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.
