The Global Burden of Tobacco Use: A Review of Methods and Recent Estimates
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The Global Burden of Tobacco Use: A Review of Methods and Recent Estimates Gauri Khanna & Gretchen Stevens
Published online: 3 December 2010 # Springer Science+Business Media, LLC 2010
Abstract Tobacco use is a risk factor for cardiovascular, cancer, and respiratory mortality. To determine deaths attributable to tobacco, the smoking impact ratio (SIR) method is used, which measures the accumulated hazards of smoking by calculating the excess lung cancer mortality in a population, compared to lung cancer mortality in a non-smoking population. This is done to account for cross-population differences in smoking intensity and duration. Studies using SIR have also generally used relative risks of smoking-related diseases derived from the American Cancer Society’s Cancer Prevention Study to estimate the proportion of the disease attributable to tobacco use. The SIR method, while important for populations lacking high-quality epidemiological studies of the hazards of tobacco use, is still an imperfect method. Recent studies in countries such as India, China, and South Africa have estimated population-specific relative risks from reported tobacco use. Keywords Smoking . Lung cancer . Mortality . Risk factors
G. Khanna (*) Tobacco Free Initiative, World Health Organization, Avenue Appia 20, 1211, Geneva 27, Switzerland e-mail: [email protected] G. Stevens Information, Evidence and Research, World Health Organization, Avenue Appia 20, 1211, Geneva 27, Switzerland e-mail: [email protected]
Introduction The risks to health from smoking have been extensively studied, and the causality between smoking and mortality, both all-cause and cause-specific, has been established. An assessment of the burden of disease from exposure to tobacco, preferably in conjunction with other risks to health, is an important tool in determining public health priorities and planning health policy. Although the danger of tobacco use is commonly accepted in the scientific community today, it was not until the 1950s that the dangers of smoking for health were established. In a seminal article written by Doll and Hill in 1954 [1], the authors reported the first wave of results from their prospective study in British male doctors on the causal effects of smoking on lung cancer. Preliminary results showed increased mortality from lung cancer as the amount of tobacco smoked increased. This prospective study has continued for 50 years since it began in 1951 and research based on it (4 years, 10 years, 20 years, and 40 years) has continued to demonstrate the association of smoking with mortality from different diseases. In the latest round of results from this study (50 years), Doll et al. [2] found that smoking was responsible for more than half of all lung cancer deaths in smokers in the United Kingdom, and that death from lung cancer accounted for about half of overall mortality in smokers. A few years after the British male doctors study began, the Report of the US Surgeon General in 1964 [3] highlighted the increased mortality in smokers over nonsmokers.
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