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Regional, disease specific patterns of smoking-attributable mortality in 2000
  1. M Ezzati1,
  2. A D Lopez2
  1. 1Harvard School of Public Health, Boston, Massachusetts, USA
  2. 2School of Population Health, University of Queensland, Brisbane, Australia
  1. Correspondence to:
 Majid Ezzati PhD
 Harvard School of Public Health, Population and International Health, 665 Huntington Avenue, Boston, MA 02115, USA;


Background: Smoking has been causally associated with increased mortality from several diseases, and has increased considerably in many developing countries in the past few decades. Mortality attributable to smoking in the year 2000 was estimated for adult males and females, including estimates by age and for specific diseases in 14 epidemiological subregions of the world.

Methods: Lung cancer mortality was used as an indirect marker of the accumulated hazard of smoking. Never-smoker lung cancer mortality was estimated based on the household use of coal with poor ventilation. Estimates of mortality caused by smoking were made for lung cancer, upper aerodigestive cancer, all other cancers, chronic obstructive pulmonary disease (COPD), other respiratory diseases, cardiovascular diseases, and selected other medical causes. Estimates were limited to ages 30 years and above.

Results: In 2000, an estimated 4.83 million premature deaths in the world were attributable to smoking, 2.41 million in developing countries and 2.43 million in industrialised countries. There were 3.84 million male deaths and 1.00 million female deaths attributable to smoking. 2.69 million smoking attributable deaths were between the ages of 30–69 years, and 2.14 million were 70 years of age and above. The leading causes of death from smoking in industrialised regions were cardiovascular diseases (1.02 million deaths), lung cancer (0.52 million deaths), and COPD (0.31 million deaths), and in the developing world cardiovascular diseases (0.67 million deaths), COPD (0.65 million deaths), and lung cancer (0.33 million deaths). The share of male and female deaths and younger and older adult deaths, and of various diseases in total smoking attributable deaths exhibited large inter-regional heterogeneity, especially in the developing world.

Conclusions: Smoking was an important cause of global mortality in 2000, affecting a large number of diseases. Age, sex, and disease patterns of smoking-caused mortality varied greatly across regions, due to both historical and current smoking patterns, and the presence of other risk factors that affect background mortality from specific diseases.

  • CDC, Centres for Disease Control and Prevention
  • COPD, chronic obstructive pulmonary disease
  • CPS-II, American Cancer Society Cancer Prevention Study phase II
  • GBD, Global Burden of Disease
  • SIR, smoking impact ratio
  • WHO, World Health Organization: AFR, African Region
  • AMR, Region of the Americas
  • EMR, Eastern Mediterranean Region
  • EUR, European Region
  • SEAR, South-East Asia Region
  • WPR, Western Pacific Region
  • cause of death
  • developing countries
  • global health
  • risk assessment

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  • * Three significant digits are reported to limit discrepancies between components and totals as a result of rounding. The precision of estimates is considerably lower due to large uncertainty in the estimates, quantified elsewhere.4

  • Contributions: Both authors contributed to adapting the Peto-Lopez method to developing countries, designed the analysis, and wrote the paper. Majid Ezzati conducted data analysis.