Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015

A systematic analysis from the Global Burden of Disease Study 2015

GBD 2015 Tobacco Collaborators, Kerrie E. Doyle, Yohannes Kinfu

Research output: Contribution to journalArticle

290 Citations (Scopus)

Abstract

Background: The scale-up of tobacco control, especially after the adoption of the Framework Convention for Tobacco Control, is a major public health success story. Nonetheless, smoking remains a leading risk for early death and disability worldwide, and therefore continues to require sustained political commitment. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) offers a robust platform through which global, regional, and national progress toward achieving smoking-related targets can be assessed. Methods: We synthesised 2818 data sources with spatiotemporal Gaussian process regression and produced estimates of daily smoking prevalence by sex, age group, and year for 195 countries and territories from 1990 to 2015. We analysed 38 risk-outcome pairs to generate estimates of smoking-attributable mortality and disease burden, as measured by disability-adjusted life-years (DALYs). We then performed a cohort analysis of smoking prevalence by birth-year cohort to better understand temporal age patterns in smoking. We also did a decomposition analysis, in which we parsed out changes in all-cause smoking-attributable DALYs due to changes in population growth, population ageing, smoking prevalence, and risk-deleted DALY rates. Finally, we explored results by level of development using the Socio-demographic Index (SDI). Findings: Worldwide, the age-standardised prevalence of daily smoking was 25·0% (95% uncertainty interval [UI] 24·2–25·7) for men and 5·4% (5·1–5·7) for women, representing 28·4% (25·8–31·1) and 34·4% (29·4–38·6) reductions, respectively, since 1990. A greater percentage of countries and territories achieved significant annualised rates of decline in smoking prevalence from 1990 to 2005 than in between 2005 and 2015; however, only four countries had significant annualised increases in smoking prevalence between 2005 and 2015 (Congo [Brazzaville] and Azerbaijan for men and Kuwait and Timor-Leste for women). In 2015, 11·5% of global deaths (6·4 million [95% UI 5·7–7·0 million]) were attributable to smoking worldwide, of which 52·2% took place in four countries (China, India, the USA, and Russia). Smoking was ranked among the five leading risk factors by DALYs in 109 countries and territories in 2015, rising from 88 geographies in 1990. In terms of birth cohorts, male smoking prevalence followed similar age patterns across levels of SDI, whereas much more heterogeneity was found in age patterns for female smokers by level of development. While smoking prevalence and risk-deleted DALY rates mostly decreased by sex and SDI quintile, population growth, population ageing, or a combination of both, drove rises in overall smoking-attributable DALYs in low-SDI to middle-SDI geographies between 2005 and 2015. Interpretation: The pace of progress in reducing smoking prevalence has been heterogeneous across geographies, development status, and sex, and as highlighted by more recent trends, maintaining past rates of decline should not be taken for granted, especially in women and in low-SDI to middle-SDI countries. Beyond the effect of the tobacco industry and societal mores, a crucial challenge facing tobacco control initiatives is that demographic forces are poised to heighten smoking's global toll, unless progress in preventing initiation and promoting cessation can be substantially accelerated. Greater success in tobacco control is possible but requires effective, comprehensive, and adequately implemented and enforced policies, which might in turn require global and national levels of political commitment beyond what has been achieved during the past 25 years.

Original languageEnglish
Pages (from-to)1885-1906
Number of pages22
JournalThe Lancet
Volume389
Issue number10082
DOIs
Publication statusPublished - 2017

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Smoking
Quality-Adjusted Life Years
Demography
Geography
Tobacco
Population Growth
Global Burden of Disease
Uncertainty
Azerbaijan
Tobacco Industry
Term Birth
Congo
Kuwait
Sexual Development
Information Storage and Retrieval
Russia
Population
India
China
Cohort Studies

