Mortalidad atribuida al consumo de tabaco en España: Revisión sistemática / Smoking-attributable mortality in Spain: A systematic review

La mortalidad atribuida (MA) al consumo de tabaco es un indicador que refleja la evolución de la epidemia tabáquica a nivel poblacional. El objetivo de este trabajo es identificar y describir los estudios publicados que hayan estimado MA al consumo de tabaco en España. Se realizó una búsqueda en las bases de datos de PubMed y EMBASE de los trabajos publicados hasta el 15/04/2021. Se incluyeron estudios que estimaron MA en España ensu conjunto o en unidades territoriales. Se identificaron 146 estudios y 22cumplieron los criterios de elegibilidad. La primera estimación de MA en España data de 1978 y la última de 2017. En 12 estudios se estimó la MA a nivel nacional, 8 en comunidades autónomas, 1 a nivel provincial y 1 en una ciudad. La mayoría de estimaciones se realizaron en adultos mayores de 34años categorizados como fumadores, exfumadores y nunca fumadores. La mortalidad observada derivó en todos los estudios de registros oficiales y los riesgos relativos mayoritariamente del Cancer Prevention Study II. En el periodo analizado se observó una disminución en la carga de MA en relación con la mortalidad total. En España se dispone de estimaciones de MA a nivel global, pero no tienen periodicidad regular y es infrecuente que se realicen en unidades territoriales. Debido a variaciones en la metodología y en las fuentes de datos es difícil evaluar de forma precisa cambios en la MA. Sería necesario disponer de estimaciones periódicas globales y regionales para monitorizar correctamente la epidemia tabáquica en España. (AU)

Smoking-attributable mortality (SAM) is an indicator that reflects the evolution of the tobacco epidemic at the population level. The objective of this study is to identify and to describe published studies that have estimated SAM in Spain. A search in PubMed and EMBASE databases was performed, limited to studies published until April 15th, 2021. Studies that estimated SAM in Spain or its constituent regions were included. Of the 146 studies identified, 22 met eligibility criteria. The first estimate of SAM in Spain dates from 1978 and the last from 2017. Twelve of the studies found estimated SAM at national level, 8 in regions, 1 in a province and 1 in a city. Most estimates were made for adults aged over 34, categorized as smokers, ex-smokers and never smokers. Observed mortality derived, in all studies, from official records, and relative risks mostly from Cancer Prevention StudyII. In the period analyzed, a decrease in the burden of SAM was observed. In Spain, different SAM estimates are available globally, but they do not haveregular periodicity, and such estimates are infrequently made by region. Dueto variations in methodology and data sources, it is difficult to assess changesin SAM. Having global and regional periodic estimates would be necessary to correctly monitor the tobacco epidemic in Spain. (AU)

Patología orgánica asociada al tabaquismo / Organic pathology associated with smoking

Introducción: El tabaquismo es un problema de salud de dimensiones epidémicas con un importante impacto sobre la salud de la población. Según la OMS, esta epidemia mata a más de 8 millones de personas. Además, es uno de los desencadenantes más importantes de enfermedades pulmonares crónicas, cardiovasculares y neoplásicas, por lo que es considerado el factor de riesgo de enfermedad y de muerte prematura evitable más importante a nivel mundial.Objetivo: En esta revisión bibliográfica se discutirá la evidencia actual del daño orgánico producido por el tabaco, los mecanismos fisiopatológicos mediante los cuales se produce y la relevancia en la prevención mediante el cese del consumo. Resultados: El hábito tabáquico es uno de los desencadenantes más importantes de cáncer, siendo actualmente el responsable del 30 % de los cánceres a nivel mundial. Por otro lado, el aparato respiratorio es uno de los que más sufre el impacto de su consumo, relacionándose de forma estrecha con el desarrollo de enfermedad pulmonar obstructiva crónica, asma e infecciones respiratorias. Además, tiene un rol muy importante en la patogenia de las enfermedades cardiovasculares; hay evidencia clara de que el tabaquismo constituye un factor de riesgo cardiovascular, estando muy relacionado con el desarrollo de cardiopatía coronaria, enfermedad arterial periférica y accidentes cerebrovasculares.Conclusiones: El humo del cigarrillo contiene partículas potencialmente peligrosas para la salud de quien está expuesto a ellas. De este modo, fumar cigarrillo se convierte en un factor etiológico común a muchos tipos de cáncer, de enfermedad cardiovascular y enfermedad pulmonar obstructiva crónica. La nicotina, uno de sus componentes, es un potente agente adictivo. Todo esto en suconjunto hace del cigarrillo un importante problema de salud pública.(AU)

