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. 2024 Oct;9(10):e729-e744.
doi: 10.1016/S2468-2667(24)00166-X.

Forecasting the effects of smoking prevalence scenarios on years of life lost and life expectancy from 2022 to 2050: a systematic analysis for the Global Burden of Disease Study 2021

Collaborators, Affiliations

Forecasting the effects of smoking prevalence scenarios on years of life lost and life expectancy from 2022 to 2050: a systematic analysis for the Global Burden of Disease Study 2021

GBD 2021 Tobacco Forecasting Collaborators. Lancet Public Health. 2024 Oct.

Abstract

Background: Smoking is the leading behavioural risk factor for mortality globally, accounting for more than 175 million deaths and nearly 4·30 billion years of life lost (YLLs) from 1990 to 2021. The pace of decline in smoking prevalence has slowed in recent years for many countries, and although strategies have recently been proposed to achieve tobacco-free generations, none have been implemented to date. Assessing what could happen if current trends in smoking prevalence persist, and what could happen if additional smoking prevalence reductions occur, is important for communicating the effect of potential smoking policies.

Methods: In this analysis, we use the Institute for Health Metrics and Evaluation's Future Health Scenarios platform to forecast the effects of three smoking prevalence scenarios on all-cause and cause-specific YLLs and life expectancy at birth until 2050. YLLs were computed for each scenario using the Global Burden of Disease Study 2021 reference life table and forecasts of cause-specific mortality under each scenario. The reference scenario forecasts what could occur if past smoking prevalence and other risk factor trends continue, the Tobacco Smoking Elimination as of 2023 (Elimination-2023) scenario quantifies the maximum potential future health benefits from assuming zero percent smoking prevalence from 2023 onwards, whereas the Tobacco Smoking Elimination by 2050 (Elimination-2050) scenario provides estimates for countries considering policies to steadily reduce smoking prevalence to 5%. Together, these scenarios underscore the magnitude of health benefits that could be reached by 2050 if countries take decisive action to eliminate smoking. The 95% uncertainty interval (UI) of estimates is based on the 2·5th and 97·5th percentile of draws that were carried through the multistage computational framework.

Findings: Global age-standardised smoking prevalence was estimated to be 28·5% (95% UI 27·9-29·1) among males and 5·96% (5·76-6·21) among females in 2022. In the reference scenario, smoking prevalence declined by 25·9% (25·2-26·6) among males, and 30·0% (26·1-32·1) among females from 2022 to 2050. Under this scenario, we forecast a cumulative 29·3 billion (95% UI 26·8-32·4) overall YLLs among males and 22·2 billion (20·1-24·6) YLLs among females over this period. Life expectancy at birth under this scenario would increase from 73·6 years (95% UI 72·8-74·4) in 2022 to 78·3 years (75·9-80·3) in 2050. Under our Elimination-2023 scenario, we forecast 2·04 billion (95% UI 1·90-2·21) fewer cumulative YLLs by 2050 compared with the reference scenario, and life expectancy at birth would increase to 77·6 years (95% UI 75·1-79·6) among males and 81·0 years (78·5-83·1) among females. Under our Elimination-2050 scenario, we forecast 735 million (675-808) and 141 million (131-154) cumulative YLLs would be avoided among males and females, respectively. Life expectancy in 2050 would increase to 77·1 years (95% UI 74·6-79·0) among males and 80·8 years (78·3-82·9) among females.

Interpretation: Existing tobacco policies must be maintained if smoking prevalence is to continue to decline as forecast by the reference scenario. In addition, substantial smoking-attributable burden can be avoided by accelerating the pace of smoking elimination. Implementation of new tobacco control policies are crucial in avoiding additional smoking-attributable burden in the coming decades and to ensure that the gains won over the past three decades are not lost.

Funding: Bloomberg Philanthropies and the Bill & Melinda Gates Foundation.

