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Original Investigation |

Smoking Prevalence and Cigarette Consumption in 187 Countries, 1980-2012

Marie Ng, PhD1; Michael K. Freeman, MPH1; Thomas D. Fleming, BS1; Margaret Robinson, BA1; Laura Dwyer-Lindgren, MPH1; Blake Thomson, BA1; Alexandra Wollum, BA1; Ella Sanman, BS1; Sarah Wulf, MPH1; Alan D. Lopez, PhD2; Christopher J. L. Murray, MD, DPhil1; Emmanuela Gakidou, PhD1
[+] Author Affiliations
1Institute for Health Metrics and Evaluation, University of Washington, Seattle
2School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
JAMA. 2014;311(2):183-192. doi:10.1001/jama.2013.284692.
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Importance  Tobacco is a leading global disease risk factor. Understanding national trends in prevalence and consumption is critical for prioritizing action and evaluating tobacco control progress.

Objective  To estimate the prevalence of daily smoking by age and sex and the number of cigarettes per smoker per day for 187 countries from 1980 to 2012.

Design  Nationally representative sources that measured tobacco use (n = 2102 country-years of data) were systematically identified. Survey data that did not report daily tobacco smoking were adjusted using the average relationship between different definitions. Age-sex-country-year observations (n = 38 315) were synthesized using spatial-temporal gaussian process regression to model prevalence estimates by age, sex, country, and year. Data on consumption of cigarettes were used to generate estimates of cigarettes per smoker per day.

Main Outcomes and Measures  Modeled age-standardized prevalence of daily tobacco smoking by age, sex, country, and year; cigarettes per smoker per day by country and year.

Results  Global modeled age-standardized prevalence of daily tobacco smoking in the population older than 15 years decreased from 41.2% (95% uncertainty interval [UI], 40.0%-42.6%) in 1980 to 31.1% (95% UI, 30.2%-32.0%; P < .001) in 2012 for men and from 10.6% (95% UI, 10.2%-11.1%) to 6.2% (95% UI, 6.0%-6.4%; P < .001) for women. Global modeled prevalence declined at a faster rate from 1996 to 2006 (mean annualized rate of decline, 1.7%; 95% UI, 1.5%-1.9%) compared with the subsequent period (mean annualized rate of decline, 0.9%; 95% UI, 0.5%-1.3%; P = .003). Despite the decline in modeled prevalence, the number of daily smokers increased from 721 million (95% UI, 700 million–742 million) in 1980 to 967 million (95% UI, 944 million–989 million; P < .001) in 2012. Modeled prevalence rates exhibited substantial variation across age, sex, and countries, with rates below 5% for women in some African countries to more than 55% for men in Timor-Leste and Indonesia. The number of cigarettes per smoker per day also varied widely across countries and was not correlated with modeled prevalence.

Conclusions and Relevance  Since 1980, large reductions in the estimated prevalence of daily smoking were observed at the global level for both men and women, but because of population growth, the number of smokers increased significantly. As tobacco remains a threat to the health of the world’s population, intensified efforts to control its use are needed.

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Figures

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Figure 1.
Estimated Age-Standardized Prevalence of Daily Smoking and Annualized Rate of Change, 1980-2012

See the Supplement for full list of developing and developed countries, as defined by the Global Burden of Disease Study. For 6 countries without data on tobacco smoking prevalence (Afghanistan, Angola, Central African Republic, Guineau-Bissau, Somalia, Turkmenistan), estimates were derived based on tobacco consumption and trends in prevalence in neighboring countries. The Supplement has more details on these methods. A, Global (187 countries) age-standardized prevalence estimates by sex and separately for developed countries (50 countries) and developing countries (137 countries) from 1980 to 2012. B, Annualized rate of change in age-standardized prevalence by sex from 1980 to 2012. Annualized rates of change are plotted at the beginning of the time interval they correspond to (eg, the rate of change shown for 2011 is the rate of change between 2011 and 2012). Shaded areas designate 95% uncertainty intervals. Interactive data display.

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Figure 2.
Estimated Prevalence of Daily Smoking and Annualized Rate of Change by Age, 2012

See the Supplement for full list of developing and developed countries, as defined by the Global Burden of Disease Study. For 6 countries without data on tobacco smoking prevalence (Afghanistan, Angola, Central African Republic, Guinea-Bissau, Somalia, Turkmenistan), estimates were derived based on tobacco consumption and trends in prevalence in neighboring countries. The Supplement has more details on these methods. A, Global (187 countries) prevalence estimates by age group and separately for developed countries (50 countries) and developing countries (137 countries) for 2012. B, Annualized rates of change from 1980 to 2012 by age group and sex. Shaded areas designate 95% uncertainty intervals. Interactive data display.

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Figure 3.
Estimated Age-Standardized Prevalence of Daily Smoking in 2012

Interactive data display.

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Figure 4.
Annualized Rate of Change in Prevalence Between 1980 and 2012 Compared With Estimated Prevalence in 1980

Annualized rate of change between 1980 and 2012 in estimated age-standardized prevalence of daily smoking compared with estimated age-standardized prevalence of daily smoking in 1980 for men (top) and women (bottom) for 187 countries. Orange data points represent countries that experienced statistically significant increases between 1980 and 2012 based on a 1-tailed test at the P=.05 significance level. Bright blue data points represent countries that experienced statistically significant decreases between 1980 and 2012 based on a 1-tailed test at the P=.05 significance level. Country names are shown for all countries that experienced statistically significant increases and for countries with statistically significant decreases of at least 1.5% per year for men and 2.0% per year for women.

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Figure 5.
Age-Standardized Smoking Intensity and Prevalence in 2012

Map classifying 187 countries by estimated age-standardized prevalence of daily smoking for both sexes combined and mean consumption per daily smoker per day. Countries were classified as low prevalence if the estimated age-standardized prevalence for both sexes combined was below the median across all countries (18.7%) and as high prevalence otherwise. Countries were classified as high consumption if mean consumption per daily smoker was greater than or equal to 20 cigarettes per day; medium consumption if mean consumption per daily smoker was greater than or equal to 10 and less than 20 cigarettes per day; and low consumption if mean consumption per daily smoker was less than 10 cigarettes per day. Insets display countries that would otherwise be difficult to see on the map.

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