The Lancet ( IF 98.4 ) Pub Date : 2021-05-27 , DOI: 10.1016/s0140-6736(21)01169-7 Marissa B Reitsma , Parkes J Kendrick , Emad Ababneh , Cristiana Abbafati , Mohsen Abbasi-Kangevari , Amir Abdoli , Aidin Abedi , E S Abhilash , Derrick Bary Abila , Victor Aboyans , Niveen ME Abu-Rmeileh , Oladimeji M Adebayo , Shailesh M Advani , Mohammad Aghaali , Bright Opoku Ahinkorah , Sohail Ahmad , Keivan Ahmadi , Haroon Ahmed , Budi Aji , Chisom Joyqueenet Akunna , Ziyad Al-Aly , Turki M Alanzi , Khalid F Alhabib , Liaqat Ali , Sheikh Mohammad Alif , Vahid Alipour , Syed Mohamed Aljunid , François Alla , Peter Allebeck , Nelson Alvis-Guzman , Tarek Tawfik Amin , Saeed Amini , Hubert Amu , Gianna Gayle Herrera Amul , Robert Ancuceanu , Jason A Anderson , Alireza Ansari-Moghaddam , Carl Abelardo T Antonio , Benny Antony , Davood Anvari , Jalal Arabloo , Nicholas D Arian , Monika Arora , Malke Asaad , Marcel Ausloos , Asma Tahir Awan , Getinet Ayano , Getie Lake Aynalem , Samad Azari , Darshan B B , Ashish D Badiye , Atif Amin Baig , Mohammad Hossein Bakhshaei , Maciej Banach , Palash Chandra Banik , Suzanne Lyn Barker-Collo , Till Winfried Bärnighausen , Hiba Jawdat Barqawi , Sanjay Basu , Mohsen Bayati , Shahrzad Bazargan-Hejazi , Masoud Behzadifar , Tariku Tesfaye Bekuma , Derrick A Bennett , Isabela M Bensenor , Kathleen S Sachiko Berfield , Akshaya Srikanth Bhagavathula , Nikha Bhardwaj , Pankaj Bhardwaj , Krittika Bhattacharyya , Sadia Bibi , Ali Bijani , Bagas Suryo Bintoro , Antonio Biondi , Setognal Birara , Dejana Braithwaite , Hermann Brenner , Andre R Brunoni , Katrin Burkart , Zahid A Butt , Florentino Luciano Caetano dos Santos , Luis Alberto Cámera , Josip Car , Rosario Cárdenas , Giulia Carreras , Juan J Carrero , Joao Mauricio Castaldelli-Maia , Maria Sofia Sofia Cattaruzza , Jung-Chen Chang , Simiao Chen , Dinh-Toi Chu , Sheng-Chia Chung , Massimo Cirillo , Vera Marisa Costa , Rosa A S Couto , Omid Dadras , Xiaochen Dai , Albertino Antonio Moura Damasceno , Giovanni Damiani , Lalit Dandona , Rakhi Dandona , Parnaz Daneshpajouhnejad , Jiregna Darega Gela , Kairat Davletov , Meseret Derbew Molla , Getenet Ayalew Dessie , Abebaw Alemayehu Desta , Samath Dhamminda Dharmaratne , Mostafa Dianatinasab , Daniel Diaz , Hoa Thi Do , Abdel Douiri , Bruce B Duncan , Andre Rodrigues Duraes , Arielle Wilder Eagan , Mohammad Ebrahimi Kalan , Kristina Edvardsson , Iffat Elbarazi , Maha El Tantawi , Saman Esmaeilnejad , Ibtihal Fadhil , Emerito Jose A Faraon , Carla Sofia e Sá Farinha , Medhat Farwati , Farshad Farzadfar , Mehdi Fazlzadeh , Valery L Feigin , Rachel Feldman , Carlota Fernandez Prendes , Pietro Ferrara , Irina Filip , Filippos Filippidis , Florian Fischer , Luisa Sorio Flor , Nataliya A Foigt , Morenike Oluwatoyin Folayan , Masoud Foroutan , Mohamed M Gad , Abhay Motiramji Gaidhane , Silvano Gallus , Biniyam Sahiledengle Geberemariyam , Mansour Ghafourifard , Alireza Ghajar , Ahmad Ghashghaee , Simona Giampaoli , Paramjit Singh Gill , Franklin N Glozah , Elena V Gnedovskaya , Mahaveer Golechha , Sameer Vali Gopalani , Giuseppe Gorini , Houman Goudarzi , Alessandra C Goulart , Felix Greaves , Avirup Guha , Yuming Guo , Bhawna Gupta , Rajat Das Gupta , Rajeev Gupta , Tarun Gupta , Vin Gupta , Nima Hafezi-Nejad , Mohammad Rifat Haider , Randah R Hamadeh , Graeme J Hankey , Arief Hargono , Risky Kusuma Hartono , Hadi Hassankhani , Simon I Hay , Golnaz Heidari , Claudiu Herteliu , Kamal Hezam , Thomas R Hird , Michael K Hole , Ramesh Holla , Mehdi Hosseinzadeh , Sorin Hostiuc , Mowafa Househ , Thomas Hsiao , Junjie Huang , Vincent C Iannucci , Segun Emmanuel Ibitoye , Bulat Idrisov , Olayinka Stephen Ilesanmi , Irena M Ilic , Milena D Ilic , Leeberk Raja Inbaraj , Seyed Sina Naghibi Irvani , Jessica Y Islam , Rakibul M Islam , Sheikh Mohammed Shariful Islam , Farhad Islami , Hiroyasu Iso , Ramaiah Itumalla , Masao Iwagami , Jalil Jaafari , Vardhmaan Jain , Mihajlo Jakovljevic , Sung-In Jang , Hosna Janjani , Shubha Jayaram , Panniyammakal Jeemon , Ravi Prakash Jha , Jost B Jonas , Tamas Joo , Mikk Jürisson , Ali Kabir , Zubair Kabir , Leila R Kalankesh , Tanuj Kanchan , Himal Kandel , Neeti Kapoor , Salah Eddin Karimi , Srinivasa Vittal Katikireddi , Hafte Kahsay Kebede , Bayew Kelkay , Ryan David Kennedy , Abdullah T Khoja , Jagdish Khubchandani , Gyu Ri Kim , Young-Eun Kim , Ruth W Kimokoti , Mika Kivimäki , Soewarta Kosen , Sindhura Lakshmi Koulmane Laxminarayana , Ai Koyanagi , Kewal Krishan , Nuworza Kugbey , G Anil Kumar , Nithin Kumar , Om P Kurmi , Dian Kusuma , Ben Lacey , Jennifer O Lam , Iván Landires , Savita Lasrado , Paolo Lauriola , Doo Woong Lee , Yo Han Lee , Janni Leung , Shanshan Li , Hualiang Lin , Shai Linn , Wei Liu , Alan D Lopez , Platon D Lopukhov , Stefan Lorkowski , Alessandra Lugo , Azeem Majeed , Afshin Maleki , Reza Malekzadeh , Deborah Carvalho Malta , Abdullah A Mamun , Narayana Manjunatha , Borhan Mansouri , Mohammad Ali Mansournia , Jose Martinez-Raga , Santi Martini , Manu Raj Mathur , Carlo Eduardo Medina-Solís , Suresh Mehata , Walter Mendoza , Ritesh G Menezes , Atte Meretoja , Tuomo J Meretoja , Bartosz Miazgowski , Irmina Maria Michalek , Ted R Miller , Erkin M Mirrakhimov , Hamed Mirzaei , Mehdi Mirzaei-Alavijeh , Sanjeev Misra , Masoud Moghadaszadeh , Yousef Mohammad , Abdollah Mohammadian-Hafshejani , Shafiu Mohammed , Ali H Mokdad , Lorenzo Monasta , Mohammad Ali Moni , Ghobad Moradi , Maziar Moradi-Lakeh , Rahmatollah Moradzadeh , Shane Douglas Morrison , Tilahun Belete Mossie , Sumaira Mubarik , Erin C Mullany , Christopher J L Murray , Mohsen Naghavi , Behshad Naghshtabrizi , Sanjeev Nair , Mahdi Nalini , Vinay Nangia , Atta Abbas Naqvi , Sreenivas Narasimha Swamy , Muhammad Naveed , Smitha Nayak , Vinod C Nayak , Javad Nazari , Sabina O Nduaguba , Sandhya Neupane Kandel , Cuong Tat Nguyen , Huong Lan Thi Nguyen , Son Hoang Nguyen , Trang Huyen Nguyen , Molly R Nixon , Chukwudi A Nnaji , Bo Norrving , Jean Jacques Noubiap , Christoph Nowak , Felix Akpojene Ogbo , Ayodipupo Sikiru Oguntade , In-Hwan Oh , Andrew T Olagunju , Eyal Oren , Nikita Otstavnov , Stanislav S Otstavnov , Mayowa O Owolabi , Mahesh P A , Smita Pakhale , Keyvan Pakshir , Raffaele Palladino , Adrian Pana , Songhomitra Panda-Jonas , Ashok Pandey , Utsav Parekh , Eun-Cheol Park , Eun-Kee Park , Fatemeh Pashazadeh Kan , George C Patton , Shrikant Pawar , Richard G Pestell , Marina Pinheiro , Michael A Piradov , Saeed Pirouzpanah , Khem Narayan Pokhrel , Roman V Polibin , Akila Prashant , Dimas Ria Angga Pribadi , Amir Radfar , Vafa Rahimi-Movaghar , Azizur Rahman , Mohammad Hifz Ur Rahman , Muhammad Aziz Rahman , Amir Masoud Rahmani , Nazanin Rajai , Pradhum Ram , Chhabi Lal Ranabhat , Priya Rathi , Lal Rawal , Andre M N Renzaho , Luz Myriam Reynales-Shigematsu , Aziz Rezapour , Seyed Mohammad Riahi , Mavra A Riaz , Leonardo Roever , Luca Ronfani , Gholamreza Roshandel , Ambuj Roy , Bedanta Roy , Simona Sacco , Basema Saddik , Amirhossein Sahebkar , Sana Salehi , Hamideh Salimzadeh , Mehrnoosh Samaei , Abdallah M Samy , Itamar S Santos , Milena M Santric-Milicevic , Nizal Sarrafzadegan , Brijesh Sathian , Monika Sawhney , Mete Saylan , Michael P Schaub , Maria Inês Schmidt , Ione Jayce Ceola Schneider , Aletta Elisabeth Schutte , Falk Schwendicke , Abdul-Aziz Seidu , Nachimuthu Senthil Kumar , Sadaf G Sepanlou , Allen Seylani , Omid Shafaat , Syed Mahboob Shah , Masood Ali Shaikh , Ali S Shalash , Mohammed Shannawaz , Kiomars Sharafi , Aziz Sheikh , Sara Sheikhbahaei , Mika Shigematsu , Rahman Shiri , Kawkab Shishani , K M Shivakumar , Siddharudha Shivalli , Roman Shrestha , Soraya Siabani , Negussie Boti Sidemo , Inga Dora Sigfusdottir , Rannveig Sigurvinsdottir , Diego Augusto Santos Silva , João Pedro Silva , Ambrish Singh , Jasvinder A Singh , Virendra Singh , Dhirendra Narain Sinha , Freddy Sitas , Valentin Yurievich Skryabin , Anna Aleksandrovna Skryabina , Matiwos Soboka , Joan B Soriano , Ali Soroush , Sergey Soshnikov , Ireneous N Soyiri , Emma Elizabeth Spurlock , Chandrashekhar T Sreeramareddy , Dan J Stein , Paschalis Steiropoulos , Stefan Stortecky , Kurt Straif , Rizwan Suliankatchi Abdulkader , Gerhard Sulo , Johan Sundström , Takahiro Tabuchi , Santosh Kumar Tadakamadla , Biruk Wogayehu Taddele , Eyayou Girma Tadesse , Animut Tagele Tamiru , Minale Tareke , Md Ismail Tareque , Ingan Ukur Tarigan , Mohamad-Hani Temsah , Kavumpurathu Raman Thankappan , Rekha Thapar , Ales Tichopad , Musliu Adetola Tolani , Fotis Topouzis , Marcos Roberto Tovani-Palone , Bach Xuan Tran , Jaya Prasad Tripathy , Gebiyaw Wudie Tsegaye , Nikolaos Tsilimparis , Hayley D Tymeson , Anayat Ullah , Saif Ullah , Brigid Unim , Rachel L Updike , Marco Vacante , Pascual R Valdez , Constantine Vardavas , Patricia Varona Pérez , Tommi Juhani Vasankari , Narayanaswamy Venketasubramanian , Madhur Verma , Marina V Vetrova , Bay Vo , Giang Thu Vu , Yasir Waheed , Yanzhong Wang , Kevin Welding , Andrea Werdecker , Joanna L Whisnant , Nuwan Darshana Wickramasinghe , Kazumasa Yamagishi , Srikanth Yandrapalli , Hiroshi Yatsuya , Vahid Yazdi-Feyzabadi , Yigizie Yeshaw , Mohammed Zewdu Yimmer , Naohiro Yonemoto , Chuanhua Yu , Ismaeel Yunusa , Hasan Yusefzadeh , Telma Zahirian Moghadam , Muhammed Shahriar Zaman , Maryam Zamanian , Hamed Zandian , Heather J Zar , Mikhail Sergeevich Zastrozhin , Anasthasia Zastrozhina , Luis Zavala-Arciniega , Jianrong Zhang , Zhi-Jiang Zhang , Chenwen Zhong , Yves Miel H Zuniga , Emmanuela Gakidou
Background
Ending the global tobacco epidemic is a defining challenge in global health. Timely and comprehensive estimates of the prevalence of smoking tobacco use and attributable disease burden are needed to guide tobacco control efforts nationally and globally.