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Conflict of interest statement

Declaration of interests S Afzal reports support for the present manuscript from HEC Digital Library Pakistan. S Afzal reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from King Edward Medical University and collaborative partners including University of Johns Hopkins, University of California, and University of Massachusetts; participation on a Data Safety Monitoring Board or Advisory Board with National Bioethics Committee Pakistan, King Edward Medical University Institutional Ethical Review Board, and Ethical Review Board Fatima Jinnah Medical University and Sir Ganga Ram Hospital; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid, with Pakistan Association of Medical Editors, Faculty of Public Health Royal Colleges UK (FFPH) as a fellow, Society of Prevention, Advocacy And Research, King Edward Medical University (SPARK), and Pakistan Society of Infectious Diseases as a member; and other financial or non-financial interests from Public Health and Preventive Medicine at King Edward Medical University as Dean, Annals of King Edward Medical University as Chief Editor, Quality Enhancement Cell at King Edward Medical University as director, Research and Publications Higher Education Commission Pakistan as a member; all outside the submitted work. A Biswas reports consulting fees from Lupin Pharmaceuticals, India, Alkem Laboratories. India, Intas Pharmaceuticals, India, Eisai Pharmaceuticals, India, and Torrent Pharmaceuticals, India, all outside the submitted work. R Bai reports support for the present manuscript from the Social Science Fund of Jiangsu Province (grant number 21GLD008) and the Fundamental Research Funds for the Central Universities (grant number 30923011101). M L Bell reports grants or contracts paid to their institution from US Environmental Protection Agency, National Institutes of Health (NIH; USA), High Tide Foundation, Health Effects Institute, Yale Women Faculty Forum, Environmental Defense Fund, Wellcome Trust Foundation, Yale Climate Change and Health Center, Robert Wood Johnson Foundation, and Hutchinson Postdoctoral Fellowship; consulting fees from Clinique, ToxiMap, and SciQuest; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Colorado School of Public Health, Duke University, University of Texas, Data4Justice, Korea University, Organization of Teratology Information Specialists, University of Pennsylvania, Boston University, IOP Publishing, NIH, Health Canada, EHS, PAC-10, UK Research and Innovation, AXA Research Fund Fellowship, Harvard University, University of Montana, and SciQuest; support for attending meetings and/or travel from Colorado School of Public Health, University of Texas, Duke University, Boston University, University of Pennsylvania, Harvard University, American Journal of Public Health, Columbia University, Community Modeling and Analysis System (CMAS) conference, Nature conference; leadership or fiduciary roles in other board, society, committee or advocacy groups, unpaid, from Fifth National Climate Assessment, Lancet Countdown, Johns Hopkins EHE Advisory Board, Harvard external advisory committee (for training grant), WHO Global Air Pollution and Health Technical Advisory group, National Academies Panels and Committees, and from US EPA Clean Air Scientific Advisory Committee (CASAC; paid); all outside the submitted work. L Belo reports other financial or non-financial support from FCT in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of UCIBIO and the project LA/P/0140/2020 of i4HB; outside the submitted work. S Bhaskar reports grants or contracts from Japan Society for the Promotion of Science (JSPS) and Japanese Ministry of Education, Culture, Sports, Science and Technology (MEXT) for a grant-in-aid for Scientific Research (KAKENHI; P23712), and from JSPS and the Australian Academy of Science for a JSPS International Fellowship (P23712); leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with Rotary District 9675, Sydney, Australia (District Chair, Diversity, Equity & Inclusion), Global Health & Migration Hub Community, Global Health Hub Germany, Berlin, Germany (Chair, Founding Member and Manager), PLoS One, BMC Neurology, Frontiers in Neurology, Frontiers in Stroke, Frontiers in Public Health, Journal of Aging Research & BMC Medical Research Methodology (Editorial Board Member), College of Reviewers, Canadian Institutes of Health Research (CIHR), Government of Canada (Member), World Headache Society, Bengaluru, India (Director of Research), Cariplo Foundation, Milan, Italy (Expert Adviser/Reviewer), National Cerebral and Cardiovascular Center, Department of Neurology, Suita, Osaka, Japan (Visiting Director), and Cardiff University Biobank, Cardiff, UK (Member, Scientific Review Committee); all outside the submitted work. E J Boyko reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Korean Diabetes Association, International Society for the Diabetic Foot, Diabetes Association of the R.O.C. (Taiwan), American Diabetes Association; support for attending meetings and/or travel from Korean Diabetes Association, Diabetes Association of the R.O.C. (Taiwan), International Society for the Diabetic Foot; all outside the submitted work. J Conde reports grants or contracts from European Research Council Starting Grant (ERC-StG-2019-848325. Funding €1.5M); patents planned, issued or pending Surfactant-Based Hydrogel, Methods and Uses Thereof with Universidade Nova de Lisboa; all outside the submitted work. G F Gil reports grants or contracts from Bill & Melinda Gates Foundation through role as researcher on the GEM team at Institute for Health Metrics and Evaluation (IHME); support for attending meetings and/or travel from University of Washington (Graduate and Professional Student Senate) paid through IHME; all outside the submitted work. A Guha reports grants or contracts from American Heart Association and Department of Defense (USA); consulting fees with Pfizer and Novartis; leadership or fiduciary roles in other board, society, committee or advocacy groups, paid or unpaid with ZERO Prostate Cancer (health equity task force); all outside the submitted work. A Hassan reports consulting fees from Novartis, Sanofi Genzyme, Biologix, Merck, Hikma Pharmaceuticals, Janssen, Inspire Pharma, Future Pharma, Elixir Pharma; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Novartis, Allergan, Merck, Biologix, Janssen, Roche, Sanofi Genzyme, Bayer, Hikma Pharmaceuticals, Al Andalus, Chemipharm, Lundbeck, Inspire Pharma, Future Pharma and Habib Scientific Office, and EVER Pharma; support for attending meetings and/or travel from Novartis, Allergan, Merck, Biologix, Roche, Sanofi Genzyme, Bayer, Hikma Pharmaceuticals, Chemipharm, and Al Andalus and Clavita Pharm; leadership or fiduciary roles in other board, society, committee or advocacy groups, paid or unpaid with the Egyptian Society of Neurology (board member of headache chapter), and International Headache Society (committee of education member, regional committee member); all outside the submitted work. C Herteliu reports grants or contracts from Romanian Ministry of Research, Innovation and Digitalization through UEFISCDI (Project “Analysis of the impact of Covid-19 on the main demographic indicators in Romania and the Republic of Moldova by using econometric modeling” code PN-IV-P8-8.3-ROMD-2023-0208), European Commision Horizon 4P-CAN (Personalised Cancer Primary Prevention Research through Citizen Participation and Digitally Enabled Social Innovation), European Union – NextgenerationEU and Romanian Government, under National Recovery and Resilience Plan for Romania (Project “Societal and Economic Resilience within multi-hazards environment in Romania,” contract number 760050/ 23.05.2023, cod PNRR-C9-I8-CF 267/ 29.11.2022, through the Romanian Ministry of Research, Innovation and Digitalization, within Component 9, Investment I8)(Project “A better understanding of socio-economic systems using quantitative methods from Physics,” contract number 760034/ 23.05.2023, cod PNRR-C9-I8-CF 255/ 29.11.2022, through the Romanian Ministry of Research, Innovation and Digitalization, within Component 9, Investment I8); all outside the submitted work. I M Ilic reports support for the present manuscript from Ministry of Education, Science and Technological development, Republic of Serbia (project No 175042, 2011-2023). M D Ilic reports support for the present manuscript from Ministry of Science, Technological Development and Innovation of the Republic of Serbia (number 451-03-47/2023-01/200111). T Joo reports support for the present manuscript from National Research, Development and Innovation Office in Hungary (RRF-2.3.1-21-2022-00006), Data-Driven Health Division of National Laboratory for Health Security. J Jozwiak reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Novartis, Adamed, and Amgen outside the submitted work. S V Katikireddi reports support for the present manuscript, paid to their institution, from Medical Research Council (MC_UU_00022/2), Scottish Government Chief Scientist Office (SPHSU17), and European Research Council (949582). K Krishan reports non-financial support from the UGC Centre of Advanced Study, CAS II, awarded to the Department of Anthropology, Panjab University, Chandigarh, India, outside the submitted work. J L Leasher reports leadership or fiduciary roles in other board, society, committee or advocacy groups, unpaid, with Member Planning Group for National Eye Health Education Program, National Eye Institute, USA outside the submitted work. H R Marateb reports grants or contracts paid to their institution, Universitat Politècnica de Catalunya–Barcelona Tech (UPC), from The Beatriu de Pinós post-doctoral programme from the Office of the Secretary of Universities and Research from the Ministry of Business and Knowledge of the Government of Catalonia (programme: 2020 BP 00261) outside the submitted work. E Mathews reports grants and contracts from the DBT India Alliance/Wellcome Trust (Clinical and Public Health Early Career Fellowship, grant number IA/CPHE/17/1/503345) outside the submitted work. S A Meo reports grants or contracts from Researchers Supporting Project, King Saud University, Riyadh, Saudi Arabia (RSP-2024 R47) outside the submitted work. R S Moreira reports grants or contracts from the National Council for Scientific and Technological Development (CNPq) for a CNPq Research Productivity Scholarship (scholarship registration number: 316607/2021-5) outside the submitted work. S Nomura reports support for the present manuscript from the Ministry of Education, Culture, Sports, Science and Technology of Japan (24H00663) and