SUMMARY

Proportion of all deaths attributable to tobacco (%)

WHO Region Men Women All adults
African 5 1 3
Americas 17 15 16
Eastern Mediterannean 12 2 7
European 25 7 16
South East Asian 14 5 10
Western Pacific 14 11 13
Global 16 7 12

Globally 12% of all deaths among adults aged 30 years and over were attributed to tobacco.
In 2004, about 5 million adults aged 30 years and over died from direct tobacco use (smoking and
smokeless) around the globe, that is one death approximately every six seconds.
The regions with the highest proportion of deaths attributable to tobacco are the Americas and the
European regions where tobacco has been used for a longer period of time.

The proportion of mortality attributable to tobacco is higher among men than among women.

Globally, 5% of all deaths from communicable diseases, and 14% of all deaths non-communicable
diseases among adults aged 30 years and over are attributable to tobacco.
Within communicable diseases, tobacco use is responsible for an estimated 7% of all deaths due to
tuberculosis and 12% of deaths due to lower respiratory infections.
Within non-communicable diseases, tobacco use is responsible for 10% of all deaths from
cardiovascular diseases, 22% of all cancer deaths, and 36% of all deaths from diseases of the respiratory
system.

Globally, death from people who died from tobacco-related diseases of the cardiovascular system was
more likely to occur among younger adults. Of those adults aged 30-44 years who died from ischemic heart
disease, 38% of the deaths were attributable to tobacco.
71% of all lung cancer deaths are attributable to tobacco use.

42% of all chronic obstructive pulmonary disease are attributable to tobacco use.
The reliance of reliable data on lung cancer deaths as the starting point of estimating the SIR means is
of paramount importance in the estimation of deaths attributable to tobacco not only for lung cancer but for
a variety of other causes of death. Some countries with a relatively recent history of tobacco use (particularly
manufactured cigarettes) may not yet exhibit substantial levels of lung cancer. By extension of the model,
information on other causes of death would, as a consequence also be lacking, likely yielding an
underestimate of the real levels of death attributable to tobacco, particularly but not exclusively among
women. This situation applies in several regions, including for example Solomon Islands, Sri Lanka,
Mauritania and Haiti.

The results for China were also interesting with crude proportions of death attributable to tobacco
being 12% for men and 11% for women. These levels appear to be very high when put in context of the
published differential in men and women smoking rates in China (17, 18). There are, however, important
differences between the patterns for men and women. The age-specific rates for men were about four times
higher than those for women at ages 30-44 and 45-59, and 1.4 times higher for the age group 60-69 years. It
is only at the very high ages (70 years and over) that the rate for women is higher than that for men. After
adjusting for these different age-patterns (through the technique of age-standardisation), the male rate was
1.4 times that for women. Two additional factors could also account for the remaining closeness between
the rates for men and women. Although this project did not include exposure to second-hand smoke, there is
increasing evidence that SHS also contributes to the development of cancer. Given the very high rates of
smoking among Chinese men, it is possible that these translate into high rates of secondhand exposure
among Chinese women (particularly those in the highest age groups), and these could in turn have an excess
impact on cancer rates among Chinese women. In addition, it is possible that the smoking rate among women
in China is under-reported. A recent study in neighbouring South Korea reported some under-reporting in
that country (19). Although there are cultural differences between China and Korea, the Korean result
indicates that it may be desirable to explore the possibility of this also occurring in neighbouring China.
The issue of smokeless tobacco for Bangladesh, India and Pakistan is partly reflected in the substantial
category of “All other neoplasms”. Globally 12% of all deaths among adults aged 30 years and over in that
category were attributable to tobacco compared with 16% in India , 17% in Pakistan and 31% in Bangladesh.
Some countries mostly those with adequate cause of death and tobacco use prevalence data produce
tobacco attributable mortality estimates using estimates of tobacco use prevalence directly to estimate their
PAFs. These methods produce estimates that may be somewhat different from those produced by the SIR
method but are equally valid. Danaei et. al (20) have shown that the specific PAF method used by the United
States (often referred to as the SAMMEC method) yields results that are essentially consistent with those
produced by the PAF/SIR method. Examples of countries that have generated their own estimates using PAF
methods for example include Brazil, Canada, France, Ireland and the United States.

