BACKGROUND: Tobacco exposure, via smoking, chewing, or secondhand smoke, is one of the strongest contributors to mortality and morbidity globally. Timely estimates of burden are essential to inform national tobacco control policies in accordance with the WHO Framework Convention on Tobacco Control. We present updated estimates of the health burden attributable to tobacco exposure in 2023.
METHODS: In the Global Burden of Disease (GBD) Study 2023, the prevalence and burden of disease attributable to tobacco exposure were estimated for males and females across 204 countries and territories, from 1990 to 2023. Exposure prevalence was based on 3.901 nationally or sub-nationally representative surveys. Burden of disease was derived using estimated population attributable fractions.
RESULTS: Globally, in 2023, we estimated 7.36 million (6.37, 8.30) deaths were attributable to tobacco: 5.59 million (4.85, 6.30) among men and 1.77 million (1.47, 2.04) among women. We estimated 203.5 million (175.0, 231.7) disability-adjusted life-years lost (DALYs) due to tobacco exposure: 155.7 million (134.5, 177.4) among men and 47.8 million (40.5, 54.9) among women. These represent increases of 24.4% (11.7, 38.2) deaths and 8.3% (-0.5, 17.8) DALYs over 1990. For males, tobacco exposure was the leading risk factor for death in 2023, attributable for 17.3% (15.2,19.5) of all-cause mortality; among females, it ranked 7th (6.4% [5.3, 7.4]). Of countries with over 50 thousand tobacco-attributable deaths, the United Kingdom experienced the largest proportional decrease (-45.0% [-40.6, -49.2), while Egypt experienced the steepest increase (124.3% [80.3, 172.0]) since 1990.
CONCLUSIONS: Tobacco exposure remains one of the single largest contributors to all-cause mortality around the globe, with deaths increasing by approximately one quarter since 1990. To reap the benefits of a healthier populace, it is essential that governments and global health organizations redouble their efforts to protect citizens and mitigate the preventable loss of lives and healthy and productive years due to tobacco.