from the Japan Science and Technology Agency for Precursory Research for Embryonic Science and Technology (JPMJPR22R8). O O Odukoya reports grants or contracts from the Northwestern/Nigeria Research Training Program in HIV and Malignancies (NN-HAM; 2D43TW009575-11) outside the submitted work. A P Okekunle reports support for the present manuscript from the National Research Foundation of Korea funded by the Ministry of Science and ICT (2020H1D3A1A04081265). A P Okekunle reports support for attending meetings and/or travel from National Research Foundation of Korea funded by the Ministry of Science and ICT (2020H1D3A1A04081265) outside the submitted work. R F Palma-Alvarez reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Angelini, Casen-Recordati, Exeltis, Lundbeck, Takeda, and Neuraxpharm outside the submitted work. R Passera reports participation on a Data Safety Monitoring Board or Advisory Board (unpaid) for “Consolidation with ADCT-402 (loncastuximab tesirine) after immunochemotherapy: a phase II study in BTKi-treated/ineligible Relapse/Refractory Mantle Cell Lymphoma (MCL) patients” with Fondazione Italiana Linfomi (FIL), Alessandria; leadership or fiduciary roles in other board, society, committee or advocacy groups (unpaid) as Member of the EBMT Statistical Committee, European Society for Blood and Marrow Transplantation, Paris (FRANCE) and past member 2020-2023 (biostatistician) of the IRB/IEC Comitato Etico AO SS. Antonio e Biagio Alessandria-ASL AL-VC (ITALY); all outside the submitted work. Y L Samodra reports grants or contracts from Taipei Medical University; leadership or fiduciary roles in other board, society, committee or advocacy groups, paid or unpaid, with Benang Merah Research Center, Indonesia as co-founder; all outside the submitted work. J Sanabria reports support for attending meetings and/or travel from the University Medical School for Continuing Medical Education (CME); three patents granted and two pending, no royalties; all outside the submitted work. B M Schaarschmidt reports grants or contracts from Else Kröner-Fresenius Foundation, Deutsche Forschungsgemeinschaft, and PharmaCept GmbH; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from AstraZeneca; support for travel from Bayer; all outside the submitted work. V Sharma reports other financial or non-financial support from DFSS (MHA)'s research project (DFSS28(1)2019/EMR/6) at Institute of Forensic Science & Criminology, Panjab University, Chandigarh, India, outside the submitted work. V Shivarov reports stock or stock options from ICON; other financial or non-financial interests CON/PRAHS via a salary; all outside the submitted work. S Shrestha reports other financial or non-financial support from the School of Pharmacy, Monash University Malaysia via the Graduate Research Merit Scholarship outside the submitted work. J P Silva reports support for the present manuscript from the Portuguese Foundation for Science and Technology via payment of a salary (contract with reference 2021.01789.CEECIND/CP1662/CT0014). J A Singh reports consulting fees from ROMTech, Atheneum, Clearview Healthcare Partners, American College of Rheumatology, Yale University, Hulio, Horizon Pharmaceuticals, DINORA, ANI/Exeltis, USA, Frictionless Solutions, Schipher, Crealta/Horizon, Medisys, Fidia, PK Med, Two Labs, Adept Field Solutions, Clinical Care Options, Putnam Associates, Focus Forward, Navigant Consulting, Spherix, MedIQ, Jupiter Life Science, UBM LLC, Trio Health, Medscape, WebMD, Practice Point Communications, and the National Institutes of Health (USA); payment or honoraria for speakers bureaus from Simply Speaking; past support for attending meetings and/or travel from OMERACT as a steering committee member; participation on a Data Safety Monitoring Board or Advisory Board (unpaid) with the Food and Drug Administration (USA) Arthritis Advisory Committee; leadership or fiduciary roles in other board, society, committee or advocacy groups with OMERACT as past steering committee member (paid), the Veterans Affairs Rheumatology Field Advisory Committee as Chair (unpaid), and the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis as Editor and Director (unpaid); stock or stock options in Atai Life Sciences, Kintara Therapeutics, Intelligent Biosolutions, Acumen Pharmaceutical, TPT Global Tech, Vaxart Pharmaceuticals, Atyu Biopharma, Adaptimmune Therapeutics, GeoVax Labs, Pieris Pharmaceuticals, Enzolytics, Seres Therapeutics, Tonix Pharmaceuticals Holding Corp., Aebona Pharmaceuticals, Charlotte's Web Holdings, and previously owned stock options in Amarin, Viking, and Moderna Pharmaceuticals; all outside the submitted work. M Solmi reports payment or honoraria for advisory boards or educational events from AbbVie, Lundbeck, and Otsuka, outside the submitted work. D J Stein reports personal fees from Discovery Vitality, Johnson & Johnson, Kanna, L’Oreal, Lundbeck, Orion, Sanofi, Servier, Takeda and Vistagen, outside the submitted work. J H V Ticoalu reports leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with Benang Merah Research Center, Indonesia as co-founder, outside the submitted work. P Willeit reports consulting fees from Novartis Pharmaceuticals, outside the submitted work. M Zielińska reports other financial or non-financial support as an AstraZeneca employee, outside the submitted work.

