Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action

Probably not a substantial claim: may not pass S3 (load-bearing).

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]”

• cites [3] sourcePartly supported

  The Results (Global attributable burden; page unavailable) say tobacco was the leading risk factor for attributable DALYs in seven of 21 regions. The National findings report substantial smoking-attributable burden in many countries, but do not establish that smoking ranked first in those countries; the claim shifts a regional ranking to a national one. (LLM, conf=0.82)

  Experimental — accuracy not yet measured
• cites [4] Reitsma, 2021, Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: a systematic analysis from the global burden of disease study 2019, The Lancet sourcePartly supported

  The Discussion (page not available in our copy) says smoking was the leading risk factor for deaths and DALYs among males globally. The Results report substantial smoking-attributable burden across countries, but do not establish that smoking ranks first for disease burden in many countries across the whole population. (LLM, conf=0.83)

  Experimental — accuracy not yet measured
• cites [5] sourceNot checked — no full text of the source
• cites [6] sourceNot checked — no full text of the source
• cites [7] Peto R , Lopez AD , Boreham J . Health Effects of Tobacco Use: Global Estimates and Projections. In: Slama K , ed. Tobacco and health. Boston, MA: Springer US, 1995: 109–20. sourceNot checked — no full text of the source

May combine two claims.

Tobacco control measures, particularly when implemented comprehensively, work, leading to a 27.2% global decline in male smoking prevalence since 1990 and a 37.9% decline among women.

“Most importantly, they strongly suggest that tobacco control measures, particularly when implemented comprehensively, work, collectively leading to a 27.2% (95% CI: 26.0% to 28.3%) global decline in smoking prevalence among men since 1990, and a much larger decline, 37.9% (95% CI: 35.3% to 40.1%) among women.31 32”

• cites [31] sourcePartly supported

  The Main section says tobacco-control policies reduce smoking prevalence and estimates that stronger combined policies would have produced further reductions. But its reported global declines are 7.7% for men and 15.2% for women between 2009 and 2017; it does not substantiate the cited 27.2% and 37.9% declines since 1990 or attribute those figures to the policies. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [32] sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

This study complies with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) recommendations.

“This study complies with the Guidelines for Accurate and Transparent Health Estimates Reporting recommendations.30”

• cites [30] sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In 2020, 1.18 billion people globally regularly smoked tobacco, causing 7.0 million deaths, about one in seven of all deaths that year.

“Globally, 1.18 (95% CI: 0.94 to 1.47) billion people in 2020 regularly smoked some form of tobacco, causing 7.0 (95% CI: 2.0 to 11.2) million deaths, or about one in seven of all deaths that occurred that year.4”

• cites [4] Reitsma, 2021, Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: a systematic analysis from the global burden of disease study 2019, The Lancet sourcePartly supported

  The Abstract Findings report 1.14 billion current smokers and 7.69 million smoking-attributable deaths in 2019, not the claimed 1.18 billion and 7.0 million in 2020. The Results report that smoking accounted for 13.6% of all deaths in 2019, supporting the approximate ‘one in seven’ share, but not its attribution to 2020. Page numbers were not supplied in our copy. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

By 2020, the fraction of deaths due to smoking had declined to 15%-19% in the USA, Canada, the UK and most of Western Europe, and even lower, to 10%-14%, in Sweden, Norway, Finland, Australia and New Zealand.

“By 2020, the fraction of deaths due to smoking had declined to 15%-19% in the USA, Canada, the UK and most of Western Europe, and even lower, to 10%-14%, in Sweden, Norway, Finland, Australia and New Zealand.”

May combine two claims.

Parts of North Africa (Egypt, Libya, Iran) and East Asia have seen some increase in male prevalence since 2000, as has Botswana.

“Parts of North Africa (Egypt, Libya, Iran) and East Asia have seen some increase in male prevalence since 2000, as has Botswana.”

May combine two claims.

85 (42%) countries are in phase two for male prevalence, with broad representation across all regions.

“Eighty-five (42%) countries have moved to phase two, with broad representation across all regions, indicating how pervasive the epidemic is.”

May combine two claims.

In many high SDI countries, male smoking prevalence was >40% around 1970 and has more than halved over the past 50 years; declined substantially in Latin America.

“From smoking levels in excess of 40% among men around 1970 in many high SDI countries, prevalence has more than halved over the past 50 years and has declined substantially in Latin America.”

