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Tobacco use is one of the most important preventable causes of premature death in the world. Across the globe, more than 8.7 million people per year die from tobacco use. Most of those deaths (7.4 million) are attributed to direct tobacco use, while the remaining more than 1.3 million are attributed to exposure to secondhand tobacco smoke. Around 80% of these deaths happen in low- and middle-income countries. In terms of regional disparities, almost 60% of tobacco-attributable deaths occur in the South-East Asia and Western Pacific regions. Limiting tobacco use is undoubtedly one of the most effective ways to save lives and improve overall well-being.

Smoking tobacco causes exposure to a lethal mixture of more than 7,000 toxic chemicals, including at least 70 known carcinogens that can damage nearly every organ system in the human body. Harms from tobacco begin before birth, as pregnant females who smoke give birth to infants at higher risk of congenital disorders, cancer, lung diseases, low birth weight, and sudden death. Newly identified risks from smoking include worse outcomes from COVID-19 (e.g., increased hospitalizations and probability of death) and increased risk of periodontal disease and gastro-esophageal reflux disease. The risk of death and disability from tobacco use rises with the number of cigarettes smoked, but damage is detectable if a person has smoked as few as 100 cigarettes in their lifetime. A regular lifelong smoker loses at least 10 years of life to tobacco on average. In addition, exposure to secondhand or environmental tobacco smoke—very often among children—is associated with increased risk of cancer and heart disease, among other deleterious health effects.

Relative risk of mortality and morbidity among smokers from tobacco-related diseases, such as ischemic heart disease, increases with the number of cigarettes smoked per day. Notably, the largest effects are in young adult females, who are the newest prime target of tobacco industry marketing in many countries.

Deaths from heart disease and stroke, the two leading causes of death in the world, are heavily tied to tobacco use. Moreover, lung cancer has long been the leading cause of cancer death among men, and in many countries, it is now also the leading cause of cancer death among adult females, even outpacing breast cancer. Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death in the world, and mortality from this condition is increasing in most countries; globally, 65% of all deaths from COPD are attributed to tobacco use.

The number of years lost to disability caused by tobacco-attributable diseases is more than 25% of all years lost due to disability for adults between 45 and 79 years of age. Ischemic heart disease, COPD, and lung cancer account for more than half of years lost due to disability caused by tobacco-attributable diseases.

Combustible tobacco use (i.e., smoking) is extremely hazardous to human health and is responsible for more than 90% of tobacco-attributable death and disease, despite efforts by the tobacco industry to market safer-sounding alternatives such as low-tar cigarettes and waterpipes. Recently, tobacco companies have aggressively pushed supposedly reduced-harm, non-combustible tobacco products. There is limited evidence that some genuinely reduced-harm products (e.g., snus in Sweden) may exist, but the only way for an individual to completely eliminate tobacco-related harms is not to use tobacco products.

References

RR and Percentage of deaths and DALY’s attributable to tobacco use:

GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020, 396: 1223-49.

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