Introduction: Smoking is a health problem of epidemic dimensions with a significant impact on the health of the population. According to the WHO, this epidemic kills more than 8 million people. In addition, it is one of the most important triggers of chronic pulmonary, cardiovascular and neoplastic diseases, which is why it is considered the most important risk factor for disease and premature death worldwide. Objective: This bibliographic review will discuss the current evidence of organic damage caused by tobacco, the pathophysiological mechanisms through which it is produced and the relevance in prevention through the cessation of consumption. Results: Smoking is one of the most important triggers of cancer, currently being responsible for 30% of cancers worldwide. On the other hand, the respiratory system is one of those that suffers the most from the impact of its consumption, being closely related to the development of chronic obstructive pulmonary disease, asthma and respiratory infections. In addition, it has a very important role in the pathogenesis of cardiovascular diseases, there is clear evidence that smoking is a cardiovascular risk factor, being closely related to the development of coronary heart disease, peripheral arterial disease and cerebrovascular accidents. Conclusions: Cigarette smoke contains particles that are potentially dangerous to the health of those who are exposed to them. In this way, cigarette smoking becomes an aetiological factor common to many types of cancer, cardiovascular disease and chronic obstructive pulmonary disease. Nicotine, one of its components, is a powerful addictive agent. All this together makes cigarettes a major public health problem.(AU)

Pare de fumar: tabagismo pode provocar câncer, tuberculose, doenças respiratórias, impotência e infertilidade

Rconhecido pela Organização Mundial da Saúde (OMS) como uma doença crônica causada pela dependência à nicotina, o tabagismo é um problema mundial de saúde pública que está relacionado ao surgimento de pelo menos 50 doenças como diabetes, hipertensão, AVC, infarto, doenças respiratórias, câncer, tuberculose, impotência e infertilidade

Mortalidad atribuida al consumo de tabaco en las comunidades autónomas de España, 2017 / Smoking-attributable mortality in the autonomous communities of Spain, 2017

Introducción y objetivos: Estimar la mortalidad atribuida (MA) al consumo de tabaco en las comunidades autónomas (CCAA) de España en población de edad ≥ 35 años en 2017. Métodos: Se estimó la MA empleando un método dependiente de prevalencias basado en el cálculo de fracciones atribuidas poblacionales. La mortalidad observada procede del Instituto Nacional de Estadística; las prevalencias de consumo por sexo y edad, de la Encuesta Nacional de Salud de 2011 y 2017 y la Encuesta europea de 2014, y los riesgos relativos, del seguimiento de 5 cohortes norteamericanas. Se presentan estimaciones de MA y fracciones atribuidas poblacionales para cada comunidad autónoma por causa de muerte, sexo y edad y tasas de MA específicas y ajustadas. Resultados: El tabaco causó 53.825 muertes en España en la población de 35 o más años (el 12,9% de la mortalidad total). La carga de MA sobre la mortalidad observada varía del 10,8% en La Rioja al 15,3% en Canarias. Tras ajustar las tasas de MA por edad, las diferencias entre CCAA se mantienen, y las tasas más altas en los varones se observan en Extremadura y en las mujeres, en Canarias. Las tasas ajustadas de los varones se correlacionan negativamente con las de las mujeres. El porcentaje que suponen las enfermedades cardiovasculares sobre la MA total de cada comunidad autónoma oscila entre el 21,8% de Castilla-La Mancha y el 30,3% de Andalucía. Conclusiones: La carga de MA al consumo de tabaco varía entre las CCAA. Realizar un análisis detallado por regiones aporta información relevante para la implantación de políticas sanitarias dirigidas a frenar el impacto del tabaquismo (AU)