A careful and detailed review of the PAF/SIR method by Khanna & Stevens (21) indicates that the
method has been well received, applied and refined in a variety of reports and publications that have
produced tobacco-related burden of disease estimates.

The incompleteness of the raw mortality data from many countries have limited their access to
information of relatively adequate quality to enable them to inform their health policy and program
development efforts. The modelling of the basic mortality data by WHO, especially those for many low and
middle income countries, has permitted the production of indicative estimates of mortality attributable to
tobacco reported in this document. Improvements in vital registration systems will enable the production of
more precise estimates of tobacco attributable mortality, enabling WHO Member States in enhancing their
tobacco control efforts.
 WHO estimated death rates (per 100,000) and proportion attributable to tobacco, 2004
Both sexes Total for
ages 30
GLOBAL Cause of death 30-44 45-59 60-69 70-79 80+
& over
Population 2004 (in thousands) Death rate: ALL CAUSES 382 880 2,304 5,188 12,806 1,482
Age Male Female Total Death rate attributable to tobacco 27 120 333 658 1,227 174
0-29 1,795,664 1,701,288 3,496,952 Proportion of deaths attributable to tobacco (%) 7 14 14 13 10 12
30-44 689,611 670,666 1,360,277
45-59 454,973 455,679 910,652 Death rate: Communicable diseases 154 163 269 485 1,235 226
60-69 171,266 186,019 357,286 Death rate attributable to tobacco 4 6 14 28 132 11
70-79 96,013 120,504 216,517 Proportion of deaths attributable to tobacco (%) 2 4 5 6 11 5
80+ 30,363 53,228 83,591
Total 3,237,891 3,187,384 6,425,275 Death rate: Tuberculosis 27 39 60 66 58 39
Death rate attributable to tobacco 2 3 4 4 4 3
Population Pyramid Proportion of deaths attributable to tobacco (%) 9 8 7 5 8 7
85+

Males 80-84 Females

75-79 Death rate: Lower respiratory infections 12 26 112 253 805 69
70-74
65-69
60-64
Death rate attributable to tobacco 1 3 10 24 126 8
55-59
50-54 Proportion of deaths attributable to tobacco (%) 11 11 9 9 16 12
45-49
40-44
35-39
30-34 Death rate: Noncommunicable diseases 132 605 1,905 4,520 11,212 1,136
25-29
20-24 Death rate attributable to tobacco 23 114 319 630 1,095 163
15-19
10-14
5-9 Proportion of deaths attributable to tobacco (%) 18 19 17 14 10 14
0-4

10 8 6 4 2 0 0 2 4 6 8 10
Percent
Death rate: All malignant neoplasms 34 177 498 938 1,547 245
Death rate attributable to tobacco 5 37 127 228 303 55
Percent Smoking
Prevalence in 2005 Tobacco Cigarette Proportion of deaths attributable to tobacco (%) 15 21 25 24 20 22
Men #N/A #N/A
Women #N/A #N/A Death rate: Trachea, bronchus, lung cancers 4 31 107 194 222 45
Death rate attributable to tobacco 2 20 77 146 168 32
Proportion of deaths attributable to tobacco (%) 47 65 72 75 76 71

Death rate: All other malignant neoplasms 31 146 391 743 1,325 200
Highlights: Death rate attributable to tobacco 3 18 49 83 136 23
Proportion of deaths attributable to tobacco (%) 11 12 13 11 10 12
• The death rate from non-communicable diseases
(1136 per 100,000 population) was about 5 times that for
Death rate: All Cardiovascular diseases 47 251 904 2,358 6,510 570
communicable diseases (226 per 100,000). Tobacco was
Death rate attributable to tobacco 16 60 115 167 192 58
responsible for 14% of all NCDs compared with 5% of all
communicable disease related deaths. Proportion of deaths attributable to tobacco (%) 35 24 13 7 3 10

