Global data estimates nearly eight million deaths from smoking in 2019

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There were nearly eight million deaths associated with smoking in 2019, and 89% of new smokers were addicted by the age of 25, global data suggests.

The number of smokers worldwide increased to 1.1 billion in 2019, with tobacco smoking causing 7.7 million deaths – including one in five deaths in males worldwide.

Researchers say the global number of smokers continues to rise, and there is particular concern over persistently high rates of smoking among young people.

Given that the large majority of new smokers become addicted by age 25, protecting young people from nicotine addiction during this window will be crucial to eliminate tobacco use among the next generation, experts suggest.

Using data from 3,625 nationally representative surveys, the three studies are published in The Lancet and The Lancet Public Health journals by the Global Burden of Disease collaboration.

They provide global estimates on smoking prevalence in 204 countries in men and women aged 15 and over.

This includes age of initiation, associated diseases, and risks among current and former smokers, as well as the first analysis of global trends in chewing tobacco use.

Published ahead of World No Tobacco Day on May 31, the authors call on all countries to urgently adopt and enforce a package of evidence-based policies to reduce the prevalence of tobacco use and prevent initiation at a young age.

Professor Emmanuela Gakidou, senior author, Institute for Health Metrics and Evaluation (IHME), University of Seattle, Washington, said: “Persistently high smoking prevalence among young people in many countries, along with the expansion of new tobacco and nicotine products, highlight an urgent need to double down on tobacco control.

“If a person does not become a regular smoker by age 25, they are very unlikely to become a smoker.

“This presents a critical window of opportunity for interventions that can prevent young people from starting smoking and improve their health for the rest of their lives.”

A woman smoker
A woman smoking. Studies have found that 89% of smokers had begun by the age of 25 (PA)

Researchers found that since 1990, global smoking prevalence among men decreased by 27.5% and by 37.7% among women.

The 10 countries with the largest number of tobacco smokers in 2019 – comprising nearly two thirds of the global tobacco smoking population – are China, India, Indonesia, the USA, Russia, Bangladesh, Japan, Turkey, Vietnam, and the Philippines.

One in three current tobacco smokers (341 million) live in China, researchers found.

According to the study, in 2019 there were 4.8 million female smokers in the UK, and 5.5 male smokers.

Researchers found that in 2019, smoking was associated with 1.7 million deaths from ischaemic heart disease and 1.6 million deaths from chronic obstructive pulmonary disease.

It was also associated with 1.3 million deaths from tracheal, bronchus, and lung cancer, and nearly one million deaths from stroke.

Previous studies suggested that at least one in two long-term smokers will die from causes directly linked to smoking, and that smokers have an average life expectancy 10 years lower than never-smokers.

The data also indicates that approximately 87% of deaths attributable to smoking tobacco occurred among current smokers.

Only 6% of global deaths attributable to smoking tobacco use occurred among individuals who had quit smoking at least 15 years previously.

Researchers say this highlights the importance of quitting.

Marissa Reitsma, lead author of the studies on smoking, IHME, said: “With nine out of 10 smokers starting before the age of 25, ensuring that young people remain smoke-free through their mid-20s will result in radical reductions in smoking rates for the next generation.”

In 2019, there were an estimated 155 million smokers aged between 15 and 24 – equivalent to 20.1% of young men and 5.0% of young women, globally.

Two thirds (65.5%) of all current smokers began smoking by the age of 20, and 89% of smokers began by age 25.

But globally, smoking prevalence among young people decreased between 1990 and 2019 among both young men (minus 32.9%) and young women (minus 37.6%).

The authors note limitations across the three studies, including that data on tobacco use are self-reported, age of initiation may be subject to recall bias, and the health effects of smoking do not include second-hand smoke.

Modelling by academics at UCL indicates that raising the age of sale to 21 would lead to a reduction in the number of smokers of 30% from 364,000 to 255,000 in year one.

After year one, 18,000 new smokers a year would be prevented.

Action on Smoking and Health (ASH) says now is the time for the Government to consult on the measure.

Deborah Arnott, chief executive of ASH, said: “Raising the age of sale to 21 could protect more than 100,000 people from a lethal addiction which many will struggle their whole lives to quit.

“And that’s just in the first year.

“If we’re to achieve the Government’s vision of a smoke-free country by 2030 this is the kind of bold action that’s needed.”

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