Introduction and objectives: To estimate smoking-attributable mortality (SAM) in the regions of Spain among people aged ≥ 35 years in 2017. Methods: SAM was estimated using a prevalence dependent method based calculating the population attributable fraction. Observed mortality was derived from the National Statistics Institute. The prevalence of smoking by age and sex was based on the Spanish National Health Survey for 2011 and 2017 and the European Survey for 2014. Relative risks were reported from the follow-up of 5 North American cohorts. SAM and population attributable fraction were estimated for each region by age group, sex, and causes of death. Cause-specific and adjusted SAM rates were estimated. Results: Smoking caused 53 825 deaths in the population aged ≥ 35 years (12.9% of all-cause mortality). SAM ranged from 10.8% of observed mortality in La Rioja to 15.3% in the Canary Islands. The differences remained after rates were adjusted by age. The highest adjusted SAM rates were observed in Extremadura in men and in the Canary Islands in women. Adjusted SAM rates in men were inversely correlated with those in women. The percentage of total SAM represented by cardiovascular diseases in each region ranged from 21.8% in Castile-La Mancha to 30.3% in Andalusia. Conclusions: The distribution of SAM differed among regions. Conducting a detailed region-by-region analysis provides relevant information for health policies aiming to curb the impact of smoking (AU)

Mortalidad atribuible al consumo de tabaco en España 2016 / Smoking-Attributable Mortality in Spain in 2016

INTRODUCCIÓN: La mortalidad atribuible (MA) al consumo de tabaco es un indicador valioso que permite caracterizar la evolución y el impacto en la salud poblacional de la epidemia tabáquica. El objetivo de este trabajo es estimar la MA al consumo de tabaco en España en 2016 en población ≥ 35 años utilizando la mejor evidencia disponible. MÉTODOS: Se aplicó un método dependiente de las prevalencias de consumo de tabaco basado en el cálculo de fracciones atribuidas poblacionales. Las prevalencias de consumo (fumadores-exfumadores-nunca fumadores) proceden de la estimación combinada de la Encuesta Nacional de Salud-2016 y la Europea-2014; el exceso de riesgo de morir en fumadores y exfumadores del seguimiento de diferentes cohortes; y la mortalidad observada del Instituto Nacional de Estadística. Se presenta la estimación global de MA y en función del sexo, grupos de edad y grandes grupos de enfermedades (cáncer, cardiometabólicas y respiratorias), acompañadas de las fracciones atribuidas poblacionales. RESULTADOS: En 2016 se atribuyeron 56.124 muertes al consumo de tabaco, el 84% sucedieron en hombres (47.000) y el 50% en mayores de 74 años (27.795). El 50% de la MA fue por tumores (28.281), de los cuales el 65% fueron de pulmón. Una de cada cuatro muertes (13.849) ocurrió antes de los 65 años. CONCLUSIONES: Una de cada siete muertes que ocurrieron en España en 2016 se atribuyen al consumo de tabaco. Esta estimación permite objetivar el gran impacto que el consumo de tabaco tiene en la mortalidad, especialmente por cáncer de pulmón y enfermedad pulmonar obstructiva crónica

INTRODUCTION: Smoking-attributable mortality (SAM) is a valuable indicator that can be used to characterize the course and health burden of the smoking epidemic. The aim of this paper was to estimate SAM in Spain in 2016 in the population aged 35 and over, using the best available evidence. METHODS: A smoking prevalence-dependent analysis based on the estimation of population-attributable fractions was performed. Smoking prevalence (never, former, or current smokers) was calculated from a combination of the Spanish Health Survey (2016) and the European Health Survey (2014); the relative risk of death among current and former smokers was taken from the follow-up of various cohorts; and mortality rates were obtained from National Center for Statistics data. SAM estimates are presented globally, and by sex, age groups, and major disease categories: cancer, cardiovascular diseases and respiratory diseases. RESULTS: In 2016, 56,124 deaths were attributed to tobacco consumption, 84% in men (47,000), and 50% in the population aged over 74 (27,795). Overall, 50% of SAM was due to cancer (28,281), 65% of which was lung cancer. One in 4 attributable deaths (13,849) occurred before the age of 65. CONCLUSIONS: One in 7 deaths in Spain in 2016 were attributable to smoking. This estimation of SAM clearly highlights the great impact of smoking on mortality in Spain, mainly due to lung cancer and chronic obstructive pulmonary disease

Trends in Disease Burden Attributable to Tobacco in China, 1990-2017: Findings From the Global Burden of Disease Study 2017.