Cite this

@article{033e32c3d6044690b6d5f83fe1504997,
title = "Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: A systematic analysis from the Global Burden of Disease Study 2015",
abstract = "Background: The scale-up of tobacco control, especially after the adoption of the Framework Convention for Tobacco Control, is a major public health success story. Nonetheless, smoking remains a leading risk for early death and disability worldwide, and therefore continues to require sustained political commitment. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) offers a robust platform through which global, regional, and national progress toward achieving smoking-related targets can be assessed. Methods: We synthesised 2818 data sources with spatiotemporal Gaussian process regression and produced estimates of daily smoking prevalence by sex, age group, and year for 195 countries and territories from 1990 to 2015. We analysed 38 risk-outcome pairs to generate estimates of smoking-attributable mortality and disease burden, as measured by disability-adjusted life-years (DALYs). We then performed a cohort analysis of smoking prevalence by birth-year cohort to better understand temporal age patterns in smoking. We also did a decomposition analysis, in which we parsed out changes in all-cause smoking-attributable DALYs due to changes in population growth, population ageing, smoking prevalence, and risk-deleted DALY rates. Finally, we explored results by level of development using the Socio-demographic Index (SDI). Findings: Worldwide, the age-standardised prevalence of daily smoking was 25·0{\%} (95{\%} uncertainty interval [UI] 24·2–25·7) for men and 5·4{\%} (5·1–5·7) for women, representing 28·4{\%} (25·8–31·1) and 34·4{\%} (29·4–38·6) reductions, respectively, since 1990. A greater percentage of countries and territories achieved significant annualised rates of decline in smoking prevalence from 1990 to 2005 than in between 2005 and 2015; however, only four countries had significant annualised increases in smoking prevalence between 2005 and 2015 (Congo [Brazzaville] and Azerbaijan for men and Kuwait and Timor-Leste for women). In 2015, 11·5{\%} of global deaths (6·4 million [95{\%} UI 5·7–7·0 million]) were attributable to smoking worldwide, of which 52·2{\%} took place in four countries (China, India, the USA, and Russia). Smoking was ranked among the five leading risk factors by DALYs in 109 countries and territories in 2015, rising from 88 geographies in 1990. In terms of birth cohorts, male smoking prevalence followed similar age patterns across levels of SDI, whereas much more heterogeneity was found in age patterns for female smokers by level of development. While smoking prevalence and risk-deleted DALY rates mostly decreased by sex and SDI quintile, population growth, population ageing, or a combination of both, drove rises in overall smoking-attributable DALYs in low-SDI to middle-SDI geographies between 2005 and 2015. Interpretation: The pace of progress in reducing smoking prevalence has been heterogeneous across geographies, development status, and sex, and as highlighted by more recent trends, maintaining past rates of decline should not be taken for granted, especially in women and in low-SDI to middle-SDI countries. Beyond the effect of the tobacco industry and societal mores, a crucial challenge facing tobacco control initiatives is that demographic forces are poised to heighten smoking's global toll, unless progress in preventing initiation and promoting cessation can be substantially accelerated. Greater success in tobacco control is possible but requires effective, comprehensive, and adequately implemented and enforced policies, which might in turn require global and national levels of political commitment beyond what has been achieved during the past 25 years.",
keywords = "Adolescent, Adult, Age Distribution, Aged, Aged, 80 and over, Female, Global Burden of Disease, Global Health, Humans, Internationality, Male, Middle Aged, Normal Distribution, Prevalence, Quality-Adjusted Life Years, Retrospective Studies, Risk Factors, Sex Distribution, Smoking/epidemiology, Socioeconomic Factors, Young Adult",
