of Liu and colleagues in China. Relative risks were corrected for confounding and extrapolation to other regions.Results We estimated that in 2000, 4.83 (uncertainty range 3.94-5.93) million premature deaths in the world were attributable to smoking; 2.41 (1.80-3.15) million in developing countries and 2.43 (2.13-2.78) million in industrialised countries. 3.84 million of these deaths were in men. The leading causes of death from smoking were cardiovascular diseases (1.69 million deaths), chronic obstructive pulmonary disease (0.97 million deaths), and lung cancer (0.85 million deaths).Interpretation Smoking was an important cause of global mortality in 2000. In view of the expected demographic and epidemiological transitions and current smoking patterns in the developing world, the health loss due to smoking will grow even larger unless effective interventions and policies that reduce smoking among men and prevent increases among women in developing countries are implemented.
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According to one study, 91% of all lung cancers, 40% of coronary heart disease and 33% of all deaths among men in 2000 were attributed to smoking.
“Global estimates have been published for smoking: according to one study 91% of all lung cancers, 40% of CHD and 33% of all deaths among men in 2000 were attributed to smoking [ 179 ].”
From Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and Elaboration (2007) · cites this paper as [179]
Cardiovascular illness may be the greatest driver of excess mortality in bipolar disorder, perhaps more so for females.
“Thus, cardiovascular illness may be the greatest driver of excess mortality in BD (56, 57), perhaps more so for females (58).”
From The detrimental effects of smoking on the course and outcome in adults with bipolar disorder—A narrative review (2023) · cites this paper as [57]
Smoking is the leading cause of disease burden in many countries.
“smoking is the leading cause of disease burden in many countries.[3][4][5][6][7]”
From Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action (2022) · cites this paper as [5]
Previous analyses of smoking prevalence and attributable disease burden often were hindered by poor data availability, methodological limitations, or both.
“Previous analyses of smoking prevalence and attributable disease burden often were hindered by poor data availability, methodological limitations, or both.25, 26, 27”
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“Cigarette smoking is a leading cause of premature death, responsible for approximately 480,000 deaths in the United States (US) annually [1, 2].”
- Authors
- Ezzati, M., & Lopez, A. D.
- Affiliations
- Harvard University (US)
- ORCID
- Ezzati, Majid
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2003-09
- Volume
- 362
- Issue
- 9387
- Pages
- 847-852
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2033156615
- Cited by
- 1,247
- References
- 31
- Citations by year
- 2026: 7 · 2025: 13 · 2024: 14 · 2023: 33 · 2022: 27 · 2021: 39 · 2020: 40 · 2019: 44 · 2018: 38 · 2017: 48 · 2016: 59 · 2015: 70 · 2014: 67 · 2013: 78 · 2012: 77
- FWCI
- 35.65
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Aging (P01AG017625, 1-PO1-AG17625)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Keywords
- smoking, attributable mortality, premature mortality, lung cancer, cardiovascular disease, chronic obstructive pulmonary disease, developing countries, developed countries, relative risk, uncertainty analysis, health policy
- MeSH terms
- Adolescent, Adult, Aged, Cardiovascular Diseases, Cause of Death, Child, Child, Preschool, Developing Countries, Female, Health Policy, Humans, Lung Neoplasms, Male, Middle Aged, Pulmonary Emphysema, Risk, Smoking, Global Health, Prevalence, Pulmonary Disease, Chronic Obstructive
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