Figures

Figure 1
Figure 1
Annual change in global smoking (A) Changes in current and former smoking prevalence over time, age standardised. (B) Number of current and former smokers over time for all ages. Estimates for 1990–2019 were obtained from GBD 2021 for (A) and (B). The solid lines in (A) and (B) indicate the mean estimate, whereas the shaded areas reflect the 95% uncertainty interval. (C) Decomposition of forecasted change in number of smokers from 2023 to 2050 due to population ageing, population growth, and changes in the prevalence rate among current and former smokers. The grey dashed vertical line in (A) and (B) indicates 2022 (the first forecast year). The black dots in (C) indicate the overall percentage change in the number of smokers from 2023 to 2050.
Figure 2
Figure 2
Global YLLs by scenario, all causes The solid lines indicate the mean estimates of the number of all-age YLLs (A) and the rate of age-standardised YLLs (B). The shaded area reflects the 95% uncertainty interval for the past and reference scenario. Estimates for 1990–2021 were obtained from GBD 2021. The grey dashed vertical line indicates 2022 (the first forecast year). YLLs=years of life lost.
Figure 3
Figure 3
Global YLLs by GBD Level 2 causes of death under the reference scenario, Elimination-2050 scenario, and Elimination-2023 scenario (A) Difference in number of YLLs compared with the reference scenario. (B) Difference in rate of age-standardised YLLs compared with the reference scenario. Negative net differences in (A) and (B) indicate causes from which YLLs would be avoided under each custom scenario, whereas net positive differences indicate causes from which additional YLLs would occur. YLLs=years of life lost.
Figure 4
Figure 4
Difference in cumulative age-standardised rate of YLLs compared with the reference scenario 2022 to 2050 (per 100 000) (A) The difference in the cumulative age-standardised rate of YLLs between the reference scenario and the Elimination-2050 scenario among males. (B) The difference between the reference scenario and the Elimination-2050 scenario among females. YLLs=years of life lost.
Figure 5
Figure 5
Global life expectancy at birth by sex and scenario The solid lines indicate the mean estimates of life expectancy at birth. The shaded area reflects the 95% uncertainty interval for the past and reference scenario. The grey dashed vertical line indicates 2022 (the first forecast year). Estimates for 1990 to 2021 were obtained from GBD 2021.

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