Despite declines in smoking rates, number of smokers and cigarettes rises

Globally, smoking prevalence—the percentage of the population that smokes every day—has decreased, but the number of cigarette smokers worldwide has increased due to population growth, according to new research from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

The study, "Smoking Prevalence and Cigarette Consumption in 187 , 1980-2012," was published January 8 in the Journal of the American Medical Association in a special issue devoted to .

Overall, age-standardized decreased by 42% for women and 25% for men between 1980 and 2012. Four countries—Canada, Iceland, Mexico and Norway—have reduced smoking by more than half in both men and women since 1980.

But substantial between 1980 and 2012 contributed to a 41% increase in the number of male daily smokers and a 7% increase for females. In 2012, smoking prevalence among men was higher than for women in all countries except Sweden. More than 50% of men smoke every day in several countries, including Russia, Indonesia, Armenia, and Timor Leste. Smoking prevalence for women was above 25% in Austria, Chile, and France and higher than 30% in Greece, among the highest percentages in the world. The lowest smoking rates for men can be found in Antigua and Barbuda, Sao Tome and Principe, and Nigeria. For women, smoking rates are lowest in Eritrea, Cameroon, and Morocco.

These differences persist despite decades of strong measures globally. Fifty years ago, the first US Surgeon General's report on the health impact of smoking led to groundbreaking research on tobacco and investments by governments and nonprofit agencies to reduce tobacco prevalence and cigarette consumption. In 2003, the Framework Convention on Tobacco Control (FCTC) was adopted by the World Health Assembly and has since been ratified by 177 countries.

"Despite the tremendous progress made on tobacco control, much more remains to be done," said IHME Director Dr. Christopher Murray. "We have the legal means to support tobacco control, and where we see progress being made we need to look for ways to accelerate that progress.

Where we see stagnation, we need to find out what's going wrong." According to the most recent figures from the Global Burden of Disease (GBD) study, coordinated by IHME, tobacco led to 5.7 million deaths, 6.9% of years of life lost, and 5.5% of total health loss around the world. These estimates exclude the health effects from secondhand smoke.

IHME arrived at its estimates based on a wide range of data sources, including in-country surveys, government statistics, and World Health Organization data, and the estimates cover all ages. Previous estimates typically have been focused on fewer data sources and a more limited age range.

The greatest health risks for both men and women are likely to occur in countries where smoking is pervasive and where smokers consume a large quantity of cigarettes. These countries include China, Ireland, Italy, Japan, Kuwait, Korea, the Philippines, Uruguay, Switzerland, and several countries in Eastern Europe. The number of cigarettes smoked around the world has grown to more than 6 trillion. In 75 countries, smokers consumed an average of more than 20 cigarettes per day in 2012.

"Tobacco control is particularly urgent in countries where the number of smokers is increasing," said Alan Lopez, Laureate Professor at the University of Melbourne. "Since we know that half of all smokers will eventually be killed by tobacco, greater numbers of smokers will mean a massive increase in premature deaths in our lifetime."

There have been three phases of global progress in reducing the age-standardized prevalence of smokers: modest progress from 1980 to 1996, followed by a decade of more rapid global progress, then a slowdown in reductions from 2006 to 2012. This was in part due to increases in the number of smokers since 2006 in several large countries, including Bangladesh, China, Indonesia, and Russia.

Annualized rate of change captures the relative reduction in smoking prevalence, and several countries had notable declines of 2% or more between 1980 and 2012. For men, annualized rates of decline of 2% or more occurred in 17 countries, with the greatest rates of decline observed in Canada, Iceland, Mexico, Norway, and Sweden. For women, annualized rates of decline greater than 2% were achieved in 22 countries. Bolivia, Canada, Denmark, Iceland, Israel, Norway, Sweden, and the United States all had prevalence rates in 1980 higher than 20% but achieved annualized rates of decline of greater than 2%. In a disturbing trend, Austria, Bulgaria, and Greece all had prevalence rates greater than 20% in 1980 and have shown statistically significant increases since then.

"Change in tobacco prevalence typically has been slow, underscoring what a hard habit it is to break," said Emmanuela Gakidou, Professor of Global Health and Director of Education and Training at IHME. "But we know from these global trends that rapid progress is possible. If more countries were able to repeat the success we have seen in Norway, Mexico, and the United States, we would see much less health loss from smoking."

Which countries had the highest and lowest smoking prevalence for men in 2012?

Highest:

Timor-Leste 61.1%
Indonesia 57%
Kiribati 54.4%
Armenia 51.7%
Papua New Guinea 51.4%
Laos 51.3%
Russia 51%
Cyprus 48%
Macedonia 46.5%
Tonga 46.4%

Lowest:

Antigua and Barbuda 5%
Sao Tome and Principe 7%
Nigeria 7.5%
Ethiopia 7.7%
Ghana 8.2%
Sudan 8.2%
Dominica 8.4%
Niger 8.8%
Suriname 9.8%
Ecuador 10.3%

Which countries had the highest and lowest smoking prevalence for women in 2012?

Highest:

Greece 34.7%
Bulgaria 31.5%
Kiribati 31.3%
Austria 28.3%
France 27.7%
Macedonia 26.7%
Belgium 26.1%
Chile 26%
Hungary 25.8%
Andorra 25.2%

Lowest:

Eritrea 0.6%
Cameroon 0.6%
Morocco 0.7%
Gambia 0.8%
Libya 0.9%
Oman 0.9%
Algeria 0.9%
Azerbaijan 0.9%
Ethiopia 1.0%
Sudan 1.0%

Which countries where smoking prevalence was greater than 20% in 1980 had the fastest declines and the biggest annual increases between 1980 and 2012?

Decreases:

Iceland -3.0%
Mexico -3.0%
Canada -3.0%
Sweden -2.4%
Norway -2.4%
Denmark -2.3%
United States -2.1%
New Zealand -1.9%
Australia -1.9%
United Kingdom -1.8%

Increases:

Lithuania 0.8%
Serbia 0.6%
Bulgaria 0.5%
Croatia 0.5%
Austria 0.5%
Tunisia 0.4%
Mongolia 0.3%
Latvia 0.2%
Portugal 0.1%
Macedonia 0.1%

In terms of number of cigarettes, which countries with populations greater than 1 million had the highest and lowest average consumption per smoker per day in 2012?

Highest:

Mauritania 41
Eritrea 38
Rwanda 36
Moldova 36
Swaziland 35
Saudi Arabia 35
Oman 33
Taiwan 32
Panama 30
Yemen 30 Benin 4

Lowest:

Chad 1
Burkina Faso 1
Guinea 1
Uganda 2
Bangladesh 3
Bolivia 3
Tajikistan 3
Peru 4
Sierra Leone 4

"Globally, there has been significant progress in combating the deadly toll of tobacco use, especially since adoption of the WHO Framework Convention on Tobacco Control, " said Matthew L. Myers, President of the Campaign for Tobacco-Free Kids. "These findings demonstrate both that where countries take strong action, tobacco use can be dramatically reduced and the devastating consequences when countries do not fully adopt and implement effective tobacco control measures."

More information: doi:10.1001/jama.2013.284692

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