issue

死亡

吸烟引发的疾病造成了巨大的全球负担,每年因吸烟致死的人数超过 710 万。预计在未来几十年,一些医疗卫生资源有限的国家的疾病负担会持续增加。

Tobacco use increases the risk of death from many diseases, including ischemic heart disease, cancer, stroke, and respiratory diseases. In 2016 alone, tobacco use caused over 7.1 million deaths worldwide (5.1 million in men, 2.0 million in women). Most of these deaths (6.3 million) were attributable to cigarette smoking, followed by secondhand smoke (884,000 deaths).

There is a several-decade lag between changes in smoking prevalence and changes in smoking-related death rates in the population. In general, countries with a very high human development index (HDI) have seen a decline in smoking prevalence at least since the 1960s, followed by a decrease in smoking-related death rates since the 1980s–90s. Nevertheless, the burden of smoking-related diseases, notably lung cancer, is still substantial in those countries. Smoking-related death rates are expected to increase for the decades to come in many countries with a lower HDI, as they saw an increase in smoking prevalence more recently (the 1980s–90s or even later); in some, the prevalence is still increasing.

In about 55 countries, at least one-fifth of all deaths in males are attributable to smoking. These countries generally are high- or very high-HDI countries, mostly located in Europe (33 countries) or the Western Pacific region (11 countries), although there are two or more such countries in the other World Health Organization regions, except the African region. The lower tobacco-related burden in Sub-Saharan Africa reflects its historical lower smoking prevalence. However, with an increase in affordability of tobacco products and the tobacco industry’s aggressive marketing in Africa, smoking prevalence has already started to rise, or is likely to substantially increase in the future. With its rapidly-growing populations and rising life expectancy, an increase in the number of smokers along with population aging is likely to make Africa suffer the most from future smoking-related burden.

Consistent with lower female smoking prevalence in many countries, the tobacco-related burden in women is lower than in men globally. However, with recent increases in smoking prevalence among female adolescents in some countries, this pattern may not continue.

In addition to very high-HDI countries, with current trends, most other countries are or will soon be facing substantial smoking-related burden, while many already have limited health resources. Even in very high-HDI countries, smoking prevalence and the related burden are now far higher among lower-income groups, which are more likely to have limited access to care. This dynamic further underscores the need for effective tobacco control to improve health and reduce disparities at the population level in all countries.


男性和女性死亡数

2016 年,所有年龄段中男性和女性因烟草使用致死的百分比

美国肺癌死亡数

肺癌是癌症死亡的主要原因,在美国男性和女性中,肺癌死亡人数至少占所有癌症死亡人数的四分之一。

2017 年,美国男性和女性中五大癌症死亡原因致死人数估计值(占所有癌症死亡人数的百分比)

References

GBD 2016 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017 Sep 16;390(10100):1345-1422.

Islami F, Ward EM, Jacobs EJ, et al. Potentially preventable premature lung cancer deaths in the USA if overall population rates were reduced to those of educated whites in lower-risk states. Cancer Causes Control. 2015;26:409-418.

Islami F, Torre LA, Jemal A. Global trends of lung cancer mortality and smoking prevalence. Transl Lung Cancer Res. 2015;4:327-338.

Ng M, Freeman MK, Fleming TD, et al. Smoking prevalence and cigarette consumption in 187 countries, 1980-2012. JAMA. 2014;311:183-192.

Pikala M, Burzyn Ska M, Pikala R, Bryla M, Maniecka-Bryla I. Educational inequalities in premature mortality in Poland, 2002-2011: a population-based cross-sectional study. BMJ Open. 2016;6:e011501.

Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin 2017; 67(1): 7-30.