Methods
We estimated the prevalence of smoking tobacco use and attributable disease burden for 204 countries and territories, by age and sex, from 1990 to 2019 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. We modelled multiple smoking-related indicators from 3625 nationally representative surveys. We completed systematic reviews and did Bayesian meta-regressions for 36 causally linked health outcomes to estimate non-linear dose-response risk curves for current and former smokers. We used a direct estimation approach to estimate attributable burden, providing more comprehensive estimates of the health effects of smoking than previously available.
Findings
Globally in 2019, 1·14 billion (95% uncertainty interval 1·13–1·16) individuals were current smokers, who consumed 7·41 trillion (7·11–7·74) cigarette-equivalents of tobacco in 2019. Although prevalence of smoking had decreased significantly since 1990 among both males (27·5% [26·5–28·5] reduction) and females (37·7% [35·4–39·9] reduction) aged 15 years and older, population growth has led to a significant increase in the total number of smokers from 0·99 billion (0·98–1·00) in 1990. Globally in 2019, smoking tobacco use accounted for 7·69 million (7·16–8·20) deaths and 200 million (185–214) disability-adjusted life-years, and was the leading risk factor for death among males (20·2% [19·3–21·1] of male deaths). 6·68 million [86·9%] of 7·69 million deaths attributable to smoking tobacco use were among current smokers.
Interpretation
In the absence of intervention, the annual toll of 7·69 million deaths and 200 million disability-adjusted life-years attributable to smoking will increase over the coming decades. Substantial progress in reducing the prevalence of smoking tobacco use has been observed in countries from all regions and at all stages of development, but a large implementation gap remains for tobacco control. Countries have a clear and urgent opportunity to pass strong, evidence-based policies to accelerate reductions in the prevalence of smoking and reap massive health benefits for their citizens.
Funding
Bloomberg Philanthropies and the Bill & Melinda Gates Foundation.
中文翻译：
1990-2019 年 204 个国家和地区吸烟流行率和可归因疾病负担的空间、时间和人口模式：2019 年全球疾病负担研究的系统分析
背景
结束全球烟草流行是全球健康领域的一项决定性挑战。需要及时、全面地估计吸烟的流行率和可归因的疾病负担，以指导国家和全球的烟草控制工作。
方法
作为全球疾病、伤害和风险因素负担研究的一部分，我们按年龄和性别估算了 1990 年至 2019 年 204 个国家和地区的吸烟流行率和可归因的疾病负担。我们根据 3625 项全国代表性调查对多项吸烟相关指标进行了建模。我们完成了系统评价，并对 36 种因果关系的健康结果进行了贝叶斯元回归，以估计当前和以前吸烟者的非线性剂量反应风险曲线。我们使用直接估计方法来估计可归因的负担，提供比以前更全面的吸烟对健康影响的估计。
发现
2019 年，全球有 1·140 亿（95% 不确定性区间 1·13–1·16）人是当前吸烟者，他们在 2019 年消费了 7·41 万亿（7·11–7·74）支卷烟当量的烟草。自1990年以来，15岁及以上男性吸烟率显着下降（减少27·5% [26·5–28·5]）和女性（减少37·7% [35·4–39·9]）人口增长导致吸烟者总数从 1990 年的 0·990 亿（0·98–1·00）大幅增加。2019 年全球吸烟者占 7·6900 万（7·16–1·00）。 8·20) 死亡和 2 亿 (185–214) 残疾调整生命年，是男性死亡的主要危险因素（占男性死亡人数的 20·2% [19·3–21·1]）。因吸烟导致的 7·6900 万人死亡中，有 6·6800 万人 [86·9%] 是当前吸烟者。
解释
如果不采取干预措施，未来几十年，每年因吸烟导致的死亡人数将增加 7·6900 万人，残疾调整生命年将增加 2 亿人。各个地区和各个发展阶段的国家在减少吸烟流行率方面都取得了实质性进展，但烟草控制的实施仍存在巨大差距。各国拥有明显而紧迫的机会来通过强有力的、基于证据的政策，以加速减少吸烟率并为其公民带来巨大的健康益处。
资金
彭博慈善基金会和比尔及梅琳达·盖茨基金会。
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