title: Smoking prevalence and its impacts on lung cancer mortality in Sub-Saharan Africa: an epidemiological study.
abstract: BACKGROUND
  Reliable mortality data are sparse for developing countries. Furthermore, risk factor prevalence information is hardly available and thus not taken into consideration when estimating mortality.
  
  
  METHODS
  The authors used a validated, statistical model combined with representative smoking prevalence from WHO STEPS surveys to estimate lung cancer mortality for six Sub-Saharan African countries (Benin, Malawi, Mozambique, Niger, Sierra Leone, Swaziland). Results were compared to a reference database (GLOBOCAN). Using different smoking prevalence scenarios, future lung cancer deaths were estimated.
  
  
  RESULTS
  The prevalence of current moderate smoking among males ranged from 8.7% to 34.6%. Prevalence was much lower among females. For all countries considered, our mortality estimates were higher than GLOBOCAN estimates that do not consider prevalence: Overall, we estimated 2405 lung cancer deaths for 2008 compared to 531 deaths estimated by GLOBOCAN. Up to 2030, lung cancer deaths are expected to increase in general and by over 100% in Benin and Niger. Even under the assumption of decrease in smoking prevalence, lung cancer mortality will rise.
  
  
  CONCLUSIONS
  On the bases of detailed smoking prevalence information, our findings implicate a higher lung cancer burden in low income countries. The epidemiologic transition in African low-income countries alludes to the need for targeted health prevention efforts.
authors.affiliation: Institute of Public Health, University Hospital Heidelberg, Germany. Electronic address: volker.winkler@urz.uni-heidelberg.de.
authors.forename: Volker
authors.initials: V
authors.lastname: Winkler
authors.forename: Jördis J
authors.initials: JJ
authors.lastname: Ott
authors.forename: Melanie
authors.initials: M
authors.lastname: Cowan
authors.forename: Heiko
authors.initials: H
authors.lastname: Becher
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D002423:Cause of Death; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005260:Female; D006306:Health Surveys; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology*; D000074606:Smoking Prevention; D055815:Young Adult
keywords: ASR; Africa; Epidemiologic model; IARC; International Agency for Research on Cancer; LMICs; Lung cancer; Mortality; RR; Smoking prevalence; age-standardized rate; low and middle income countries; relative risk