Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019

Smoking-attributable mortality in Portugal and its regions in 2019

INTRODUCTION AND OBJECTIVES

Timely regional-specific estimates of smoking-attributable mortality (SAM) are crucial for healthcare planning and tobacco control advocacy. Currently, this information is lacking in Portugal. The aim of this study was to estimate SAM by region in 2019 among the Portuguese population aged ≥35 years.

METHODS

SAM was estimated using an independent-prevalence method. Observed mortality was obtained from Portugal Statistics; lung cancer mortality rates in smokers and never-smokers from the Cancer Prevention Study I-II and updated relative risks from five contemporary US cohort studies. SAM was estimated for each NUTS-II region by sex, age, and cause of death. Crude SAM rates, sex and age-specific rates, and age-adjusted rates were calculated using the direct method.

RESULTS

In 2019, tobacco consumption caused 13,847 deaths, representing 12.3% of total mortality among the Portuguese population aged ≥35 years. Of the total SAM, 71.2% occurred in men and 22.2% in those under 65 years; 42.5% was due to cancer, 35.4% to cardiovascular and metabolic diseases, and 22.2% to respiratory diseases. SAM greatly varied among regions from 2.1% in Madeira to 36.2% in the North region. In men, cancer was the leading cause of death in all regions, while in women it was cardiovascular and metabolic diseases.

CONCLUSION

In Portugal, tobacco-mortality burden is high and varies significantly by region, sex and age. Therefore, estimates disaggregated by sociodemographic data and region may better support decision-makers while tailoring and implementing tobacco control policies addressing health population needs. The apparent lower tobacco burden among women and in some Portuguese regions may dramatically rise in the near future. This and the high SAM in Portugal, particularly in some regions, highlights the need to accelerate tobacco control both at national and regional levels.

Subnational trend and driving factors for pancreatic cancer burden in China, 1990-2021: an analysis based on the Global Burden of Disease Study 2021

BACKGROUND

The mortality of pancreatic cancer in China showed an increasing trend between 2005 and 2020, with significant discrepancies in the burden of pancreatic cancer in provinces.

METHODS

We analyzed numbers of death, incidence, disability-adjusted life years (DALY) and corresponding age-standardized rates for pancreatic cancer in China using data from the Global Burden of Disease Study 2021. We conducted trend analysis in pancreatic cancer burden over time by age group and gender. Decomposition analysis was used to assess the drivers of change in cancer-related deaths in China due to three explanatory factors: population growth, population ageing and age-specific mortality.

RESULTS

In 2021, the ASMR of pancreatic cancer in China was 5.72/100,000(95%UI: 4.59, 6.91), the age-standardized incidence (ASIR) rate was 5.64/100,000(95%UI: 4.52, 6.84) and the age-standardized DALY rate was 137.23/100,000 (95%UI:108.15, 166.74). From 1990 to 2021, the ASMR of pancreatic cancer in China generally showed an increasing trend (AAPC: 0.56, 95%UI: 0.52, 0.59). The burden of pancreatic cancer was consistently higher in Chinese men compared to women during the study period.Compared with 1990, the number of deaths from pancreatic cancer has increased in all provinces of China in 2021, with the overall number of deaths increasing by 67.49%. Population ageing was the major cause of the increase in deaths from pancreatic cancer in China, accounting for 45.89%.

CONCLUSIONS

The burden of pancreatic cancer in China is still at a high level and population ageing is the main reason for the increase in pancreatic cancer deaths.