author = "{GBD 2015 Tobacco Collaborators} and Reitsma, {Marissa B.} and Nancy Fullman and Marie Ng and Salama, {Joseph S.} and Amanuel Abajobir and Abate, {Kalkidan Hassen} and Cristiana Abbafati and Abera, {Semaw Ferede} and Biju Abraham and Abyu, {Gebre Yitayih} and Adebiyi, {Akindele Olupelumi} and Ziyad Al-Aly and Aleman, {Alicia V.} and Raghib Ali and {Al Alkerwi}, Ala'a and Peter Allebeck and Al-Raddadi, {Rajaa Mohammad} and Amare, {Azmeraw T.} and Alemayehu Amberbir and Walid Ammar and Amrock, {Stephen Marc} and Antonio, {Carl Abelardo T.} and Hamid Asayesh and Atnafu, {Niguse Tadela} and Peter Azzopardi and Amitava Banerjee and Aleksandra Barac and Tonatiuh Barrientos-Gutierrez and Basto-Abreu, {Ana Cristina} and Shahrzad Bazargan-Hejazi and Neeraj Bedi and Brent Bell and Bello, {Aminu K.} and Bensenor, {Isabela M.} and Beyene, {Addisu Shunu} and Neeraj Bhala and Stan Biryukov and Kaylin Bolt and Hermann Brenner and Zahid Butt and Fiorella Cavalleri and Kelly Cercy and Honglei Chen and Christopher, {Devasahayam Jesudas} and Ciobanu, {Liliana G.} and Valentina Colistro and Mercedes Colomar and Leslie Cornaby and Xiaochen Dai and Damtew, {Solomon Abrha} and Lalit Dandona and Rakhi Dandona and Emily Dansereau and Kairat Davletov and Anand Dayama and Degfie, {Tizta Tilahun} and Amare Deribew and Dharmaratne, {Samath D.} and Dimtsu, {Balem Demtsu} and Doyle, {Kerrie E.} and Endries, {Aman Yesuf} and Ermakov, {Sergey Petrovich} and Kara Estep and Faraon, {Emerito Jose Aquino} and Farshad Farzadfar and Feigin, {Valery L.} and Feigl, {Andrea B.} and Florian Fischer and Joseph Friedman and G/hiwot, {Tsegaye Tewelde} and Gall, {Seana L.} and Wayne Gao and Gillum, {Richard F.} and Gold, {Audra L.} and Gopalani, {Sameer Vali} and Gotay, {Carolyn C.} and Rahul Gupta and Rajeev Gupta and Vipin Gupta and Hamadeh, {Randah Ribhi} and Graeme Hankey and Harb, {Hilda L.} and Hay, {Simon I.} and Masako Horino and Nobuyuki Horita and Hosgood, {H. Dean} and Abdullatif Husseini and Ileanu, {Bogdan Vasile} and Farhad Islami and Guohong Jiang and Ying Jiang and Jonas, {Jost B.} and Zubair Kabir and Ritul Kamal and Amir Kasaeian and Kesavachandran, {Chandrasekharan Nair} and Khader, {Yousef S.} and Ibrahim Khalil and Khang, {Young Ho} and Sahil Khera and Jagdish Khubchandani and Daniel Kim and Kim, {Yun Jin} and Kimokoti, {Ruth W.} and Yohannes Kinfu and Knibbs, {Luke D.} and Yoshihiro Kokubo and Dhaval Kolte and Jacek Kopec and Soewarta Kosen and Kotsakis, {Georgios A.} and Koul, {Parvaiz A.} and Ai Koyanagi and Krohn, {Kristopher J.} and Hans Krueger and Defo, {Barthelemy Kuate} and Bicer, {Burcu Kucuk} and Chanda Kulkarni and Kumar, {G. Anil} and Leasher, {Janet L.} and Alexander Lee and Mall Leinsalu and Tong Li and Shai Linn and Patrick Liu and Shiwei Liu and Lo, {Loon Tzian} and Lopez, {Alan D.} and Stefan Ma and {El Razek}, {Hassan Magdy Abd} and Azeem Majeed and Reza Malekzadeh and Malta, {Deborah Carvalho} and Manamo, {Wondimu Ayele} and Jose Martinez-Raga and Mekonnen, {Alemayehu Berhane} and Walter Mendoza and Miller, {Ted R.} and Mohammad, {Karzan Abdulmuhsin} and Lidia Morawska and Musa, {Kamarul Imran} and Gabriele Nagel and Neupane, {Sudan Prasad} and Quyen Nguyen and Oh, {In Hwan} and Oyekale, {Abayomi Samuel} and Mahesh PA and Adrian Pana and Park, {Eun Kee} and Patil, {Snehal T.} and Patton, {George C.} and Joao Pedro and Mostafa Qorbani and Anwar Rafay and Mahfuzar Rahman and Rai, {Rajesh Kumar} and Usha Ram and Ranabhat, {Chhabi Lal} and Refaat, {Amany H.} and Nickolas Reinig and Roba, {Hirbo Shore} and Alina Rodriguez and Yesenia Roman and Gregory Roth and Ambuj Roy and Rajesh Sagar and Joshua Salomon and Juan Sanabria and {de Souza Santos}, Itamar and Benn Sartorius and Maheswar Satpathy and Monika Sawhney and Susan Sawyer and Mete Saylan and Schaub, {Michael P.} and Neil Schluger and Schutte, {Aletta Elisabeth} and Sepanlou, {Sadaf G.} and Berrin Serdar and Shaikh, {Masood Ali} and Jun She and Shin, {Min Jeong} and Rahman Shiri and Kawkab Shishani and Ivy Shiue and Sigfusdottir, {Inga Dora} and Silverberg, {Jonathan I.} and Jasvinder Singh and Virendra Singh and Slepak, {Erica Leigh} and Samir Soneji and Soriano, {Joan B.} and Sergey Soshnikov and Sreeramareddy, {Chandrashekhar T.} and Stein, {Dan J.} and Saverio Stranges and Subart, {Michelle L.} and Soumya Swaminathan and Szoeke, {Cassandra E.I.} and Tefera, {Worku Mekonnen} and Roman Topor-Madry and Bach Tran and Nikolaos Tsilimparis and Hayley Tymeson and Ukwaja, {Kingsley Nnanna} and Rachel Updike and Uthman, {Olalekan A.} and Violante, {Francesco Saverio} and Vladimirov, {Sergey K.} and Vasiliy Vlassov and Vollset, {Stein Emil} and Theo Vos and Elisabete Weiderpass and Wen, {Chi Pan} and Andrea Werdecker and Shelley Wilson and Mamo Wubshet and Lin Xiao and Bereket Yakob and Yuichiro Yano and Penpeng Ye and Naohiro Yonemoto and Yoon, {Seok Jun} and Younis, {Mustafa Z.} and Chuanhua Yu and Zoubida Zaidi and {El Sayed Zaki}, Maysaa and Zhang, {Anthony Lin} and Ben Zipkin and Murray, {Christopher J.L.} and Forouzanfar, {Mohammad H.} and Emmanuela Gakidou",
year = "2017",
doi = "10.1016/S0140-6736(17)30819-X",
language = "English",
volume = "389",
pages = "1885--1906",
journal = "Lancet",
issn = "0140-6736",
publisher = "Elsevier Limited",
number = "10082",

