BACKGROUND: Addressing the epidemic of tobacco use remains a public health priority around the globe. Comprehensive estimates of the prevalence of smoking and the burden of disease attributable to smoking are essential to inform and guide tobacco control interventions.
METHODS: In the Global Burden of Disease (GBD) Study 2023, we used spatiotemporal Gaussian process regression to estimate the prevalence of current and former smoking across 204 countries and territories, stratified by age and sex, from 1990 to 2023. Estimates were based on 3217 nationally or sub-nationally representative surveys. Population attributable fractions were calculated and applied to generate updated estimates of global deaths and disability-adjusted life-years lost (DALYs) attributable to smoking.
RESULTS: In 2023, we estimated 1.10 billion (95% uncertainty interval 0.98, 1.27) individuals aged fifteen and older were current smokers. Though the prevalence of current smoking has significantly decreased among both males (-29.9% [-18.8, -39.3]) and females (-42.8% (-23.3, -57.6]), increases in global population mean that the total number of current smokers has increased by around 120 million since 1990. Most current smokers reside in the East/South Asia and Oceania regions (43.3% [40.5, 45.5]). Globally, in 2023, smoking was attributable for 5.81 million (4.92, 6.82) deaths and 161.3 million (135.6, 190.9) DALYs. Smoking was the 2nd leading risk factor for death among males (15.3% of deaths [13.0, 17.7]) and 8th among females (3.1% of deaths [2.4, 4.0]).
CONCLUSIONS: Initiatives to strengthen tobacco control are essential to curb the global epidemic; in their absence, the sizable burden of deaths and DALYs will continue to grow. Reductions in smoking prevalence are not limited by geography or wealth but by the success of implementation of tobacco control policies. If the World Health Organization's evidence-based MPOWER goals can be achieved, countries stand to enjoy economic and health benefits that will compound far into the future.