METTL3‑mediated m6A methylation and its impact on OTUD1 expression in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation and chronic inflammation, often exacerbated by cigarette smoke exposure. Ovarian tumor protease domain‑containing protein 1 (OTUD1), a deubiquitinase, has previously been identified as a negative regulator of inflammation through its suppression of NF‑κB signaling. The present study explored the role of OTUD1 in COPD and the regulatory effects of N6‑methyladenosine (m6A) methylation on OTUD1 expression. The expression of OTUD1 in COPD was analyzed using public datasets (GSE38974 and GSE69818). In addition, BEAS‑2B cells were exposed to cigarette smoke extract (CSE) to investigate OTUD1 expression changes. OTUD1 overexpression and knockdown models were also constructed, and the levels of inflammation‑related genes and proteins, inflammatory cytokines and cell pyroptosis were measured using reverse transcription‑quantitative PCR, western blotting, ELISA and flow cytometry. The role of methyltransferase‑like 3 (METTL3)‑mediated m6A methylation in regulating OTUD1 was also examined. Notably, OTUD1 expression was significantly reduced in advanced COPD compared with that in the earlier stage. Furthermore, CSE exposure suppressed OTUD1 expression, which was associated with increased cell pyroptosis and elevated levels of the inflammatory cytokines IL‑1β and IL‑18. OTUD1 overexpression mitigated these effects, indicating its protective role against CSE‑induced cellular damage. Furthermore, METTL3‑mediated m6A methylation inhibited OTUD1 expression, with YTH m6A RNA binding protein 2 (YTHDF2) acting as the reader of this modification. Knockdown of METTL3 or YTHDF2 reduced m6A methylation and restored OTUD1 expression, highlighting a potential mechanism by which cigarette smoke suppresses OTUD1 through enhanced m6A methylation. In conclusion, OTUD1 may serve a protective role in COPD by inhibiting inflammation and reducing cell damage caused by cigarette smoke exposure. The suppression of OTUD1 through METTL3‑mediated m6A methylation and YTHDF2 interaction represents a novel mechanism contributing to COPD pathogenesis, suggesting potential therapeutic targets for mitigating disease progression.

Effects of maternal smoking on inflammation, autophagy/mitophagy, and miRNAs in endothelial cells: Influence of newborn sex

Maternal smoking (MS) during pregnancy is linked to well-documented adverse health effects for the mother and foetus, however the role of fetal sex was largely overlooked. Primary cultures of male and female human umbilical vein endothelial cells (MHUVECs and FHUVECs, respectively) were used. IL-6, IL-8, and TNF-α levels were measured in HUVECs supernatant. The expression of genes and proteins (oestrogen receptors (ERs), Hsp90, Beclin-1, p62, LC3, LAMP-1 and Parkin), as well as the expression of miR-29a-3p, miR-29b-3p, miR-126-3p, miR-133a-3p, and miR-146a-5p were analysed in cells obtained from foetuses born to non-smoking and smoking mothers. In HUVECs from foetuses born to non-smoking mothers, Beclin-1 protein was higher in MHUVECs (1.8 fold increase), while Parkin, Hsp90 proteins, and miR-146a-5p were elevated in FHUVECs (2.2, 2.6, and 2.1 fold increase, respectively), with no other significant differences. MS amplified these sex differences, with specific effects based on foetus sex. FHUVECs obtained from foetus born to smoking mothers showed higher levels of IL-8 (1399.36 ± 123.96 pg/ml for FHUVECs vs 655.11 ± 215.94; pg/ml for MHUVECs; P < 0.001), Hsp90 gene and protein (3.3 and 2.6 fold increase), and ERβ protein and Beclin-1 gene (2.1, and 4.9 fold increase), and lower levels of miR-29b-3p, miR-133a-3p, and miR-146a-5p than MHUVECs (0.27, 0.68, and 0.1 fold change, respectively). This study shows that primary HUVECs from fetuses born to smoking mothers retain a memory of smoking effects, with sex differences in gene expression, miRNA profiles, and autophagic responses, suggesting that maternal smoking impacts endothelial cell physiology in a sex-dependent manner.

Comprehensive analysis of smoking as a risk factor and its prognostic implications in patients with deep neck infections

BACKGROUND

Deep neck infection (DNI) is a potentially life-threatening bacterial infection that affects the anatomical spaces within the neck, with upper airway infections being among the most common etiological factors. Smoking has well-documented local and systemic effects on the respiratory tract, immune system, as well as on the skin and soft tissues. However, the relationship between smoking and the development of DNI remains inadequately addressed in the existing literature. The objective of this study is to investigate the potential association between smoking and the occurrence of DNI.