}

Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015 : A systematic analysis from the Global Burden of Disease Study 2015. / GBD 2015 Tobacco Collaborators; Doyle, Kerrie E.; Kinfu, Yohannes.

In: The Lancet, Vol. 389, No. 10082, 2017, p. 1885-1906.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015

T2 - A systematic analysis from the Global Burden of Disease Study 2015

AU - GBD 2015 Tobacco Collaborators

AU - Reitsma, Marissa B.

AU - Fullman, Nancy

AU - Ng, Marie

AU - Salama, Joseph S.

AU - Abajobir, Amanuel

AU - Abate, Kalkidan Hassen

AU - Abbafati, Cristiana

AU - Abera, Semaw Ferede

AU - Abraham, Biju

AU - Abyu, Gebre Yitayih

AU - Adebiyi, Akindele Olupelumi

AU - Al-Aly, Ziyad

AU - Aleman, Alicia V.

AU - Ali, Raghib

AU - Al Alkerwi, Ala'a

AU - Allebeck, Peter

AU - Al-Raddadi, Rajaa Mohammad

AU - Amare, Azmeraw T.

AU - Amberbir, Alemayehu

AU - Ammar, Walid

AU - Amrock, Stephen Marc

AU - Antonio, Carl Abelardo T.

AU - Asayesh, Hamid

AU - Atnafu, Niguse Tadela

AU - Azzopardi, Peter

AU - Banerjee, Amitava

AU - Barac, Aleksandra

AU - Barrientos-Gutierrez, Tonatiuh

AU - Basto-Abreu, Ana Cristina

AU - Bazargan-Hejazi, Shahrzad

AU - Bedi, Neeraj

AU - Bell, Brent

AU - Bello, Aminu K.

AU - Bensenor, Isabela M.

AU - Beyene, Addisu Shunu

AU - Bhala, Neeraj

AU - Biryukov, Stan

AU - Bolt, Kaylin

AU - Brenner, Hermann

AU - Butt, Zahid

AU - Cavalleri, Fiorella

AU - Cercy, Kelly

AU - Chen, Honglei

AU - Christopher, Devasahayam Jesudas

AU - Ciobanu, Liliana G.

AU - Colistro, Valentina

AU - Colomar, Mercedes

AU - Cornaby, Leslie

AU - Dai, Xiaochen

AU - Damtew, Solomon Abrha

AU - Dandona, Lalit

AU - Dandona, Rakhi

AU - Dansereau, Emily

AU - Davletov, Kairat

AU - Dayama, Anand

AU - Degfie, Tizta Tilahun

AU - Deribew, Amare

AU - Dharmaratne, Samath D.

AU - Dimtsu, Balem Demtsu

AU - Doyle, Kerrie E.

AU - Endries, Aman Yesuf

AU - Ermakov, Sergey Petrovich

AU - Estep, Kara

AU - Faraon, Emerito Jose Aquino

AU - Farzadfar, Farshad

AU - Feigin, Valery L.

