Cited by 535Smoking Behavior and CessationGlobal Cancer Incidence and ScreeningGlobal Public Health Policies and Epidemiology

The DOI matches its Crossref record; 28 of the 29 references it cites were found in a registry or an index; 7 of the 14 sources its claims cite were checked for support.

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

Open access
Dai, Xiaochen, Gakidou, Emmanuela, Lopez, Alan D·2022·Tobacco Control

Abstract

Background: 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. Methods: 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. Results: 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. Implications: 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. Funding: 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).

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This Global Burden of Disease analysis estimates that global adult smoking prevalence in 2020 was 32.6% among men and 6.5% among women, with 1.18 billion smokers and 7.0 million smoking-attributable deaths. Although prevalence has declined since 1990, the epidemic is shifting toward low- and middle-income countries, especially in Asia.

Key findings

  • In 2020, adult smoking prevalence was 32.6% (32.2% to 33.1%) among men and 6.5% (6.3% to 6.7%) among women; 1.18 (0.94 to 1.47) billion people regularly smoked tobacco, causing 7.0 (2.0 to 11.2) million deaths.
  • Since 1990, smoking prevalence declined by 27.2% (26.0% to 28.3%) for men and 37.9% (35.3% to 40.1%) for women; declines were largest in higher sociodemographic countries, falling by more than 40% in some high-income countries, and Brazil’s prevalence fell by 70% since 1990.
  • There has been little decline in most low- and middle-income countries, with more than half of adult men smoking in large Asian populations such as China (52%) and Indonesia, as well as Pacific Island countries; female prevalence remains low throughout Asia and Africa.
  • By 2020, countries classified by epidemic phase were distributed for men as less than 10% incipient, 42% phase two, 25% phase three, and about one-quarter phase four; for women the respective distribution was 40/31/13/16.

Methods

  • Using GBD 2020 methods, the study estimated annual prevalence of smoked tobacco use from 1970 to 2020 and attributable mortality/DALYs from 1990 to 2020 for 204 countries and territories by 5-year age group and sex; secondhand smoke, smokeless tobacco, electronic cigarettes, vaping products, and heated tobacco products were excluded.
  • Data included 2808 nationally or subnationally representative surveys covering 200 of 204 countries, 623 studies for dose-response risk estimation, and consumption data from Euromonitor, the US Department of Agriculture, and the Food and Agriculture Organization; current and former smoking prevalence was modelled with spatiotemporal Gaussian process regression, and population-attributable fractions were calculated.
  • Estimates were also provided by quintile of Sociodemographic Index, with countries grouped by their 2020 SDI; analyses were performed in R and Python.

Limitations

  • The paper states that data quality and availability limitations, including data gaps and inconsistencies, lead to substantial uncertainty in trends and patterns of smoking prevalence and consumption in some countries, reducing the policy utility of the estimates.
  • The paper notes that it used the direct method to estimate population-attributable fractions, whereas an indirect method has also been used; it reports that total burden due to smoking did not change significantly using different methods.
  • Evident from the text: the analysis excludes secondhand smoke exposure, smokeless tobacco, electronic cigarettes, vaping products, and heated tobacco products, so the findings cover smoked tobacco use only; countries were grouped by 2020 SDI even though SDI can change over time.

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Integrity signals

Registry

Crossref · 10.1136/tobaccocontrol-2021-056535

Cites

28 of 29 references verified0 citation errors · 1 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

48 Own result · 26 No basis given · 7 Own method · 7 Own interpretation · 4 Partly supported · 2 Not checked yet · 1 Supported · accuracy not yet measured

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Show all 46 claims

  • Probably not a substantial claim. 10
  • It may state two separate claims as one. 41
  • The quote only partly states this claim. 1
49 of 49
  • The authors state this as an assumption.

    The addiction will eventually kill half of all smokers.

    “assuming that the addiction will eventually kill half of all smokers”
1 of 1

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Percentages, sums and reported differences re-computed from the paper’s own numbers.

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Citations

Cites

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Research works printed but not linked: 1

  1. United States Public Health Service Office of the Surgeon General, National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health . Smoking Cessation: A Report of the Surgeon General. Washington (DC) : US Department of Health and Human Services 2020. Available: http://www.ncbi.nlm.nih.gov/books/NBK555591/ [Accessed 13 Dec 2021].

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Metadata

Authors
Dai, X., Gakidou, E., & Lopez, A. D.
Affiliations
University of Washington (US)
Venue
Tobacco Control
Publisher
BMJ
Published
2022-03
Volume
31
Issue
2
Pages
129-137
ISSN
  • 0964-4563 (ISSN-L)
  • 1468-3318
OpenAlex
W4214882427
Cited by
535
References
28
Citations by year
2026: 107 · 2025: 177 · 2024: 153 · 2023: 75 · 2022: 23
FWCI
66.60
Type
journal article
Language
en
Open access
Locations
  • Tobacco Control (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Bloomberg Philanthropies
  • Bill and Melinda Gates Foundation
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Public Health Policies and Epidemiology
Keywords
smoking prevalence, smoking-related mortality, population attributable fraction, pack-years, smoking cessation, sex differences in smoking, low- and middle-income countries, tobacco control, global burden of disease, Latin America
MeSH terms
Global Burden of Disease, Adult, Female, Humans, Male, Smoking, Global Health, Prevalence, Policy

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