May combine two claims.

In most low- and middle-SDI countries, there has been little decline in smoking; more than half adult male population in China, Indonesia, and Pacific Island countries smoke regularly.

“Conversely, with few exceptions, there has been little decline in smoking in most low-and middle-SDI countries, with more than half the adult male population in large populations of Asia (China, Indonesia) and Pacific Island countries smoking regularly.”

May combine two claims.

In 2020, more than half of all adult men in parts of the Indo-Pacific region (Micronesia, Kiribati, Timor-Leste, Indonesia, Papua New Guinea, Solomon Islands) were smokers, as was the case for Armenia, Mongolia, Jordan (54%-56%) and China (52%).

“In 2020, more than half of all adult men in parts of the Indo-Pacific region (Micronesia, Kiribati, Timor-Leste, Indonesia, Papua New Guinea, Solomon Islands) were smokers, as was the case for Armenia, Mongolia, Jordan (54%-56%) and China (52%).”

May combine two claims.

33 countries (16% of total) have transitioned to phase four for female prevalence with <20% prevalence, including the USA, UK, Australia, Canada, New Zealand, Japan, and all of Scandinavia except Denmark.

“Only 33 countries (16% of total) have transitioned to phase four with comparatively low (<20%) prevalence, including the USA, the UK, Australia, Canada, New Zealand, Japan and all of Scandinavia, except Denmark.”

May combine two claims.

By 2000, smoking rates in the USA and several other OECD countries fell below 30%, and fell below 20% by 2020, except for a handful of European countries including Spain, France, Switzerland, Poland and Hungary.

“By 2000, smoking rates in the USA and several other OECD countries fell below 30%, and fell below 20% by 2020, except for a handful of countries in Europe, including Spain, France, Switzerland, Poland and Hungary.”

May combine two claims.

40% of countries, half of them in sub-Saharan Africa, are still in the incipient stage of the female tobacco epidemic, with very low prevalence.

“Female prevalence data suggest that 40% of countries, half of them in sub-Saharan Africa, are still in the incipient stage of the epidemic, with very low prevalence.”

May combine two claims.

By far the largest declines in consumption have occurred in the high SDI group, falling by about 50%, compared with 25%-30% in other SDI groups.

“By far the largest declines in consumption have occurred in the high SDI group, falling by about 50%, compared with 25%-30% in other SDI groups.”

May combine two claims.

In 1990, smoking attributable mortality among women aged 30+ was 15-20% in the USA, Canada, and Ireland, and 10-15% in Australia.

“Smoking also claimed 15%-20% of deaths among women at these ages in the USA, Canada and Ireland, and 10%-15% in Australia, where the impact of smoking control measures was already apparent.”

May combine two claims.

Female prevalence has not changed significantly since 2000 in most countries, or declined by less than 10 percentage points.

“female prevalence has not changed significantly since 2000 in most countries, or declined by less than 10 percentage points.”

May combine two claims.

In high SDI countries, female smoking rates never reached male levels, typically lagging by 2-3 decades.

“Smoking rates among women in the more high SDI countries never attained the levels of men, typically lagging male smoking by two to three decades.”

May combine two claims.

In 2020, female smoking prevalence was highest (34%-40%) in Pacific Island countries (Nauru, Micronesia, Kiribati), but less than 2%-3% for women in several countries in Africa, as well as Tajikistan and Sri Lanka.

“Female prevalence was highest (34%-40%) in Pacific Island countries (Nauru, Micronesia, Kiribati), but less than 2%-3% for women in several countries in Africa, as well as Tajikistan and Sri Lanka”

May combine two claims.

All 17 initial phase male countries are low or low-middle SDI, including 10 in sub-Saharan Africa and 6 Caribbean countries (Haiti, Dominican Republic).

“All are low or low-middle SDI countries, including 10 in sub-Saharan Africa, and 6 Caribbean countries, including Haiti and the Dominican Republic.”

May combine two claims.

50 countries (25%) are in phase four for male prevalence (<25%), primarily Anglo-Saxon nations, all of Scandinavia including Denmark, plus Singapore, Belgium, and the Netherlands.

“One-quarter of countries (50) have reduced male smoking prevalence to below 25% (phase four), primarily the Anglo-Saxon nations, all of Scandinavia, including Denmark, as well as Singapore, Belgium and the Netherlands, where smoking rates had been among the highest in the world.”