Death rate: Ischaemic heart disease 19 121 426 1,003 2,475 243
• Within the non-communicable disease group, ischaemic
heart disease accounted for 243 deaths per 100,000 Death rate attributable to tobacco 7 32 58 71 95 28
population aged 30 years and over, with 12% of these deaths Proportion of deaths attributable to tobacco (%) 38 26 14 7 4 12
attributed to tobacco. Cancer of the trachea, bronchus and
lung accounted for 45 deaths per 100,000 population but with
Death rate: Cerebrovascular disease 11 74 307 858 2,226 193
71% of these deaths attributed to tobacco.
Death rate attributable to tobacco 3 15 32 55 8 14
Proportion of deaths attributable to tobacco (%) 26 20 11 6 0 7
• Within the communicable disease group, deaths attributed
to tobacco accounted for 12% of all lower respiratory
Death rate: Other cardiovascular diseases 17 56 171 496 1,809 135
infection deaths and 7% of all tuberculosis deaths.
Death rate attributable to tobacco 6 14 25 41 89 16
• The death rate due to tobacco in men was (248 per 100,000 Proportion of deaths attributable to tobacco (%) 37 25 14 8 5 12
men aged 30 years and over) compared with women (103 per
100,000 women aged 30 years and over). The proportion of
Death rate: Respiratory diseases 9 54 219 595 1,464 134
deaths attributable to tobacco was almost 16% for men and
7% for women. Death rate attributable to tobacco 2 15 73 225 577 48
Proportion of deaths attributable to tobacco (%) 19 29 33 38 39 36
• Among those who died prematurely, almost one in every 14
deaths among those aged 30-44 and one in 7 among those Death rate: Chronic obstructive pulmonary disease 2 36 177 489 1,148 103
aged 45-59 years were attributable to tobacco use. Of those Death rate attributable to tobacco 1 14 68 212 526 44
who died in the 45-59 year age bracket, tobacco use
Proportion of deaths attributable to tobacco (%) 39 37 39 43 46 42
accounted for 10.7% of those whose death was due to a lower
respiratory infection, 24% of deaths due to the category of 'all
cardiovascular diseases combined', and 64.7% of those who Death rate: Other respiratory diseases 7 17 43 106 316 31
had died from cancer of the trachea, bronchus and lung. Death rate attributable to tobacco 1 2 5 13 51 4
Proportion of deaths attributable to tobacco (%) 12 10 11 12 16 13
Note 1: The total death rates are crude rates, and not standardized therefore cannot be used for comparison between countries/regions.
Note 2: The estimates above are based on SIR method (see Technical Note), some countries have used other methods which can produce somewhat different but equally valid estimates.
 GLOBAL
WHO estimated death rates (per 100,000) and proportion attributable to tobacco, 2004
Men Total for Women Total for
ages 30 ages 30
Cause of death 30-44 45-59 60-69 70-79 80+ 30-44 45-59 60-69 70-79 80+
& over & over
Death rate: ALL CAUSES 448 1,087 2,802 6,065 14,062 1,590 315 674 1,846 4,488 12,090 1,377
Death rate attributable to tobacco 45 202 544 946 1,651 248 8 38 138 428 986 103
Proportion of deaths attributable to tobacco (%) 10 19 19 16 12 16 3 6 7 10 8 7

Death rate: Communicable diseases 153 202 329 587 1,471 246 155 123 214 403 1,100 207
Death rate attributable to tobacco 6 10 25 42 173 16 1 1 4 16 109 7
Proportion of deaths attributable to tobacco (%) 4 5 8 7 12 6 1 1 2 4 10 3

Death rate: Tuberculosis 35 56 89 102 109 54 18 23 34 37 29 24

Death rate attributable to tobacco 4 6 8 6 9 5 1 0 1 1 2 1
Proportion of deaths attributable to tobacco (%) 11 10 9 6 8 9 4 2 2 4 6 3