METHODS

A total of 332 patients diagnosed with DNI were enrolled in this study. Of these, 81 patients were identified as smokers, while 251 were non-smokers. A comprehensive analysis of relevant clinical data was conducted to assess the potential association between smoking status and clinical outcomes in this cohort.

RESULTS

In the univariate analysis, age ≥ 60 years (OR = 3.5161, 95 % CI: 1.0481-11.792, p = 0.0293), elevated C-reactive protein (CRP) levels ≥300 mg/L (OR = 3.9375, 95 % CI: 1.1958-12.965, p = 0.0263), and the involvement of multiple anatomical spaces (≥ 3) (OR = 5.8776, 95 % CI: 1.9446-17.764, p = 0.0012) were identified as statistically significant risk factors for prolonged hospitalization (>14 days) in patients with DNI who were smokers. Upon conducting multivariate analysis, it was found that the involvement of multiple spaces (≥ 3) (OR = 3.7383, 95 % CI: 1.1332-12.331, p = 0.0304) emerged as an independent and significant predictor of prolonged hospitalization in this cohort of smokers. However, no statistically significant differences were observed between the groups in terms of the extent of space involvement, the spectrum of pathogens, or the incidence of complications.

CONCLUSIONS

This study explored the potential association between smoking and the development of DNI. The findings demonstrated that advanced age, elevated CRP levels, and the involvement of multiple deep neck spaces were significant risk factors for prolonged hospitalization. Multivariate analysis further identified the involvement of three or more deep neck spaces as an independent predictor of extended hospital stay among smokers. Collectively, these results suggest that smokers with DNI exhibit a worse clinical prognosis, which may be attributed to smoking-induced impairments in immune function and upper respiratory tract integrity.

Analysis of the mortality trends of laryngeal cancer attributable to smoking worldwide from 1990 to 2021 and projections up to 2036

OBJECTIVE

This study aims to examine the global trends in the disease burden of laryngeal cancer (LC) attributable to smoking from 1990 to 2021, including mortality, and disability-adjusted life years (DALYs), and to predict trends for 2036.

METHODS

Data on LC attributable to smoking were obtained from the 2021 Global Burden of Disease (GBD) online database. Joinpoint regression analysis was used to calculate the average annual percent change (AAPC) to evaluate trends in LC attributable to smoking. Additionally, an Autoregressive Integrated Moving Average (ARIMA) model was applied to forecast future disease burden over the next 15 years.

RESULTS

From 1990 to 2021, the global age-standardized mortality rate (ASMR) of LC attributable to smoking decreased from 1.61 to 0.89 per 100,000 with an AAPC of -1.87%. The male mortality rate is significantly higher than that of females. In 2021, specific regions within the Balkans, the Middle East, and South Asia demonstrated notably higher compared to other global regions. According to the ARIMA model, the ASMR for LC attributable to smoking among males is projected to decline gradually from 2022 to 2036, while the decline in females is more gradual.

CONCLUSION

From 1990 to 2021, the global mortality rate of LC attributable to smoking has declined, indicating a relative reduction in disease burden. However, the burden remains disproportionately higher among older adults, with males at a greater risk of mortality than females. Although the disease burden from LC attributable to smoking is expected to decline gradually over the next 15 years, it remains imperative to enhance smoking cessation efforts to further alleviate the disease burden.

Disentangling the effects of nicotine versus non-nicotine constituents of tobacco smoke on major depressive disorder: A multivariable Mendelian randomisation study

BACKGROUND AND AIMS

There is growing evidence that tobacco smoking causes depression, but it is unclear which constituents of tobacco smoke (e.g. nicotine, carbon monoxide) may be responsible. We used Mendelian randomisation (MR) to measure the independent effect of nicotine on depression, by adjusting the effect of circulating nicotine exposure [via nicotine metabolite ratio (NMR)] for the overall effect of smoking heaviness [via cigarettes per day (CPD)] to account for the non-nicotine constituents of tobacco smoke.

