Smoking and Inequalities: Quantifying Policies and Interventions

Abstract

Smoking has been identified as a risk factor for many decades . The strongest and most comprehensive evidence we have on the association between any risk factor and mortality comes from studies of smoking. Smoking is causally related to morbidity and premature mortality from many diseases. The Global Burden of Disease Project (GBD) has estimated that, 4.83 million deaths occurred due to smoking in the year 2000. Surprisingly, these estimates were nearly evenly divided between developing and industrialized countries. Approximately 80% of the deaths attributable to smoking were observed among men, while 20% were observed among women. By 2010 the overall number of deaths had reached 5.70 million with 75% of deaths among men and 25% among women. It was as high as 6.30 million, including deaths from second-hand smoke. This makes smoking the second leading risk factor for the global disease burden (behind high blood pressure), moving up from third place in 1990. Including second-hand smoke this accounts for 8.4% of the worldwide disease burden among men and 3.7% among women. The burden of disease due to smoking does not only differ by sex but also by socioeconomic status (SES) since smoking is a socially patterned behavior. Smoking is associated with an elevated risk of a number of diseases. These include various cancers (trachea, bronchus and lung, upper aero-digestive, stomach, kidney and other urinary organs, liver, pancreas, cervix uteri, bladder, colon and rectum, leukemia), respiratory diseases (including chronic obstructive pulmonary disease (COPD)), cardiovascular diseases (including ischemic heart disease (IHD) and stroke) diabetes mellitus, and several other diseases in adults over 30 years of age. Additionally, second-hand smoke, also known as environmental tobacco smoke (ETS) or as passive smoking, is related to a heightened risk of IHD, lower respiratory infections, asthma and lung cancer. The relative risks (RRs) pertaining to the different diseases related to smoking differ between men and women [9], while the evidence on regional and national variation is scarce.