Send to

Choose Destination
Lancet. 2017 May 13;389(10082):1885-1906. doi: 10.1016/S0140-6736(17)30819-X. Epub 2017 Apr 5.

Smoking prevalence and attributable disease burden in 195 countries and territories, 1990-2015: a systematic analysis from the Global Burden of Disease Study 2015.

Collaborators (233)

Reitsma MB, Fullman N, Ng M, Salama JS, Abajobir A, Abate KH, Abbafati C, Abera SF, Abraham B, Abyu GY, Adebiyi AO, Al-Aly Z, Aleman AV, Ali R, Al Alkerwi A, Allebeck P, Al-Raddadi RM, Amare AT, Amberbir A, Ammar W, Amrock SM, Antonio CAT, Asayesh H, Atnafu NT, Azzopardi P, Banerjee A, Barac A, Barrientos-Gutierrez T, Basto-Abreu AC, Bazargan-Hejazi S, Bedi N, Bell B, Bello AK, Bensenor IM, Beyene AS, Bhala N, Biryukov S, Bolt K, Brenner H, Butt Z, Cavalleri F, Cercy K, Chen H, Christopher DJ, Ciobanu LG, Colistro V, Colomar M, Cornaby L, Dai X, Damtew SA, Dandona L, Dandona R, Dansereau E, Davletov K, Dayama A, Degfie TT, Deribew A, Dharmaratne SD, Dimtsu BD, Doyle KE, Endries AY, Ermakov SP, Estep K, Faraon EJA, Farzadfar F, Feigin VL, Feigl AB, Fischer F, Friedman J, G/Hiwot TT, Gall SL, Gao W, Gillum RF, Gold AL, Gopalani SV, Gotay CC, Gupta R, Gupta R, Gupta V, Hamadeh RR, Hankey G, Harb HL, Hay SI, Horino M, Horita N, Hosgood HD, Husseini A, Ileanu BV, Islami F, Jiang G, Jiang Y, Jonas JB, Kabir Z, Kamal R, Kasaeian A, Kesavachandran CN, Khader YS, Khalil I, Khang YH, Khera S, Khubchandani J, Kim D, Kim YJ, Kimokoti RW, Kinfu Y, Knibbs LD, Kokubo Y, Kolte D, Kopec J, Kosen S, Kotsakis GA, Koul PA, Koyanagi A, Krohn KJ, Krueger H, Defo BK, Bicer BK, Kulkarni C, Kumar GA, Leasher JL, Lee A, Leinsalu M, Li T, Linn S, Liu P, Liu S, Lo LT, Lopez AD, Ma S, El Razek HMA, Majeed A, Malekzadeh R, Malta DC, Manamo WA, Martinez-Raga J, Mekonnen AB, Mendoza W, Miller TR, Mohammad KA, Morawska L, Musa KI, Nagel G, Neupane SP, Nguyen Q, Nguyen G, Oh IH, Oyekale AS, Pa M, Pana A, Park EK, Patil ST, Patton GC, Pedro J, Qorbani M, Rafay A, Rahman M, Rai RK, Ram U, Ranabhat CL, Refaat AH, Reinig N, Roba HS, Rodriguez A, Roman Y, Roth G, Roy A, Sagar R, Salomon JA, Sanabria J, de Souza Santos I, Sartorius B, Satpathy M, Sawhney M, Sawyer S, Saylan M, Schaub MP, Schluger N, Schutte AE, Sepanlou SG, Serdar B, Shaikh MA, She J, Shin MJ, Shiri R, Shishani K, Shiue I, Sigfusdottir ID, Silverberg JI, Singh J, Singh V, Slepak EL, Soneji S, Soriano JB, Soshnikov S, Sreeramareddy CT, Stein DJ, Stranges S, Subart ML, Swaminathan S, Szoeke CEI, Tefera WM, Topor-Madry R, Tran B, Tsilimparis N, Tymeson H, Ukwaja KN, Updike R, Uthman OA, Violante FS, Vladimirov SK, Vlassov V, Vollset SE, Vos T, Weiderpass E, Wen CP, Werdecker A, Wilson S, Wubshet M, Xiao L, Yakob B, Yano Y, Ye P, Yonemoto N, Yoon SJ, Younis MZ, Yu C, Zaidi Z, El Sayed Zaki M, Zhang AL, Zipkin B, Murray CJL, Forouzanfar MH, Gakidou E.

Erratum in



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.

[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Elsevier Science Icon for PubMed Central
Loading ...
Support Center