Global Smoking Deaths Approach 5 Million
Deaths in Developing Nations Rival Industrialized World

Sept. 11, 2003 -- More people than ever are dying of smoking-related causes, and for the first time, smoking deaths in developing countries equal those seen in the industrialized world.

There were nearly 5 million smoking deaths in the year 2000, with the majority -- roughly one third -- due to heart disease and stroke. Lung cancer killed 850,000 smokers, and 1 million more died of other lung diseases.

Men were much more likely than women to die from smoking, especially in less developed areas, although this could be changing. Three quarters of all smoking deaths worldwide occurred among men, but in developing countries more than four-fifths of deaths attributed to smoking were among males.

Though fewer people are smoking in industrialized nations such as the U.S., Australia, Canada, and Western Europe, people continue to pick up the habit at very high levels in less developed countries, study co-researcher Majid Ezzati, PhD, of Boston's Harvard School of Public Health, tells WebMD.

Doubling of Smoking Deaths

American Lung Association spokesman Paul Billings blames the "cynical marketing practices of the tobacco companies and the highly addictive nature of their product," for the rise in smoking deaths in developing areas.

"The image that the tobacco industry sells around the world is one of success and Western affluence," he tells WebMD. "There is even a cigarette brand called 'West' sold in Eastern Europe. Sadly, this study confirms that the developed world is exporting tobacco-caused disease to the developing world."

Ezzati and colleague Alan Lopez, PhD, of the University of Queensland, Australia, used lung cancer death rates among nonsmokers to estimate smoking deaths in developing nations, where an estimated 930 million of the world's 1.1 billion smokers live. Their findings are published in the latest issue of the journal The Lancet.

The latest figures show a dramatic increase in smoking deaths over the past decade, but estimates for the next 20 or 30 years are even more troubling. Ezzati says the World Health Organization's projection of a doubling in deaths due to smoking worldwide over the next two decades is probably accurate.

"These projections take into account the belief that smoking will continue to decline in many western countries and will continue to go up in many developing nations," he says. "It is clear that more of our tobacco control resources need to be focused on these developing areas."

Smoking is highest among Asian men, especially those living in China and Vietnam. Up to 70% of Chinese men smoke, and Ezzati says they are uniquely vulnerable to smoking-related diseases because the Chinese routinely use coal-burning stoves inside their homes. Indoor cooking with coal is a major risk factor for lung cancer.

Young Girls Smoking More

Though smoking deaths are much higher among men than women, a recent report by the World Health Organization suggests that this may not last. The WHO survey, presented at an international conference in August, found that in many countries where smoking has traditionally been a male pursuit, young girls are now smoking almost as much as young boys.

Among adults in Africa, for example, seven men smoke for every one woman. But among teens between the ages of 13 and 15, the survey found the ratio to be closer to two to one. In Southeast Asia, 11 adult males smoke for every one female, but only four young boys smoke for every one young girl.

The WHO report suggests that projections of future smoking deaths worldwide might be too small because they do not take the change in sex patterns into account.

"Many developing countries are already dealing with a monumental infectious disease burden, and now they are facing a huge increase in chronic disease that is smoking related," Ezzati says. "Addressing this added burden is critical."

SOURCES: The Lancet, Sept. 12, 2003. Majid Ezzati, PhD, assistant professor of international health, Harvard School of Public Health, Boston. Paul Billings, vice president for national policy and advocacy, American Lung Association. WHO report on tobacco use by young girls, presented at the World Conference on Tobacco and Health, Aug. 3-8, 2003, Helsinki, Finland.