AU - Feigl, Andrea B.

AU - Fischer, Florian

AU - Friedman, Joseph

AU - G/hiwot, Tsegaye Tewelde

AU - Gall, Seana L.

AU - Gao, Wayne

AU - Gillum, Richard F.

AU - Gold, Audra L.

AU - Gopalani, Sameer Vali

AU - Gotay, Carolyn C.

AU - Gupta, Rahul

AU - Gupta, Rajeev

AU - Gupta, Vipin

AU - Hamadeh, Randah Ribhi

AU - Hankey, Graeme

AU - Harb, Hilda L.

AU - Hay, Simon I.

AU - Horino, Masako

AU - Horita, Nobuyuki

AU - Hosgood, H. Dean

AU - Husseini, Abdullatif

AU - Ileanu, Bogdan Vasile

AU - Islami, Farhad

AU - Jiang, Guohong

AU - Jiang, Ying

AU - Jonas, Jost B.

AU - Kabir, Zubair

AU - Kamal, Ritul

AU - Kasaeian, Amir

AU - Kesavachandran, Chandrasekharan Nair

AU - Khader, Yousef S.

AU - Khalil, Ibrahim

AU - Khang, Young Ho

AU - Khera, Sahil

AU - Khubchandani, Jagdish

AU - Kim, Daniel

AU - Kim, Yun Jin

AU - Kimokoti, Ruth W.

AU - Kinfu, Yohannes

AU - Knibbs, Luke D.

AU - Kokubo, Yoshihiro

AU - Kolte, Dhaval

AU - Kopec, Jacek

AU - Kosen, Soewarta

AU - Kotsakis, Georgios A.

AU - Koul, Parvaiz A.

AU - Koyanagi, Ai

AU - Krohn, Kristopher J.

AU - Krueger, Hans

AU - Defo, Barthelemy Kuate

AU - Bicer, Burcu Kucuk

AU - Kulkarni, Chanda

AU - Kumar, G. Anil

AU - Leasher, Janet L.

AU - Lee, Alexander

AU - Leinsalu, Mall

AU - Li, Tong

AU - Linn, Shai

AU - Liu, Patrick

AU - Liu, Shiwei

AU - Lo, Loon Tzian

AU - Lopez, Alan D.

AU - Ma, Stefan

AU - El Razek, Hassan Magdy Abd

AU - Majeed, Azeem

AU - Malekzadeh, Reza

AU - Malta, Deborah Carvalho

AU - Manamo, Wondimu Ayele

AU - Martinez-Raga, Jose

AU - Mekonnen, Alemayehu Berhane

AU - Mendoza, Walter

AU - Miller, Ted R.

AU - Mohammad, Karzan Abdulmuhsin

AU - Morawska, Lidia

AU - Musa, Kamarul Imran

AU - Nagel, Gabriele

AU - Neupane, Sudan Prasad

AU - Nguyen, Quyen

AU - Oh, In Hwan

AU - Oyekale, Abayomi Samuel

AU - PA, Mahesh

AU - Pana, Adrian

AU - Park, Eun Kee

AU - Patil, Snehal T.

AU - Patton, George C.

AU - Pedro, Joao

AU - Qorbani, Mostafa

AU - Rafay, Anwar

AU - Rahman, Mahfuzar

AU - Rai, Rajesh Kumar

AU - Ram, Usha

AU - Ranabhat, Chhabi Lal

AU - Refaat, Amany H.

AU - Reinig, Nickolas

AU - Roba, Hirbo Shore

AU - Rodriguez, Alina

AU - Roman, Yesenia

AU - Roth, Gregory

AU - Roy, Ambuj

AU - Sagar, Rajesh

AU - Salomon, Joshua

AU - Sanabria, Juan

AU - de Souza Santos, Itamar

AU - Sartorius, Benn

AU - Satpathy, Maheswar

AU - Sawhney, Monika

AU - Sawyer, Susan

AU - Saylan, Mete

AU - Schaub, Michael P.

AU - Schluger, Neil

AU - Schutte, Aletta Elisabeth

AU - Sepanlou, Sadaf G.

AU - Serdar, Berrin

AU - Shaikh, Masood Ali

AU - She, Jun

AU - Shin, Min Jeong

AU - Shiri, Rahman

AU - Shishani, Kawkab

AU - Shiue, Ivy

AU - Sigfusdottir, Inga Dora

AU - Silverberg, Jonathan I.