May combine two claims.

By 2000, male smoking prevalence had declined substantially in many countries but remained high in Eastern Europe, Southeast Asia, China, Spain and parts of Latin America.

“By 2000, male prevalence had already declined substantially in many countries, but remained high in Eastern Europe, Southeast Asia, China, Spain (among Western Europe) and parts of Latin America.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Currently (around 2020), smoking causes 10-14% of female deaths in the USA, Canada, and Europe, but less than 5% in Asia and Africa.

“Typically, smoking currently causes 10%-14% of female deaths in the USA, Canada and Europe, but remains low as a cause of deathless than 5%-throughout Asia and Africa.”

May combine two claims.

In 2020, consumption among men was highest in Southeast and East Asia, rising sharply between 1970 and 1990, followed by modest declines.

“In 2020, consumption among men was highest in Southeast and East Asia, rising sharply between 1970 and 1990, followed by modest declines.”

May combine two claims.

By 2020, smoking-attributable mortality had fallen to less than 1 in 10 deaths in Mexico and tropical Latin America, and remained low in sub-Saharan Africa.

“had fallen to less than 1 in 10 deaths in Mexico and tropical Latin America, and remained low in sub-Saharan Africa.”

May combine two claims.

Prevalence has also declined among other sociodemographic categories, less so in the high-middle sociodemographic group.

“Prevalence has also declined among other sociodemographic categories, less so in the high-middle sociodemographic group.”

May combine two claims.

52 countries (25%) are in phase three for male prevalence, including 10 from Southeast Asia (including China) and 5 in the Pacific (including Fiji and Tonga).

“Prevalence has started to decline in 52 countries (25%) classified into phase three, including 10 from Southeast Asia (including China), and 5 in the Pacific, including Fiji and Tonga.”

May combine two claims.

Of the phase two female countries, one quarter are Pacific Island countries, another quarter include Russia and Central and Eastern European countries, and 10 are in Latin America.

“Onequarter of these are Pacific Island countries, another quarter include Russia, and Central and Eastern European countries, and 10 countries are in Latin America.”

May combine two claims.

The most noticeable change was an increase in the fraction of former smokers, most of whom were former daily smokers.

“The most noticeable change was an increase in the fraction of former smokers, most of whom were former daily smokers.”

May combine two claims.

Among 27 phase three countries for female prevalence, 17 are high-income Western European nations, plus Argentina, Chile, and Uruguay, and 8 are from Central/Eastern Europe.

“Among 27 phase three countries, 17 are high-income Western European nations, as well as Argentina, Chile and Uruguay, and 8 countries from Central/Eastern Europe.”

May combine two claims.

Female consumption is highest in the high SDI group, being about twice the level in other SDI categories, although consumption levels have fallen by about 60% since 1970.

“Female consumption is highest in the high SDI group, being about twice the level in other SDI categories, although consumption levels have fallen by about 60% since 1970.”

May combine two claims.

There has been little change over the past few decades in the number of cigarette-equivalents smoked per smoker per day, except for the high SDI category and the modest but steady increase in consumption in the high-middle SDI group.

“There has been little change over the past few decades in the number of cigarette-equivalents smoked per smoker per day, except for the high SDI category-although this decline appears to have stalled during the past 5 years-and the modest but steady increase in consumption in the high-middle SDI group”

May combine two claims.

Among women, youth smoking prevalence declined by more than 10 percentage points in the majority of high SDI countries, but by less than 10 percentage points in Japan and Eastern and Central European countries.

“Among women, youth smoking prevalence also declined by more than 10 percentage points in the majority of high SDI countries, but by less than 10 percentage points in Japan and Eastern and Central European countries.”

May combine two claims.

By 2020, male smoking prevalence fell further, particularly in Latin America and India, with levels below 30%.

“Prevalence fell further by 2020, particularly in Latin America and India, with levels below 30%.”

May combine two claims.

Among women, smoking prevalence in the high SDI group has fallen by about 50% since 1970, with little change evident for all other SDI categories.

“Among women, smoking prevalence in the high SDI group has fallen by about 50% since 1970, with little change evident for all other SDI categories.”

May combine two claims.

France and Portugal are the only high-income countries in phase two for female prevalence; six phase two countries are from sub-Saharan Africa.