In 2018, there were more than 371 million cigarette smokers and 12. 6 million electronic cigarette users, with 340.2 million non-smokers exposed to secondhand smoke (SHS) in China, which resulted in heavy tobacco-attributable disease burden. According to the definition by the Global Burden of Disease Study 2017 (GBD 2017), tobacco is a level 2 risk factor that consists of three sublevel risk factors, namely, smoking, SHS, and chewing tobacco. In this study, we aimed to evaluate the trends in deaths and disability-adjusted life years (DALYs) attributable to tobacco, smoking, SHS, and chewing tobacco by sex in China from 1990 to 2017 and to explore the leading causes of tobacco-attributable deaths and DALYs using data from the GBD 2017. From 1990 to 2017, the tobacco-attributable death rates per 100,000 people decreased from 75.65 [95% uncertainty interval (95% UI) = 56.23-97.74] to 70.90 (95% UI = 59.67-83.72) in females and increased from 198.83 (95% UI = 181.39-217.47) to 292.39 (95% UI = 271.28-313.76) in males. From 1990 to 2017, the tobacco-attributable DALY rates decreased from 2209.11 (95% UI = 1678.63-2791.91) to 1489.05 (95% UI = 1237.65-1752.57) in females and increased from 5650.42 (95% UI = 5070.06-6264.39) to 6994.02 (95% UI = 6489.84-7558.41) in males. In 2017, the tobacco-attributable deaths in China were concentrated on chronic obstructive pulmonary disease, ischemic heart disease, lung cancer, and stroke. The focus of tobacco control for females was SHS in 1990, whereas smoking and SHS were equally important for tobacco control in females in 2017. Increasing tobacco taxes and prices may be the most effective and feasible measure to reduce tobacco-attributable disease burdens.

La violencia tabáquica: papel de los medios audiovisuales, influencers y las think tanks / Tobacco violence: the role of audiovisual media, influencers and think tanks

Se presenta un análisis sobre los posibles motivos que han causado un aumento de los índices de prevalencia e incidencia en el consumo de tabaco en España en los últimos años y que inevitablemente lleva a un aumento del tabaquismo pasivo infantil. Se analizan pormenorizadamente tres estrategias novedosas que están utilizando la industria del tabaco en la actualidad: los influencers, el producto placement de películas y series de TV y la aparición de las think tanks. Se proponen medidas a implantar para reducir esta "in-cultura" del tabaquismo, principal causa de muerte evitable en España

An analysis is presented on the possible reasons that have caused an increase in the prevalence and incidence rates in tobacco consumption in Spain in recent years and that inevitably leads to an increase in passive infant smoking. We analyze in detail three novel strategies that the tobacco industry is currently using: influencers, the product placement of films and TV series and the emergence of think tanks. We propose measures to be implemented to reduce this "in-culture" of smoking, the main cause of avoidable death in Spain

Tabaquismo: aspectos novedosos para su abordaje y revisión actualizada de conceptos / Smoking: novel aspects for its approach and updated review of concepts

El tabaquismo es una enfermedad adictiva crónica, la primera causa de muerte evitable, y los objetivos de esta revisión son actualizar algunos conceptos clave y aportar aspectos novedosos en su abordaje. Se realiza, para ello, una búsqueda en las principales bases de datos biomédicas hasta mayo de 2020. Se describen aspectos como el de que no hay nivel seguro de fumar, los tratamientos de elección, la interacción del tabaco con los tratamientos farmacológicos, el humo de tercera y cuarta mano, la obesidad y el tabaquismo, la alteración del microbioma oral, el tabaquismo y la genética, y la intervención en adolescentes. Se concluye que el mayor conocimiento sobre el tabaquismo y sus interacciones ha de permitir una mayor efectividad tanto en su prevención como en su tratamiento, y especialmente en adolescentes, principal objetivo actual de la industria tabaquera

Smoking is a chronic addictive disease, the leading cause of preventable death, and the aims of this review are to update some key concepts and provide novel aspects in its approach. To meet the objective of our work, a search of the literature published in biomedical databases until April 30, 2020 was made. There were described aspects such as the fact that there is no safe level of smoking, the choice treatments, the drug interactions with tobacco smoke, third and fourth-hand smoking, obesity and smoking, the oral microbiome dysbiosis, smoking and genetics, and intervention for adolescents smokers. It is concluded that the greater knowledge about smoking and its interactions must allow greater effectiveness both, on its prevention and on its treatment, and especially in adolescents, the current main objective of the tobacco industry

