Elsevier

The Lancet

Volume 385, Issue 9972, 14–20 March 2015, Pages 966-976
The Lancet

Articles
Global trends and projections for tobacco use, 1990–2025: an analysis of smoking indicators from the WHO Comprehensive Information Systems for Tobacco Control

https://doi.org/10.1016/S0140-6736(15)60264-1Get rights and content

Summary

Background

Countries have agreed on reduction targets for tobacco smoking stipulated in the WHO global monitoring framework, for achievement by 2025. In an analysis of data for tobacco smoking prevalence from nationally representative survey data, we aimed to provide comprehensive estimates of recent trends in tobacco smoking, projections for future tobacco smoking, and country-level estimates of probabilities of achieving tobacco smoking targets.

Methods

We used a Bayesian hierarchical meta-regression modelling approach using data from the WHO Comprehensive Information Systems for Tobacco Control to assess trends from 1990 to 2010 and made projections up to 2025 for current tobacco smoking, daily tobacco smoking, current cigarette smoking, and daily cigarette smoking for 173 countries for men and 178 countries for women. Modelling was implemented in Python with DisMod-MR and PyMC. We estimated trends in country-specific prevalence of tobacco use, projections for future tobacco use, and probabilities for decreased tobacco use, increased tobacco use, and achievement of targets for tobacco control from posterior distributions.

Findings

During the most recent decade (2000–10), the prevalence of tobacco smoking in men fell in 125 (72%) countries, and in women fell in 155 (87%) countries. If these trends continue, only 37 (21%) countries are on track to achieve their targets for men and 88 (49%) are on track for women, and there would be an estimated 1·1 billion current tobacco smokers (95% credible interval 700 million to 1·6 billion) in 2025. Rapid increases are predicted in Africa for men and in the eastern Mediterranean for both men and women, suggesting the need for enhanced measures for tobacco control in these regions.

Interpretation

Our findings show that striking between-country disparities in tobacco use would persist in 2025, with many countries not on track to achieve tobacco control targets and several low-income and middle-income countries at risk of worsening tobacco epidemics if these trends remain unchanged. Immediate, effective, and sustained action is necessary to attain and maintain desirable trajectories for tobacco control and achieve global convergence towards elimination of tobacco use.

Funding

Ministry of Health, Labour and Welfare, Japan; Ministry of Education, Culture, Sports and Technology, Japan; Department of Health, Australia; Bloomberg Philanthropies.

Introduction

Tobacco control is a global health priority. The WHO Framework Convention on Tobacco Control, which entered into force in 2005, formalised global commitment,1 and so far has been ratified by 180 parties.2 However, country-specific progress varies substantially, with very high prevalence of smoking among both men and women in many countries.3 WHO estimates that about 6 million people worldwide die each year from causes attributed to smoking, with most of these deaths occurring in low-income and middle-income countries.4 The 2011 UN political declaration on non-communicable diseases provided additional impetus both for urgent and sustained control of tobacco use and for preventive action against other risk factors for non-communicable diseases.5 In 2013, the World Health Assembly endorsed the WHO global monitoring framework for non-communicable diseases and an associated voluntary global target of a 30% relative reduction in tobacco use worldwide among people aged 15 years or older by 2025 (with 2010 levels as baseline). This target was officially agreed on by WHO member states on the basis of experience from countries that had successfully implemented at the highest level of achievement at least three of the demand reduction measures outlined in the WHO Framework Convention, and will account for varying initial starting points for tobacco control in assessment of national progress.6 This target was endorsed at the Sixth Meeting of the Convention of Parties in Moscow in October, 2014.7 Monitoring of progress towards these targets will be of enormous benefit to individual countries because it will assist them in taking necessary corrections or new actions to reduce consumption of tobacco products.

Although some country-specific estimates of prevalence and trends in tobacco smoking are available, a comprehensive and consistent set of estimates—combining historical trends and the most up-to-date data with projections of the future burden of tobacco use—is needed for as many countries as possible. The WHO Reports on the Global Tobacco Epidemic regularly provide specific-year estimates for smoking prevalence, but do not provide changes over time or levels of uncertainty around estimates.3 The Institute for Health Metrics and Evaluation recently estimated prevalence trends from 1980 to 2012, but only for one measure, daily smoking.8 Neither of these studies projected trends in smoking prevalence nor assessed target achievement.3, 8

The tobacco epidemic proceeds through distinct stages,9 which can be affected by policy interventions;10 because many countries with mature tobacco epidemics have now implemented extensive control policies under the 2003 Framework Convention,3 trends from the past 10 years can serve as a useful guide for future strategies. Synthesis of existing trend data by region and country, with projections, can provide a useful instrument to assist development for tobacco control. We aimed to provide a comprehensive and consistent set of trend estimates for four tobacco use indicators from 2000 to 2010, and projections to 2025, with target achievement probabilities under the WHO global monitoring framework, using the most comprehensive and up-to-date nationally representative data available.

Section snippets

Study design and data sources

We did a systematic assessment of trends for four tobacco smoking indicators—current tobacco smoking, daily tobacco smoking, current cigarette smoking, and daily cigarette smoking—for 178 countries from 1990 to 2014 with baseline projections to 2025. The four indicators we modelled represent important characteristics of frequency and product type, and are intended to capture the full diversity of tobacco smoking for which data are available. We report estimates for prevalence and trends in

Results

We generated estimates about current tobacco smoking for 173 countries for men and 178 countries for women. The appendix contains country-specific estimates of prevalence in 2010 and 2025; relative percentage changes and posterior probabilities of reduction, increase, and target achievement; and prevalence quintiles in 2010 and 2025 by WHO region and income categories. Figure 1 shows maps of predicted prevalence quintiles in 2025. The first quintile represents countries with the lowest

Discussion

This analysis of nationally representative survey data provides a comprehensive set of comparable and consistent estimates and projections for four tobacco use indicators and target achievement probabilities under the global monitoring framework for non-communicable diseases; the use of the most up-to-date data and a comprehensive modelling process enabled information from multiple indicators to be used directly in a single flexible model (panel). We estimated trends in prevalence of tobacco

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