Fifty years after the U.S. Surgeon General first warned of the health effects of smoking, a new analysis from the University of Washington shows that the number of smokers worldwide — and the number of cigarettes consumed — has never been higher.
Between 1980 and 2012, the number of adults who smoke increased from 721 million to nearly 1 billion, reports the study published Tuesday in the Journal of the American Medical Association. The number of cigarettes smoked globally jumped from about 5 trillion to 6.25 trillion.
The study, which is one of the most comprehensive ever to examine global tobacco use, shows that the remarkable reductions in smoking rates in the United States and other wealthy countries have been offset by a growing epidemic in the developing world.
“The University of Washington study demonstrated clearly how much further the world, particularly low- and middle-income countries, still has to go,” said Matthew Myers, president of the Washington, D.C.-based Campaign for Tobacco-Free Kids.
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The rise in the number of smokers reflects both population growth — particularly in nations such as China and Indonesia — and the tobacco industry’s heavy marketing in poorer nations, experts say.
Smoking statistics are usually reported in terms of rates — or the percentage of people who smoke. The UW analysis confirmed that the global smoking rate dropped from 26 percent to 18.7 percent during the study period.
But the sheer number of smokers is most relevant when it comes to the public- health impact, said Ruth Malone, who studies global tobacco issues at the University of California, San Francisco.
“It’s premature deaths … and the total global burden of suffering — of preventable suffering — that we’re talking about here,” said Malone, who was not involved in the UW analysis.
After dropping rapidly for a decade, global smoking rates have declined more slowly since the mid-2000s, said Marie Ng, lead author of the analysis from the UW’s Institute for Health Metrics and Evaluation (IHME). And though the data are still uncertain, the analysis hints that the worldwide smoking rate for men may have started to climb in the past three years.
Since the surgeon general’s 1964 report drew a clear link between smoking and lung cancer and other diseases, tobacco-control efforts in the U.S. have saved 8 million lives, according to another JAMA study. The fraction of Americans who smoke has fallen by more than half, from 42 percent in 1964 to 18 percent in 2012.
And despite population growth, the number of smokers in the U.S. has also dropped, from 52 million in 1980 to 38 million in 2012.
“Tobacco control has been described, accurately, as one of the great public-health successes of the 20th century,” Centers for Disease Control and Prevention Director Thomas Frieden wrote in an editorial accompanying the studies.
But lung cancer remains the leading cause of cancer deaths among both men and women. The World Health Organization estimates tobacco-related illness kills 5 million people a year worldwide — more than AIDS, malaria and tuberculosis combined.
Ng and her colleagues spent three years compiling and analyzing more than 1,000 data sets from 182 countries. An online visualization tool prepared by IHME allows anyone to parse the results by country, sex, age and other variables.
Those details reveal that countries with effective tobacco-control programs have all seen dramatic declines in tobacco use, Myers said.
Uruguay, which was the first nation to adopt a set of WHO-recommended policies, such as higher cigarette taxes and restrictions on advertising, saw smoking rates plummet 25 percent in just three years.
Since 1980, the smoking rate in Mexico, which requires graphic warning labels on cigarette packages, has fallen faster than in the U.S. But countries such as Russia, Indonesia and China, where up to 54 percent of men still smoke, have slowed global progress, Myers said.
Russia, however, recently adopted some of the world’s toughest anti-smoking measures, which will kick in soon.
“This study is not a reason for a sense of hopelessness,” Myers said. “It is, however, a clarion call that in those countries that have not yet implemented tobacco-control policies, the death toll from tobacco is going to be devastating.”
Seattle Times news researcher Gene Balk contributed to this report.