Interferência da Indústria do Tabaco no Brasil: a Necessidade do Ajuste de Contas / Tobacco Industry Interference in Brazil: the Necessity of Settling Accounts / Interferencia de la Industria Tabacalera en Brasil: la Necesidad del Ajuste de Cuentas

Introdução: No Brasil, cada vez mais são identificadas ações ilegais de publicidade, propaganda e patrocínio por parte da indústria do tabaco em eventos musicais e por meio das redes sociais, voltadas a atrair principalmente o público jovem para o uso do cigarro. Objetivo: Desenvolver uma metodologia que permita estabelecer um parâmetro de quantificação dos impactos negativos para o setor saúde desse descumprimento da lei. Método: Combinaram-se as informações nacionais existentes sobre i) a equivalência entre "custo direto médio da assistência médica" e "mortes por doenças atribuíveis ao tabagismo" e ii) a equivalência entre "a parcela do lucro revertido em ações de marketing" e "mortes de fumantes que contribuíram para a geração desse lucro por meio da compra de cigarros", de forma a se obter a relação "custo direto do tratamento" vs "parcela do lucro revertido em ações de marketing". As doenças selecionadas foram aquelas que apresentam os maiores custos diretos de tratamento atribuíveis ao fumo. Resultados: Para cada centavo investido em marketing pela indústria do tabaco, o Brasil tem um gasto com tratamento de doenças relacionadas ao tabaco 1,93 vezes superior ao dinheiro investido pela indústria. Conclusão: A mensuração da responsabilização dos violadores da legislação nacional para o controle do tabaco é fundamental para compensar parte dos custos associados ao tratamento de pacientes e aos programas de cessação ao fumo, favorecendo assim a redução do tabagismo no país.

Introduction: In Brazil, illegal actions of advertising, promotion, and sponsorship by part of the tobacco industry are increasingly identified in music events, and through social media, aimed mainly to attract young people to use cigarettes. Objective: To develop a methodology that allows the creation of a parameter of quantification of the negative impacts to the health sector of non-compliance with the law. Method: Combination of the current national information about i) the equivalence between "mean direct cost of medical care" and "deaths by diseases attributable to tobacco addiction" and ii) the equivalence between "the portion of the profit translated into marketing actions" and "deaths of smokers who contributed for the generation of this profit through purchase of cigarettes" in order to obtain the relation between "direct cost of the treatment" vs "portion of the profit translated into market actions". The diseases selected were those that presented the biggest direct cost of treatment attributable to tobacco. Results: For every cent invested in marketing strategies by the tobacco industry, Brazil spends 1.93 times more financial resources to treat tobacco-related diseases. Conclusion: The measurement of the liability for non-compliance of the tobacco national legislation is essential to offset part of the associated costs of the treatment of patients and programs of tobacco cessation to favor the reduction of smoking prevalence in Brazil.

Introducción: En Brasil, es cada vez más común identificar acciones ilegales de publicidad, promoción y patrocinio del tabaco por parte de la industria tabacalera en eventos musicales y a través de redes sociales, destinadas principalmente a atraer al público joven al consumo de cigarrillos. Objetivo: Desarrollar una metodología que permita establecer un parámetro para cuantificar los impactos negativos al setor de la salud de esa acción ilegal de la ley. Método: El artículo integra la información nacional existente sobre i) la equivalencia entre el "costo directo promedio de asistencia médica" y "muertes por enfermedades atribuibles al tabaquismo" y ii) la equivalencia entre "la parte del ingreso usado en acciones de marketing" y "las muertes de fumadores que han contribuido a la generación de estos ingresos a través de la compra de cigarrillos", para obtener la relación "costo directo del tratamiento" vs "parte de los ingresos usados en acciones de marketing". Las enfermedades seleccionadas fueron las que presentaron los costos más altos de tratamiento directo atribuibles al uso del tabaco. Resultados: Por cada centavo invertido en marketing por la industria tabacalera, Brasil tiene un gasto en tratamiento de enfermedades relacionadas con el tabaco 1,93 veces mayor que el monto invertido por la industria. Conclusión: Medir la responsabilidad de los infractores de la legislación nacional de control del tabaco es esencial para compensar parte de los costos asociados con el tratamiento de los pacientes y com los programas para dejar de fumar, favoreciendo así la reducción del consumo de tabaco en el país.

