Background

The tobacco-free generation aims to prevent the sale of tobacco to people born after a specific year. We aimed to estimate the impact of eliminating tobacco smoking on lung-cancer mortality in people born during 2006–10 in 185 countries.

Methods

For this population-based birth-cohort simulation study, we proposed a scenario in which tobacco sales were banned for people born between Jan 1, 2006, and Dec 31, 2010, and in which this intervention was perfectly enforced, quantified until Dec 31, 2095. To predict future lung-cancer mortality rates, we extracted lung-cancer mortality data by sex, 5-year age group, and 5-year calendar period for countries with at least 15 years of data from the WHO Mortality Database. For countries for which mortality data were not available, we extracted data on lung-cancer incidence from the Cancer Incidence in Five Continents. To establish the number of lung-cancer deaths that could be prevented in the birth cohort if tobacco smoking was eliminated, we subtracted reported age-specific rate of deaths in people who had never smoked tobacco (hereafter referred to as never smokers) from a previous study from the expected rate of lung-cancer deaths in our birth cohort and applied this difference to the size of the population. We computed population impact fractions (PIFs), the percentage of lung-cancer deaths that could be prevented, by dividing the number of preventable lung-cancer deaths by the expected lung-cancer deaths in the birth cohort. We also aggregated expected and prevented deaths into the four World Bank income groups (ie, high-income, upper-middle-income, lower-middle-income, and low-income). The primary outcome was the impact on lung-cancer mortality of implementing a tobacco-free generation.

Findings

Our birth cohort included a total population of 650 525 800 people. Globally, we predicted that 2 951 400 lung-cancer deaths could occur in the population born during 2006–10 if lung-cancer rates continue to follow trends observed during the past 15 years. Of these deaths, 1 842 900 (62·4%) were predicted to occur in male individuals and 1 108 500 (37·6%) were expected to occur in female individuals. We estimated that 1 186 500 (40·2%) of 2 951 400 lung-cancer deaths in people born during 2006–10 could be prevented if tobacco elimination (ie, a tobacco-free generation) was achieved. We estimated that more lung-cancer deaths could be prevented in male individuals (844 200 [45·8%] of 1 842 900 deaths) than in female individuals (342 400 [30·9%] of 1 108 500 deaths). In male individuals, central and eastern Europe had the highest PIF (48 900 [74·3%] of 65 800 deaths) whereas in female individuals, western Europe had the highest PIF (56 200 [77·7%] of 72 300 deaths). Middle Africa was the region with the lowest PIF in both male individuals (180 [2·1%] of 8600 deaths) and female individuals (60 [0·9%] of 6400 deaths). In both sexes combined, PIF was 17 400 (13·5%) of 128 900 deaths in low-income countries, 104 900 (15·8%) of 662 800 deaths in lower-middle-income countries, 650 100 (43·9%) of 1 482 200 deaths in upper-middle-income countries, and 414 100 (61·1%) of 677 600 deaths in high-income countries.

Interpretation

The implementation of a tobacco-free generation could substantially reduce global lung-cancer mortality. However, data from low-income countries were scarce and our estimates should be interpreted with caution.

Funding

Spanish Society of Pneumology and Thoracic Surgery.

中文翻译：

---

185 个国家/地区消除烟草策略对肺癌死亡率的估计影响：一项基于人群的出生队列模拟研究

 背景

无烟一代旨在防止向特定年份后出生的人出售烟草。我们旨在估计消除吸烟对 185 个国家/地区 2006-10 年出生的人群肺癌死亡率的影响。

 方法

对于这项基于人群的出生队列模拟研究，我们提出了一个场景，其中禁止 2006 年 1 月 1 日至 2010 年 12 月 31 日出生的人销售烟草，并且这种干预得到完美执行，量化到 2095 年 12 月 31 日。为了预测未来的肺癌死亡率，我们提取了从 WHO 死亡率数据库中拥有至少 15 年数据的国家的性别、5 岁年龄组和 5 年日历期的肺癌死亡率数据。对于无法获得死亡率数据的国家，我们从五大洲癌症发病率中提取了肺癌发病率的数据。为了确定如果消除吸烟，出生队列中可以预防的肺癌死亡人数，我们从出生队列的预期肺癌死亡率中减去先前研究中报告的从未吸烟者（以下简称从不吸烟者）的年龄特定死亡率，并将这一差异应用于人群规模。我们通过将可预防的肺癌死亡人数除以出生队列中预期的肺癌死亡人数来计算群体影响分数 （PIFs），即可以预防肺癌死亡的百分比。我们还将预期死亡和预防死亡分为世界银行的四个收入组别（即高收入、中高收入、中低收入和低收入）。主要结局是实施无烟一代对肺癌死亡率的影响。

 发现

我们的出生队列包括总人口 650 525 800 人。在全球范围内，我们预测，如果肺癌发病率继续遵循过去 15 年观察到的趋势，2006-10 年出生的人群中可能会出现 2 951 400 例肺癌死亡。在这些死亡中，预计 1 842 900 例 （62·4%） 发生在男性个体中，预计 1 108 500 例 （37·6%） 发生在女性个体中。我们估计，如果实现消除烟草（即无烟一代），则可以预防 2006-10 年出生的人群中 2 951 400 例肺癌死亡中的 1 186 500 例 （40·2%）。我们估计，男性个体（1 842 900 例死亡中的 844 200 例 [45·8%]）比女性个体（1 108 500 例死亡中的 342 400 例 [30·9%]）可以预防更多的肺癌死亡。在男性个体中，中欧和东欧的 PIF 最高（65 800 例死亡中的 48 900 例 [74·3%]），而在女性个体中，西欧的 PIF 最高（72 300 例死亡中的 56 200 例 [77·7%]）。中非是男性个体（8600 例死亡中的 180 例 [2·1%]）和女性个体（60 例死亡中的 60 例 [0·9%]）PIF 最低的地区。在男女总和中，PIF 为低收入国家 128 900 例死亡中的 17 400 例 （13·5%），中低收入国家 662 800 例死亡中的 104 900 例 （15·8%），中高收入国家 1 482 200 例死亡中的 650 100 例 （43·9%），以及高收入国家 677 600 例死亡中的 414 100 例 （61·1%）。

 解释

实施无烟一代可以大大降低全球肺癌死亡率。然而，来自低收入国家的数据很少，应谨慎解释我们的估计。

 资金

西班牙肺病学和胸外科学会。