AU - Singh, Jasvinder

AU - Singh, Virendra

AU - Slepak, Erica Leigh

AU - Soneji, Samir

AU - Soriano, Joan B.

AU - Soshnikov, Sergey

AU - Sreeramareddy, Chandrashekhar T.

AU - Stein, Dan J.

AU - Stranges, Saverio

AU - Subart, Michelle L.

AU - Swaminathan, Soumya

AU - Szoeke, Cassandra E.I.

AU - Tefera, Worku Mekonnen

AU - Topor-Madry, Roman

AU - Tran, Bach

AU - Tsilimparis, Nikolaos

AU - Tymeson, Hayley

AU - Ukwaja, Kingsley Nnanna

AU - Updike, Rachel

AU - Uthman, Olalekan A.

AU - Violante, Francesco Saverio

AU - Vladimirov, Sergey K.

AU - Vlassov, Vasiliy

AU - Vollset, Stein Emil

AU - Vos, Theo

AU - Weiderpass, Elisabete

AU - Wen, Chi Pan

AU - Werdecker, Andrea

AU - Wilson, Shelley

AU - Wubshet, Mamo

AU - Xiao, Lin

AU - Yakob, Bereket

AU - Yano, Yuichiro

AU - Ye, Penpeng

AU - Yonemoto, Naohiro

AU - Yoon, Seok Jun

AU - Younis, Mustafa Z.

AU - Yu, Chuanhua

AU - Zaidi, Zoubida

AU - El Sayed Zaki, Maysaa

AU - Zhang, Anthony Lin

AU - Zipkin, Ben

AU - Murray, Christopher J.L.

AU - Forouzanfar, Mohammad H.

AU - Gakidou, Emmanuela

PY - 2017

Y1 - 2017

N2 - Background: The scale-up of tobacco control, especially after the adoption of the Framework Convention for Tobacco Control, is a major public health success story. Nonetheless, smoking remains a leading risk for early death and disability worldwide, and therefore continues to require sustained political commitment. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) offers a robust platform through which global, regional, and national progress toward achieving smoking-related targets can be assessed. Methods: We synthesised 2818 data sources with spatiotemporal Gaussian process regression and produced estimates of daily smoking prevalence by sex, age group, and year for 195 countries and territories from 1990 to 2015. We analysed 38 risk-outcome pairs to generate estimates of smoking-attributable mortality and disease burden, as measured by disability-adjusted life-years (DALYs). We then performed a cohort analysis of smoking prevalence by birth-year cohort to better understand temporal age patterns in smoking. We also did a decomposition analysis, in which we parsed out changes in all-cause smoking-attributable DALYs due to changes in population growth, population ageing, smoking prevalence, and risk-deleted DALY rates. Finally, we explored results by level of development using the Socio-demographic Index (SDI). Findings: Worldwide, the age-standardised prevalence of daily smoking was 25·0% (95% uncertainty interval [UI] 24·2–25·7) for men and 5·4% (5·1–5·7) for women, representing 28·4% (25·8–31·1) and 34·4% (29·4–38·6) reductions, respectively, since 1990. A greater percentage of countries and territories achieved significant annualised rates of decline in smoking prevalence from 1990 to 2005 than in between 2005 and 2015; however, only four countries had significant annualised increases in smoking prevalence between 2005 and 2015 (Congo [Brazzaville] and Azerbaijan for men and Kuwait and Timor-Leste for women). In 2015, 11·5% of global deaths (6·4 million [95% UI 5·7–7·0 million]) were attributable to smoking worldwide, of which 52·2% took place in four countries (China, India, the USA, and Russia). Smoking was ranked among the five leading risk factors by DALYs in 109 countries and territories in 2015, rising from 88 geographies in 1990. In terms of birth cohorts, male smoking prevalence followed similar age patterns across levels of SDI, whereas much more heterogeneity was found in age patterns for female smokers by level of development. While smoking prevalence and risk-deleted DALY rates mostly decreased by sex and SDI quintile, population growth, population ageing, or a combination of both, drove rises in overall smoking-attributable DALYs in low-SDI to middle-SDI geographies between 2005 and 2015. Interpretation: The pace of progress in reducing smoking prevalence has been heterogeneous across geographies, development status, and sex, and as highlighted by more recent trends, maintaining past rates of decline should not be taken for granted, especially in women and in low-SDI to middle-SDI countries. Beyond the effect of the tobacco industry and societal mores, a crucial challenge facing tobacco control initiatives is that demographic forces are poised to heighten smoking's global toll, unless progress in preventing initiation and promoting cessation can be substantially accelerated. Greater success in tobacco control is possible but requires effective, comprehensive, and adequately implemented and enforced policies, which might in turn require global and national levels of political commitment beyond what has been achieved during the past 25 years.