DESIGN

Univariable MR and multivariable MR (MVMR) were used to measure the total and independent effects of genetic liability to NMR and CPD on major depressive disorder (MDD). Our primary method was inverse variance weighted (IVW) regression, with other methods as sensitivity analyses.

SETTING AND PARTICIPANTS

For the exposures, we used genome-wide association study (GWAS) summary statistics among European ancestry individuals for CPD (n = 143 210) and NMR (n = 5185). For the outcome, a GWAS of MDD stratified by smoking status was conducted using individual-level data from UK Biobank (n = 35 871-194 881).

MEASUREMENTS

Genetic variants associated with NMR (n = 6) and CPD (n = 53).

FINDINGS

Univariable MR-IVW indicated a causal effect of CPD on MDD [odds ratio (OR) = 1.13, 95% confidence interval (CI) = 1.04-1.23, P = 0.003] but no clear evidence for an effect of NMR on MDD (OR = 0.98, 95% CI = 0.97-1.00, P = 0.134). MVMR indicated a causal effect of CPD on MDD when accounting for NMR (IVW: OR = 1.19, 95% CI = 1.03-1.37, P = 0.017; Egger: OR = 1.13, 95% CI = 0.89-1.43, P = 0.300) and weak evidence of a small effect of NMR on MDD when accounting for CPD (IVW: OR = 0.98, 95% CI = 0.96-1.00, P = 0.057; Egger: OR = 0.98, 95% CI = 0.96-1.00, P = 0.038).

CONCLUSIONS

The role of nicotine exposure in risk of depression cannot be entirely dismissed. However, the causal effect of tobacco smoking increasing depression risk appears to be largely independent of circulating nicotine exposure, which implies the role of alternative causal pathways.

Age period cohort analysis of cancer incidence from 1990 to 2019 in Türkiye

BACKGROUND

Cancer is a major public health concern worldwide and in Türkiye, as it is one of the leading causes of disability-adjusted life years (DALYs) and mortality. This study aims to analyze long-term cancer trends in Türkiye from 1990 to 2019 using the Age-Period-Cohort (APC) model to determine the independent effects of aging, time periods, and birth cohorts on cancer incidence.

METHODS

Cancer incidence data for all cancers and the most common site-specific cancers in men and women were obtained from the Global Burden of Disease 2021 study. The analysis included 14 five-year age groups (20-94 years) and 6 five-year time periods (1990-2019). Age-standardized incidence rates (ASIR) per 100,000 persons were calculated using the world standard population. The APC analysis estimated net drift, local drifts, period rate ratios, and cohort rate ratios. The 2000-2004 period and 1945 birth cohort were set as reference points. Statistical analyses were conducted using the APC R-based Web Tool provided by the National Cancer Institute.

RESULTS

The ASIR for all cancers in men exhibited a fluctuating pattern over the study period, without a consistent annual increase or decrease; while in women, the ASIR exhibited an upward trend, increasing by 1.32 % annually, reaching its peak in 2016. Lung and stomach cancer incidence declined in males, whereas prostate, colon and rectum and bladder cancers increased. Incidence rates were higher in the periods 1990-2000 and 2010-2019 compared to the reference period (2000-2004), with similar rates in both periods. In females, breast, uterine and thyroid cancers showed substantial increases. The increase in incidence rates became particularly noticeable from the 2005-2009 period onwards. The cohort effect revealed increasing risks in recent birth cohorts, particularly for breast, uterine, thyroid, prostate and bladder cancers.

CONCLUSION

The findings highlight the dynamic nature of cancer epidemiology in Türkiye, with variations across age groups, time periods, and birth cohorts. While Türkiye's cancer incidence remains lower than in many developed countries, specific cancers, such as lung and stomach cancers, remain more prevalent. The rising burden of breast, uterine, prostate, bladder and colon and rectum cancers suggests an impact of aging, lifestyle changes, and screening programs. Continuous monitoring, preventive strategies, and early detection programs are crucial to mitigate future cancer trends.