Improving Utility of Data on Cancer Mortality Risk Associated with Smokeless Tobacco: Recommendations for Future Research

Background: We analyzed in detail the studies utilized in most recent global systematic review of risk of cancer mortality with smokeless tobacco (SLT) use to report challenges in the available data that limit the understanding of association between SLT use and cancer mortality. Methods: For each study, we documented study design, reporting of mortality risk by type of SLT variant, SLT use frequency, and sex of SLT user for oral, oesophageal, pharyngeal, laryngeal and orolaryngeal cancers. These findings are discussed within the context of prevalence of SLT use by geographic regions and sex. Results: Majority of studies reported mortality risk for oral (70.6%) followed by oesophageal cancer (38.2%). The availability of population-based evidence was low (35.3%). The geographic distribution of studies did not reflect the geographic distribution of countries with high SLT consumption; 61.8% of the studies were from India followed by Sweden (20.6%). Hospital-based (84.2%) studies reported risk with chewing tobacco and the population-based studies (61.5%) with non-chewing tobacco. Hardly any study reported on a particular type of SLT. Definition of SLT use as current, ever or former was limited without consideration of the wide variations in frequency and duration of use within these patterns. Mortality risk reporting for males dominated all cancers other than oral (50% males). Conclusions: Unless the methodological and generalizability challenges identified in this review are addressed in future research to develop a stronger scientific basis of the association of SLT use and cancer mortality, we would continue to face significant challenges in monitoring the health effects of SLT.

Mortality and disability from tobacco-related diseases in Brazil, 1990 to 2015. / Mortalidade e incapacidade por doenças relacionadas à exposição ao tabaco no Brasil, 1990 a 2015.

INTRODUCTION:: The global tobacco epidemic has taken pandemic proportions, with about 1.3 billion users and 6 million annual deaths. This study aimed to analyze the trends in mortality from chronic obstructive pulmonary disease (COPD) and lung, lips, oral cavity, pharynx, and esophagus cancer in Brazil between 1990 and 2015. METHODS:: The study was made possible through a partnership between the Metrics and Health Assessment Institute (IHME), University of Washington, Ministry of Health and the GBD Brazil technical group, using estimates from the Global Disease Charge 2015 study. RESULTS:: The mortality rates due to COPD fell; in 1990, it was 64.5/100,000 inhabitants and in 2015, 44.5, a decrease of 31%. For the various types of cancer related to smoking, the decrease was in a lower proportion than for COPD. For lung cancer, rates were 18.7/100,000 inhabitants in 1990 to 18.3 in 2015. For women, there is an upward curve for lung cancer from 1990 to 2015, with an increase of 20.7%. DISCUSSION:: The study points to smoking as a risk factor for premature mortality and disability due to COPD and cancer. The significant reduction in tobacco prevalence in recent decades could explain reductions in tobacco-related disease trends. The higher mortality from lung cancer in women may express the delayed increase in smoking in this gender. CONCLUSION:: Nationwide actions taken in the last decades have had a great effect on reducing mortality from tobacco-related diseases, but there are still major challenges, especially when it comes to women and young people.

The health cost of tobacco use in Uganda.