Death rate: Lower respiratory infections 15 32 135 302 936 73 9 20 91 215 730 65
Death rate attributable to tobacco 2 5 17 35 161 10 1 1 4 15 106 6
Proportion of deaths attributable to tobacco (%) 14 15 13 12 17 14 7 4 4 7 14 9

Death rate: Noncommunicable diseases 155 730 2,301 5,248 12,141 1,183 107 480 1,540 3,940 10,682 1,091
Death rate attributable to tobacco 39 192 519 904 1,478 232 7 37 134 412 877 96
Proportion of deaths attributable to tobacco (%) 25 26 23 17 12 20 6 8 9 10 8 9

Death rate: All malignant neoplasms 34 200 628 1,222 2,076 279 35 154 378 711 1,246 213
Death rate attributable to tobacco 8 64 218 390 567 88 2 11 42 99 153 23

Proportion of deaths attributable to tobacco (%) 25 32 35 32 27 32 5 7 11 14 12 11

Death rate: Trachea, bronchus, lung cancers 5 45 167 310 390 65 3 16 52 102 126 25
Death rate attributable to tobacco 3 33 132 251 326 51 1 7 27 62 78 14
Proportion of deaths attributable to tobacco (%) 56 73 79 81 83 78 30 42 52 60 62 53

Death rate: All other malignant neoplasms 29 155 461 912 1,686 214 33 138 327 609 1,120 187
Death rate attributable to tobacco 6 31 86 139 242 37 1 4 15 38 75 9
Proportion of deaths attributable to tobacco (%) 20 20 19 15 14 17 3 3 5 6 7 5

Death rate: All Cardiovascular diseases 58 317 1,076 2,584 6,483 564 34 185 747 2,177 6,526 576
Death rate attributable to tobacco 28 101 175 199 82 81 4 20 59 142 254 36
Proportion of deaths attributable to tobacco (%) 48 32 16 8 1 14 12 11 8 7 4 6

Death rate: Ischaemic heart disease 26 169 533 1,174 2,612 262 12 72 327 866 2,396 224
Death rate attributable to tobacco 13 56 94 99 33 42 1 7 24 48 130 14
Proportion of deaths attributable to tobacco (%) 50 33 18 8 1 16 8 10 7 6 5 6

Death rate: Cerebrovascular disease 12 86 357 915 2,155 182 9 63 262 813 2,267 203
Death rate attributable to tobacco 4 23 46 52 22 19 2 7 19 57 - 10
Proportion of deaths attributable to tobacco (%) 33 27 13 6 1 10 17 10 7 7 - 5

Death rate: Other cardiovascular diseases 20 62 185 496 1,716 120 14 50 158 497 1,862 148
Death rate attributable to tobacco 11 22 35 47 27 20 2 6 15 36 124 12
Proportion of deaths attributable to tobacco (%) 55 36 19 10 2 17 11 12 10 7 7 8

Death rate: Respiratory diseases 10 64 275 742 1,796 145 8 44 168 478 1,274 123
Death rate attributable to tobacco 3 25 119 303 800 60 1 5 31 164 450 35
Proportion of deaths attributable to tobacco (%) 25 40 43 41 45 42 12 12 18 34 35 29

Death rate: Chronic obstructive pulmonary disease 3 44 223 610 1,417 112 2 29 134 393 994 94
Death rate attributable to tobacco 1 23 111 284 734 55 1 5 29 155 408 32
Proportion of deaths attributable to tobacco (%) 50 52 50 47 52 49 24 16 21 39 41 34

Death rate: Other respiratory diseases 8 20 53 132 379 33 6 14 33 85 280 28

Death rate attributable to tobacco 1 3 8 19 67 5 0 1 2 9 43 3
Proportion of deaths attributable to tobacco (%) 16 14 15 14 18 15 7 5 7 10 15 10
Note 3: For information on the sources of mortality data, please refer to Annex C, Table C4 of The global burden of disease: 2004 update.
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