“Interestingly, France and Portugal, alone among high-income countries, are at phase two, and six phase two countries are from sub-Saharan Africa.”

May combine two claims.

In phase two for male prevalence, there are 13 Pacific Island countries/territories, 17 sub-Saharan African, 15 Central/Eastern European, 10 Latin American, 16 Middle East/North African, plus Indonesia and Timor-Leste (with the highest smoking rates in the world), and a handful of high-income countries including Austria, Portugal, Cyprus, and Chile.

“Thirteen Pacific Island countries or territories, 17 in sub-Saharan Africa, 15 from Central/Eastern Europe, 10 from Latin America and 16 from the Middle East/North African region have been classified phase two, as well as Indonesia and Timor-Leste, with the highest smoking rates in the world, and a handful of high-income countries, including Austria, Portugal, Cyprus and Chile.”

May combine two claims.

12 phase three male countries are from Central/Eastern Europe (Russia, Hungary, Poland) and 2 from Latin America (Mexico, Cuba).

“Another 12 are from Central/Eastern Europe, including Russia, Hungary and Poland, and 2 (Mexico and Cuba) from Latin America.”

May combine two claims.

Male consumption is highest in the high-middle SDI group, being about twice as high as for other SDI categories.

“male consumption is highest in the high-middle SDI group, being about twice as high as for other SDI categories.”

May combine two claims.

31% (64 countries) have moved into phase two for female prevalence, with rising prevalence and little evidence of decline.

“Another 31% (64 countries) have moved into phase two, with rising prevalence and little evidence of decline.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Cigarette smoking is estimated to have caused over 100 million deaths last century and will cause over 1 billion deaths this century unless more effective measures are taken to end the tobacco epidemic.

“cigarette smoking is estimated to have caused over 100 million deaths last century and will cause over 1 billion deaths this century unless more effective measures are taken to end the tobacco epidemic.19”

• cites [19] Peto R , Lopez AD . Future worldwide health effects of current smoking patterns. Jossey-Bass, 2001. Available: https://espace.library.uq.edu.au/view/UQ:114032 [Accessed 29 Sep 2021].Not checked yet

  Not checked in the free run.

• AssumptionThe authors state this as an assumption: The addiction will eventually kill half of all smokers.

May combine two claims.

While global smoking prevalence has fallen, smoking is still common and causes a significant health burden worldwide.

“While global smoking prevalence has fallen, smoking is still common and causes a significant health burden worldwide.”

The quote only partly states this claim.

All non-reference case definitions were mapped to reference case definitions to ensure data comparability and avoid compositional bias.

“we mapped all non-reference case definitions to our reference case definitions.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The study's findings should be interpreted considering limitations primarily related to data quality and availability.

“Our findings should be interpreted taking into consideration the study's limitations, primarily related to data quality and availability.”

May combine two claims.

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.

“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.”

May combine two claims.

Declines are much less evident in the high-middle sociodemographic category, possibly due to compositional issues with China dominating this category.

“This is much less evident among the next sociodemographic category (high-middle), although this may well reflect compositional issues since the experience of China would dominate this category, at least in more recent years.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Uncertainty intervals around final estimates were constructed using the 25th and 975th draws from 1000 posterior draws.

“We produced 1000 draws from the posterior distribution of ST-GPR and used the 25th and the 975th draws to construct uncertainty intervals around the final estimates.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Predictions of 1 billion deaths from smoking this century unless there is urgent and substantial progress with cessation strategies.

“Predictions of 1 billion deaths from smoking this century unless there is urgent and substantial progress with cessation strategies 19 highlight the enormous toll of avoidable mortality that smoking will cause, in the absence of effective national policy responses, especially in high prevalence countries.”

• cites [19] Peto R , Lopez AD . Future worldwide health effects of current smoking patterns. Jossey-Bass, 2001. Available: https://espace.library.uq.edu.au/view/UQ:114032 [Accessed 29 Sep 2021].Not checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

Systematic data quality checks were performed to identify and exclude implausible or inconsistent data.

“systematic data quality checks were performed to identify and exclude implausible or inconsistent data.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In Australia, the impact of smoking control measures was already apparent by 1990.

“Smoking also claimed 15%-20% of deaths among women at these ages in the USA, Canada and Ireland, and 10%-15% in Australia, where the impact of smoking control measures was already apparent.”