The economic cost of tobacco use is well documented in high-income countries. It has been measured in relatively fewer low-and middle-income countries, and much less in sub-Saharan Africa despite the longstanding recognition of significant current and future health risk to people attributed by tobacco use in this region. This article fills this gap by estimating the economic cost of tobacco use in Uganda, a low-income country in sub-Saharan Africa. This study estimates the economic cost of tobacco use in Uganda using the cost-of-illnesses approach based on data collected from a survey of patients and caregivers in four major service centers in Mulago National Referral Hospital, namely, Uganda Cancer Institute, Uganda Heart Institute, Chest Clinic and Diabetic Clinic, key informant interviews and secondary sources for the year 2014. The total direct health care and non-health care cost of tobacco-related illnesses in Uganda was USD 41.56 million. The total indirect morbidity and mortality costs from the loss of productivity due to tobacco-related illnesses were USD 11.91 million and USD 73.01 million, respectively. The direct and indirect costs of tobacco use added up to USD 126.48 million, which is equivalent to 0.5% of GDP, a proportion comparable to the estimated health cost of tobacco use in other countries. The total health care cost of tobacco-related illnesses constitutes 2.3% of the national health care account which is already over-burdened with the cost of infectious diseases, limited medical personnel and infrastructure. In addition, tobacco-related illnesses heavily reduce life expectancy of tobacco users and ultimately their economic productivity. The cost of tobacco-related illnesses in Uganda far outweighs the benefits of employment and tax revenue generated from the tobacco sector. Stronger tobacco control measures need to be undertaken to reduce the disease and economic burden of tobacco use in this country.

Mortalidade e incapacidade por doenças relacionadas à exposição ao tabaco no Brasil, 1990 a 2015 / Mortality and disability from tobacco-related diseases in Brazil, 1990 to 2015

RESUMO: Introdução: A epidemia global do tabaco já assumiu proporções de pandemia, com cerca de 1,3 bilhão de usuários e 6 milhões de mortes anuais. Objetivo: Este trabalho teve como objetivo analisar as tendências de mortalidade por doença pulmonar obstrutiva crônica (DPOC) e câncer de pulmão, lábios, cavidade oral, faringe e esôfago, no Brasil, entre 1990 e 2015. Métodos: O estudo foi viabilizado mediante parceria entre o Instituto Métricas e Avaliação em Saúde (IHME), da Universidade de Washington, Ministério da Saúde e o grupo técnico GBD Brasil, utilizando análise de estimativas do estudo Carga Global de Doenças 2015. Resultados: As taxas de mortalidade por DPOC caíram, já que, em 1990, foi de 64,5/100.000 habitantes e, em 2015, 44,5, queda de 31%. Para os vários tipos de câncer relacionados ao tabaco, a queda foi em menor proporção do que a verificada para DPOC. A mortalidade por câncer de pulmão permaneceu estável, com taxa de 18,7/100.000 habitantes, em 1990, e 18,3/100.000 habitantes, em 2015. Entre as mulheres, observa-se curva ascendente, com aumento de 20,7%. Discussão: O estudo aponta o tabaco como fator de risco para mortalidade prematura e incapacidades por DPOC e câncer. A importante redução da prevalência do tabaco nas últimas décadas poderia explicar reduções nas tendências de doenças relacionadas com o tabaco. A maior mortalidade por câncer de pulmão em mulheres pode expressar o aumento tardio do tabagismo nesse sexo. Conclusão: Ações nacionais nas últimas décadas têm tido grande efeito na diminuição da mortalidade de doenças relacionadas ao tabaco, mas ainda há grandes desafios, principalmente quando se trata de mulheres e jovens.

ABSTRACT: Introduction: The global tobacco epidemic has taken pandemic proportions, with about 1.3 billion users and 6 million annual deaths. This study aimed to analyze the trends in mortality from chronic obstructive pulmonary disease (COPD) and lung, lips, oral cavity, pharynx, and esophagus cancer in Brazil between 1990 and 2015. Methods: The study was made possible through a partnership between the Metrics and Health Assessment Institute (IHME), University of Washington, Ministry of Health and the GBD Brazil technical group, using estimates from the Global Disease Charge 2015 study. Results: The mortality rates due to COPD fell; in 1990, it was 64.5/100,000 inhabitants and in 2015, 44.5, a decrease of 31%. For the various types of cancer related to smoking, the decrease was in a lower proportion than for COPD. For lung cancer, rates were 18.7/100,000 inhabitants in 1990 to 18.3 in 2015. For women, there is an upward curve for lung cancer from 1990 to 2015, with an increase of 20.7%. Discussion: The study points to smoking as a risk factor for premature mortality and disability due to COPD and cancer. The significant reduction in tobacco prevalence in recent decades could explain reductions in tobacco-related disease trends. The higher mortality from lung cancer in women may express the delayed increase in smoking in this gender. Conclusion: Nationwide actions taken in the last decades have had a great effect on reducing mortality from tobacco-related diseases, but there are still major challenges, especially when it comes to women and young people.