AB - Background: The scale-up of tobacco control, especially after the adoption of the Framework Convention for Tobacco Control, is a major public health success story. Nonetheless, smoking remains a leading risk for early death and disability worldwide, and therefore continues to require sustained political commitment. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) offers a robust platform through which global, regional, and national progress toward achieving smoking-related targets can be assessed. Methods: We synthesised 2818 data sources with spatiotemporal Gaussian process regression and produced estimates of daily smoking prevalence by sex, age group, and year for 195 countries and territories from 1990 to 2015. We analysed 38 risk-outcome pairs to generate estimates of smoking-attributable mortality and disease burden, as measured by disability-adjusted life-years (DALYs). We then performed a cohort analysis of smoking prevalence by birth-year cohort to better understand temporal age patterns in smoking. We also did a decomposition analysis, in which we parsed out changes in all-cause smoking-attributable DALYs due to changes in population growth, population ageing, smoking prevalence, and risk-deleted DALY rates. Finally, we explored results by level of development using the Socio-demographic Index (SDI). Findings: Worldwide, the age-standardised prevalence of daily smoking was 25·0% (95% uncertainty interval [UI] 24·2–25·7) for men and 5·4% (5·1–5·7) for women, representing 28·4% (25·8–31·1) and 34·4% (29·4–38·6) reductions, respectively, since 1990. A greater percentage of countries and territories achieved significant annualised rates of decline in smoking prevalence from 1990 to 2005 than in between 2005 and 2015; however, only four countries had significant annualised increases in smoking prevalence between 2005 and 2015 (Congo [Brazzaville] and Azerbaijan for men and Kuwait and Timor-Leste for women). In 2015, 11·5% of global deaths (6·4 million [95% UI 5·7–7·0 million]) were attributable to smoking worldwide, of which 52·2% took place in four countries (China, India, the USA, and Russia). Smoking was ranked among the five leading risk factors by DALYs in 109 countries and territories in 2015, rising from 88 geographies in 1990. In terms of birth cohorts, male smoking prevalence followed similar age patterns across levels of SDI, whereas much more heterogeneity was found in age patterns for female smokers by level of development. While smoking prevalence and risk-deleted DALY rates mostly decreased by sex and SDI quintile, population growth, population ageing, or a combination of both, drove rises in overall smoking-attributable DALYs in low-SDI to middle-SDI geographies between 2005 and 2015. Interpretation: The pace of progress in reducing smoking prevalence has been heterogeneous across geographies, development status, and sex, and as highlighted by more recent trends, maintaining past rates of decline should not be taken for granted, especially in women and in low-SDI to middle-SDI countries. Beyond the effect of the tobacco industry and societal mores, a crucial challenge facing tobacco control initiatives is that demographic forces are poised to heighten smoking's global toll, unless progress in preventing initiation and promoting cessation can be substantially accelerated. Greater success in tobacco control is possible but requires effective, comprehensive, and adequately implemented and enforced policies, which might in turn require global and national levels of political commitment beyond what has been achieved during the past 25 years.

KW - Adolescent

KW - Adult

KW - Age Distribution

KW - Aged

KW - Aged, 80 and over

KW - Female

KW - Global Burden of Disease

KW - Global Health

KW - Humans

KW - Internationality

KW - Male

KW - Middle Aged

KW - Normal Distribution

KW - Prevalence

KW - Quality-Adjusted Life Years

KW - Retrospective Studies

KW - Risk Factors

KW - Sex Distribution

KW - Smoking/epidemiology

KW - Socioeconomic Factors

KW - Young Adult

UR - http://www.scopus.com/inward/record.url?scp=85017146418&partnerID=8YFLogxK

U2 - 10.1016/S0140-6736(17)30819-X

DO - 10.1016/S0140-6736(17)30819-X

M3 - Article

VL - 389

SP - 1885

EP - 1906

JO - Lancet

JF - Lancet

SN - 0140-6736

IS - 10082

ER -