Smoking prevalence and attributable disease burden in 195 countries and territories, 1990-2015: a systematic analysis from the Global Burden of Disease Study 2015.
Smoking prevalence and attributable disease burden in 195 countries and territories, 1990-2015: a systematic analysis from the Global Burden of Disease Study 2015.
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DOI：
10.1016/s0140-6736(17)30819-x
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发表时间：
2017-05-13
期刊：
影响因子：
--
通讯作者：
GBD 2015 Tobacco Collaborators
中科院分区：
文献类型：
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作者：
GBD 2015 Tobacco Collaborators
烟草控制的扩大，特别是在《烟草控制框架公约》通过之后，是一个重大的公共卫生成功故事。尽管如此，吸烟仍然是全世界过早死亡和残疾的主要风险，因此仍然需要持续的政治承诺。全球疾病、伤害和风险因素负担研究 (GBD) 提供了一个强大的平台，通过该平台可以评估全球、区域和国家在实现吸烟相关目标方面取得的进展。我们利用时空高斯过程回归综合了 2818 个数据源，并按性别、年龄组和年份对 195 个国家和地区 1990 年至 2015 年间的每日吸烟流行率进行了估计。我们分析了 38 个风险结果对，以生成由吸烟引起的死亡率和疾病负担的估计值，以残疾调整生命年 (DALY) 为衡量标准。然后，我们按出生年份队列对吸烟率进行队列分析，以更好地了解吸烟的时间年龄模式。我们还进行了分解分析，分析了由于人口增长、人口老龄化、吸烟流行率和风险删除 DALY 率的变化而导致的全因吸烟归因 DALY 的变化。最后，我们使用社会人口指数（SDI）按发展水平探讨了结果。在世界范围内，自 1990 年以来，每日吸烟的年龄标准化患病率男性为 25·0%（95% 不确定区间 [UI] 24·2–25·7），女性为 5·4%（5·1–5·7），分别减少了 28·4%（25·8–31·1）和 34·4%（29·4–38·6）。更多国家和地区实现了显着的年化吸烟率1990年至2005年吸烟率比2005年至2015年下降率；然而，2005 年至 2015 年间，只有四个国家的吸烟率按年计算显着增加（男性为刚果[布拉柴维尔]和阿塞拜疆，女性为科威特和东帝汶）。 2015 年，全球死亡人数的 11·5%（6·4 百万 [95% UI 5·7–7·0 百万]）归因于吸烟，其中 52·2% 发生在四个国家（中国、印度、美国和俄罗斯）。 2015 年，吸烟在 109 个国家和地区的伤残调整生命年 (DALY) 中被列为五大主要危险因素之一，而 1990 年有 88 个国家和地区。就出生队列而言，男性吸烟率在不同 SDI 水平上遵循相似的年龄模式，而女性吸烟者的年龄模式则根据发展水平存在更多异质性。虽然吸烟率和风险删除 DALY 率主要随性别和 SDI 五分位数而下降，但人口增长、人口老龄化或两者的结合，推动了 2005 年至 2015 年间低 SDI 至中 SDI 地区吸烟所致 DALY 的整体上升。降低吸烟率的进展速度在不同地区、发展状况和性别之间存在差异，正如最近的趋势所强调的那样，不应将过去的下降率视为理所当然，特别是在女性以及低 SDI 国家和中等 SDI 国家中。除了烟草业和社会风气的影响之外，烟草控制举措面临的一个关键挑战是人口因素将导致全球吸烟造成的死亡人数增加，除非能够大幅加速在预防吸烟和促进戒烟方面取得进展。在烟草控制方面取得更大成功是可能的，但需要有效、全面和充分实施和执行的政策，这反过来可能需要全球和国家层面的政治承诺，超越过去 25 年所取得的成就。比尔及梅琳达·盖茨基金会和彭博慈善基金会。
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. 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). 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. 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. Bill & Melinda Gates Foundation and Bloomberg Philanthropies.
影响因子：
3.7
作者：
Unal B;Critchley J;Capewell S
通讯作者：
Capewell S