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Tuesday, 12 November, 2024
HomeWeekly RoundupThe global tobacco epidemic is far from over – Study

The global tobacco epidemic is far from over – Study

One in 10 deaths around the world is caused by smoking, reports The Guardian. And a major study shows that the tobacco epidemic is far from over and that the threat to lives is spreading across the globe.

There were nearly 1bn smokers in 2015, in spite of tobacco control policies having been adopted by many countries. That number is expected to rise as the world’s population expands. One in every four men is a smoker and one in 20 women. Their lives are likely to be cut short – smoking is the second biggest risk factor for early death and disability after high blood pressure.

The report says the researchers found there were 6.4m deaths attributed to smoking in 2015, of which half were in just four populous countries – China, India, the US and Russia.

Major efforts to control tobacco have paid off, according to the study. A World Health Organisation treaty in 2005 ratified by 180 countries recommends measures including smoking bans in public places, high taxes in cigarettes and curbs on advertising and marketing.

Between 1990 and 2015, smoking prevalence dropped from 35% to 25% among men and 8% to 5% among women. High income countries and Latin America – especially Brazil, which brought in tough curbs on tobacco – achieved the biggest drops in numbers of smokers.

But many countries have made marginal progress since the treaty was agreed, say the authors of the study from the Institute of Health Metrics and Evaluation at the University of Washington – Seattle in the US. And although far more men smoke than women, there have been bigger reductions in the proportions of men smoking also, with minimal changes among women.

Senior author Dr Emmanuela Gakidou at the Institute for Health Metrics and Evaluation said there were 933m daily smokers in 2015, which she called “a very shocking number”. The paper focused only on those who smoke every day. “The toll of tobacco is likely to be much larger if we include occasional smokers and former smokers and people who use other tobacco products like smokeless tobacco. This is on the low end of how important tobacco is,” she is quoted in the report as saying.

There is much more that needs to be done, she said. “There is a widespread notion that the war on tobacco has been won but I think our evidence shows that we need renewed and sustained efforts because the toll of smoking in 2015 is much larger than most people would think, so we absolutely have a lot more to do. We need new and improved strategies to do it and a lot of effort and political will.”

Traditionally there have been far fewer women smoking around the world than men, but it was a huge problem for both, she said. “There are some really worrisome findings – for example in Russia female smoking has increased in the last 25 years significantly. There are also some western European countries where about one in three women are smoking. So it is true globally that a lot fewer women smoke than men but there are some countries where it is a big problem for women,” she said.

Dr Kelly Henning of Bloomberg Philanthropies, which is committed to tobacco control and co-funded the study with the Bill and Melinda Gates Foundation, said in the report: “I think the study highlights the fact that the work is not finished on tobacco. The good news is the decline in daily smoking among men and women… however there are still many smokers in the world and there is still a lot of work to do. I think we have to keep our eye on the issue and really do more.”

Countries with some of the highest death tolls such as China and Indonesia “really don’t need those health problems – they have so many other issues they are trying to address. But tobacco control is critically important in those places,” she said.

“China has more than a million deaths a year from smoking-related diseases and China is only beginning to see the effects of their high male smoking rate. That is only one instance of what is expected to become an extremely major epidemic,” she said.

The report says writing in a linked comment, Professor John Britton from the University of Nottingham said: “Responsibility for this global health disaster lies mainly with the transnational tobacco companies, which clearly hold the value of human life in very different regard to most of the rest of humanity.” British American Tobacco, for instance, sold 665bn cigarettes in 2015 and made a £5.2bn profit.

“Today, the smoking epidemic is being exported from the rich world to low-income and middle-income countries, slipping under the radar while apparently more immediate priorities occupy and absorb scarce available human and financial resources,” he writes. “The epidemic of tobacco deaths will progress inexorably throughout the world until and unless tobacco control is recognised as an immediate priority for development, investment, and research.”

Summary
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.

Authors
GBD 2015 Tobacco Collaborators

[link url="https://www.theguardian.com/society/2017/apr/05/smoking-causes-one-in-ten-deaths-globally-major-new-study-reveals"]The Guardian report[/link]
[link url="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30819-X/fulltext"]The Lancet article summary[/link]
[link url="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30867-X/fulltext"]The Lancet comment[/link]

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