Systematic analysis of tobacco smoking prevalence in 204 countries from 1990 to 2019

1. In 2019, 1.14 billion individuals worldwide were active smokers, accounting for 7.41 trillion cigarette-equivalents of tobacco.

2. Without intervention, the current count of 7.69 million deaths and 200 million disability-adjusted life-years annually is predicted to increase in the coming years.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Reducing tobacco use has been identified to be a prominent aspect of the 2030 UN Sustainable Development Goals (SDGs). Timely estimates of prevalence are needed to guide tobacco control both nationally and internationally. This systematic analysis aimed to update previous estimates of tobacco prevalence and smoking-related disease for 204 countries and territories, from 1990 to 2019. Smoking-attributable indicators from 3625 nationally representative surveys were modelled and systematic reviews were conducted to estimate the dose-response risk for active and previous smokers. Estimates of the effect of smoking were reported using direct estimation. According to study results, a marked decrease in the prevalence of tobacco use was observed globally, and across all stages of development. However, while prevalence of smoking tobacco use has decreased globally, it has not been sufficient to offset the concurrent rise in the population growth. To overcome the large implementation gap for tobacco control, it is imperative that affected nations pass urgent, evidence-based policies. How and what these policies would look like remains unclear. Nevertheless, the present study provided valuable insight on worldwide tobacco prevalence using a systematic design, which included data from multiple countries over a long period of time.

Click to read the study in The Lancet

Relevant Reading: Global burden of disease due to smokeless tobacco consumption in adults: an updated analysis of data from 127 countries

In-depth [systematic review and meta-analysis]: In 2019, there were 1.14 billion (95% uncertainty interval [UI] 1.13-1.16) active smokers worldwide, which accounted for 7.41 trillion (7.11-7.74) cigarette-equivalents of tobacco consumed. Among individuals aged 15 years and older, the prevalence of tobacco use was higher among males than females (32.7%, [95% UI 32.3-33.0] vs. 6.62%, [95% UI 6.43-6.83]). For both sexes, the current numbers mark a decline in smoking prevalence (males: 27.5% reduction [95% UI 26.5-28.5] vs. females: 37.7% reduction [95% UI 35.4-39.9]) from 1990. However, due to population growth, the overall number of smokers since 1990 has increased in the past three decades (0.99 billion [95% UI 0.98-1.00] in 1990). Smoking tobacco accounted for 7.69 million (95% UI 7.16-8.20) deaths and 200 million (95% UI 185-214) disability-adjusted life-years (DALYs) in 2019 with the majority of tobacco-related deaths (6.68 million of 7.69 million, 86.9%) occurring among active smokers. It was also the leading risk factor for death among males during this time (20.2%, 95% UI 19.3-21.1). Findings from this study suggest that without adequate intervention, the annual toll of tobacco-related mortality and DALYs will continue to be a significant health burden worldwide. In addition, with the continually increasing population, mortality and DALYs may increase in the coming decades.

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