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.

中文翻译：

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预测 2022 年至 2050 年吸烟流行情景对寿命损失年限和预期寿命的影响：2021 年全球疾病负担研究的系统分析

 背景

吸烟是全球死亡的主要行为风险因素，从 1990 年到 2021 年，吸烟导致超过 1.75 亿人死亡和近 4300 亿年的寿命损失 （YLL）。近年来，许多国家吸烟率下降的速度有所放缓，尽管最近提出了实现无烟世代的战略，但迄今尚未实施。评估如果当前吸烟率趋势持续存在会发生什么，以及如果吸烟率进一步降低会发生什么，对于传达潜在吸烟政策的效果非常重要。

 方法

在本分析中，我们使用健康指标与评估研究所的未来健康情景平台来预测三种吸烟流行情景对全因和特定原因的 YLL 以及到 2050 年的出生预期寿命的影响。使用 2021 年全球疾病负担研究参考寿命表和每种情景下特定原因死亡率预测计算每种情景的 YLLs。参考情景预测了如果过去的吸烟流行率和其他风险因素趋势继续下去会发生什么，到 2023 年消除吸烟（消除-2023 年）情景量化了假设从 2023 年起吸烟率为零的最大潜在未来健康益处，而到 2050 年消除吸烟（消除-2050 年）情景为考虑制定政策以将吸烟流行率稳步降低到 5% 的国家提供了估计。这些情景共同强调了如果各国采取果断行动消除吸烟，到 2050 年可以达到的巨大健康益处。估计的 95% 不确定性区间 （UI） 基于通过多阶段计算框架进行的第 2·5 个和第 97·5 个百分位数的绘制。

 发现

据估计，2022 年全球年龄标准化吸烟流行率男性为 28·5%（95% UI 27·9-29·1），女性为 5·96%（5·76-6·21）。在参考情景中，从 2022 年到 2050 年，男性吸烟率下降了 25·9% （25·2-26·6），女性下降了 30·0% （26·1-32·1）。在这种情况下，我们预测在此期间男性累计 293 亿 （95% UI 26·8-32·4） 总体 YLLs 和女性 22·20 亿 （20·1-24·6） YLLs。在这种情况下，出生时的预期寿命将从 2022 年的 73·6 岁（95% UI 72·8-74·4）增加到 2050 年的 78·3 岁（75·9-80·3）。在我们的消除-2023 情景下，我们预测到 2050 年，与参考情景相比，累积 YLL 减少 20.4 亿（95% UI 1·90-2·21），男性出生预期寿命将增加到 77·6 岁（95% UI 75·1-79·6），女性将增加到 81·0 岁（78·5-83·1）。在我们的 Elimination-2050 情景下，我们预测男性和女性将分别避免 7.35 亿 （675-808） 和 1.41 亿 （131-154） 的累积 YLL。到 2050 年，男性的预期寿命将增加到 77·1 岁（95% UI 74·6-79·0），女性将增加到 80·8 岁（78·3-82·9）。

 解释

如果吸烟率要像参考情景预测的那样继续下降，则必须维持现有的烟草政策。此外，通过加快消除吸烟的步伐，可以避免因吸烟而造成的重大负担。实施新的烟草控制政策对于避免未来几十年因吸烟而增加的负担以及确保过去三十年取得的成果不会丧失至关重要。

 资金

彭博慈善基金会和比尔&梅琳达·盖茨基金会。