Peer-reviewed article
Global, regional, and national prevalence of second-hand smoke and attributable disease burden in 204 countries and territories, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023.
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Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study estimates that 2.71 billion people worldwide were exposed to second-hand smoke in 2023, including 767 million children aged 0-14 years. Second-hand smoke caused 1.66 million deaths and 44.8 million disability-adjusted life-years globally, with ischaemic heart disease as the leading cause of disease burden overall and lower respiratory infections predominating among children. While global age-standardised prevalence declined by 22% since 1990, the absolute number of exposed people has remained stable and risen sharply in sub-Saharan Africa and North Africa/Middle East. The study emphasises the need for stronger tobacco control measures to protect women and children.
Key points
- 767 million children aged 0-14 years were exposed to second-hand smoke in 2023
- Second-hand smoke accounted for 1.66 million deaths and 44.8 million DALYs globally in 2023
- Lower respiratory infections were the leading cause of disease burden from second-hand smoke among children
- Sub-Saharan Africa saw a 98.5% increase in absolute numbers of exposed individuals since 1990, despite global prevalence declining by 22.2%
- Female individuals in some countries experienced nearly 1.8 times higher second-hand smoke exposure than male individuals
Limitations
This is a descriptive epidemiological study that quantifies prevalence and disease burden but does not evaluate any specific intervention to reduce second-hand smoke exposure. The study cannot tell us what policy or programme measures would be most effective in reducing exposure or protecting children.
Abstract
BACKGROUND: Second-hand smoke (SHS) exposure remains a major source of morbidity and mortality among non-smokers. This study presents the first dedicated Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) publication to systematically quantify SHS prevalence and evaluate its effect as a global risk factor across a broader range of outcomes. METHODS: Using the GBD 2023 comparative risk assessment framework, we estimated SHS exposure prevalence and attributable disease burden across 204 countries and territories from 1990 to 2023, stratified by age and sex. Exposure estimates were derived by synthesising population-based surveys and household composition data through spatiotemporal Gaussian process regression. Relative risks for nine health outcomes, now including asthma, were estimated using the Burden of Proof methodology, and applied to calculate attributable deaths and disability-adjusted life-years (DALYs). FINDINGS: In 2023, an estimated 2·71 billion (95% UI 2·44-3·02) people worldwide were exposed to SHS, including 767 million (687-858) children aged 0-14 years. Age-standardised prevalence was highest in southeast Asia, east Asia, and Oceania (48·4% [44·0-53·4]), with female individuals in some countries experiencing nearly 1·8 times the exposure prevalence of male individuals. Despite a 22·2% (10·6-32·4) decline in global age-standardised prevalence since 1990, this progress has not been sufficient to reduce the absolute number of exposed individuals, which has remained stable globally and has risen sharply in sub-Saharan Africa (98·5% [62·0-144·4] increase) and North Africa and the Middle East (72·1% [47·8-101·8] increase). In 2023, SHS exposure accounted for 1·66 million (1·33-2·07) deaths and 44·8 million (35·8-54·3) DALYs globally. Ischaemic heart disease was the leading contributor to SHS-attributable DALYs (12·0 million [9·31-15·2]) overall, while lower respiratory infections predominated among children (5·16 million [3·48-7·12]). INTERPRETATION: We estimated that SHS remains a substantial driver of global health loss, particularly through cardiovascular and paediatric respiratory diseases. Persistent geographical disparities and growing absolute numbers of exposed individuals in several regions underscore the urgent need for accelerated implementation and enforcement of comprehensive tobacco control measures, particularly to protect women and children in both public and domestic environments. FUNDING: Bloomberg Philanthropies and the Gates Foundation.