Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries.
BACKGROUND
Exposure to second-hand smoke is common in many countries but the magnitude of the problem worldwide is poorly described. We aimed to estimate the worldwide exposure to second-hand smoke and its burden of disease in children and adult non-smokers in 2004.


METHODS
The burden of disease from second-hand smoke was estimated as deaths and disability-adjusted life-years (DALYs) for children and adult non-smokers. The calculations were based on disease-specific relative risk estimates and area-specific estimates of the proportion of people exposed to second-hand smoke, by comparative risk assessment methods, with data from 192 countries during 2004.


RESULTS
Worldwide, 40% of children, 33% of male non-smokers, and 35% of female non-smokers were exposed to second-hand smoke in 2004. This exposure was estimated to have caused 379,000 deaths from ischaemic heart disease, 165,000 from lower respiratory infections, 36,900 from asthma, and 21,400 from lung cancer. 603,000 deaths were attributable to second-hand smoke in 2004, which was about 1·0% of worldwide mortality. 47% of deaths from second-hand smoke occurred in women, 28% in children, and 26% in men. DALYs lost because of exposure to second-hand smoke amounted to 10·9 million, which was about 0·7% of total worldwide burden of diseases in DALYs in 2004. 61% of DALYs were in children. The largest disease burdens were from lower respiratory infections in children younger than 5 years (5,939,000), ischaemic heart disease in adults (2,836,000), and asthma in adults (1,246,000) and children (651,000).


CONCLUSIONS
These estimates of worldwide burden of disease attributable to second-hand smoke suggest that substantial health gains could be made by extending effective public health and clinical interventions to reduce passive smoking worldwide.


BACKGROUND
Swedish National Board of Health and Welfare and Bloomberg Philanthropies.
Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
Mattias
M
Oberg
Maritta S
MS
Jaakkola
Alistair
A
Woodward
Armando
A
Peruga
Annette
A
Prüss-Ustün
D000293:Adolescent; D000328:Adult; D000349:Africa / Q000453:epidemiology; D000368:Aged; D000569:Americas / Q000453:epidemiology; D001208:Asia / Q000453:epidemiology; D001249:Asthma / Q000453:epidemiology / Q000209:etiology; D001315:Australia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D004185:Disability Evaluation; D005060:Europe / Q000453:epidemiology; D005260:Female; D014943:Global Health; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology / Q000209:etiology; D008297:Male; D019083:Mediterranean Region / Q000453:epidemiology; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000209:etiology; D010033:Otitis Media / Q000453:epidemiology / Q000209:etiology; D019057:Quality-Adjusted Life Years; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D014028:Tobacco Smoke Pollution / Q000009:adverse effects* / Q000706:statistics & numerical data*; D055815:Young Adult
D014028:Tobacco Smoke Pollution