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Chapter 2 Global Patterns of Smoking and Smoking-Attributable Mortality C.K. Gajalaksmi, Prabhat Jha, Kent Ranson, and Son Nguyen This
chapter reviews the global data on the prevalence of smoking
and its incidence (or uptake), on consumption trends, and on
smoking-attributable deaths. The vast majority of the
world's 1.1 billion smokers in 1995 lived in low-income and
middle-income countries. Cigarette consumption has risen
over the past two decades in these countries, in contrast to
declines in overall consumption in high-income countries.
Most smokers start in youth, and there is some evidence that
the average age of smoking uptake is falling. Because of the
long delay between the age at which people take up smoking
and their death from tobacco-related disease, current
mortality patterns largely reflect past smoking patterns,
and future mortality depends on current and future smoking.
Currently, tobacco deaths number about 4 million per year
worldwide, about one in ten of all adult deaths. For the
twentieth century, the cumulative number of tobacco deaths
is estimated to have been about 100 million, with about 60
million of these in the high-income countries and the former
socialist countries. Projections are difficult to make with
precision, but on current smoking trends it is plausible
that there will be 10 million tobacco deaths per year, about
one in six of all adult deaths, by 2030. About seven in ten
of these deaths will be low-income countries. The variations
in the tobacco epidemic over time, sex, age group, and
region, attest to the importance of conducting further
reliable long-term epidemiological studies. If current
patterns of smoking continue, about 0.5 billion of the
world's population alive today will be killed by smoking,
half of them in middle age (defined as ages 35069). Over the
twenty-first century as a whole, about 1 billion tobacco
deaths are projected. Much of the projected mortality
increase over the next fifty years could be avoided if
adults quit smoking. However, quitting remains rare in
low-income and middle-income countries.
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