Microplastics from cigarette filters: Comparative effects on selected terrestrial and aquatic invertebrates

Cigarette filters comprise plasticised cellulose acetate, a synthetic polymer categorized as bioplastic. They represent a significant source of microplastics (MPs), in particular microfibers, and associated chemicals, yet their impact on organisms, especially soil invertebrates, is not well-studied. This research examines the effects of MPs milled from smoked (SCF-MPs) and unsmoked cigarette filters (UCF-MPs) on terrestrial invertebrates (Porcellio scaber, Tenebrio molitor) and aquatic invertebrates (Daphnia magna, Brachionus calyciflorus). SCF-MPs and UCF-MPs were found to be 9.06 ± 4.1 μm and 12.71 ± 6.82 μm in size, respectively. Both samples contained triacetin and potentially toxic metals, while SCF-MPs also contained nicotine and a larger number of trace organic compounds. While exposure to SCF-MPs or UCF-MPs (up to 1.5 % MPs, w/w in soil) did not affect the survival of either terrestrial invertebrate, several physiological responses were observed. These included changes in immune parameters, energy-related biomarker levels, and altered glutathione S-transferase and acetylcholinesterase activities. Both types of MPs were acutely toxic to aquatic invertebrates, reducing the survival rates of B. calyciflorus (10 mg L-1 of either particle after 48h exposure) and D. magna (100 mg L-1 of SCF-MPs after 48h exposure). SCF-MPs generally caused more pronounced effects than UCF-MPs. This study highlights the need for effective environmental management to address both smoked and unsmoked cigarette filters.

Temporal changes in smoking prevalence among adolescents across 23 countries

AIM

This study aimed to investigate temporal changes in smoking prevalence among adolescents aged 13-15 across 23 countries and to assess individual and country-level factors influencing smoking behaviour.

METHODS

This study used data from 168 286 young adolescents aged 13-15 years obtained from the Global School-based Student Health, 2003-2021. Linear regression models and meta-analyses were conducted to analyse the changes in current smoking prevalence among young adolescents.

RESULTS

Among the 23 countries, smoking prevalence decreased in six countries, including Argentina, Fiji, Jamaica, Samoa, Tonga and Uruguay, while it increased in four countries, namely Guyana, Morocco, Thailand and Vanuatu. The prevalence of smoking was higher among male adolescents at 15.5% (95% CI 13.8%-17.2%) compared to females at 8.0% (95% CI 6.7%-9.3%). Adolescents exposed to secondhand smoke had a prevalence of 16.3% (95% CI 14.5%-18.2%), significantly higher than 4.2% (95% CI 3.7-4.6) in those not exposed. Smoking prevalence was 16.5% (95% CI 14.8%-18.2%) among those with smoking parents or guardians, compared to 8.1% (95% CI 7.1%-9.1%) among those without.

CONCLUSION

The findings highlight the need for tailored tobacco control measures to reduce adolescent smoking globally. Strengthening policy enforcement and addressing social determinants of smoking are critical to achieving further reductions.

Global Incidence, Risk Factors, and Temporal Trends of Adrenal Cancer: A Systematic Analysis of Cancer Registries

OBJECTIVE

Adrenal gland cancer (AGC) is a rare cancer with a poor prognosis. Studies on this cancer have been limited. This study, for the first time, aims to analyze the global disease burden and trends of AGC in country level and examine lifestyle and socioeconomic risk factors to generate hypotheses.

METHODS

The Global Cancer Observatory database was used to extract the incidence rate of AGC in 2020. Age-standardized rates (ASRs) of AGC incidence and lifestyle/metabolic risk factor prevalence were obtained from databases. Linear regression and Joinpoint regression were used to assess associations with risk factors and Average Annual Percentage Change of AGC incidence.

RESULTS

Globally, there were an estimated 16 961 new AGC cases in 2020 (ASR: 0.14 per 100 000 persons). Higher disease burden was observed mainly in European regions. ASRs were comparable between sexes (males: 0.16; females: 0.14). The higher ASR was observed among the older population aged 50 to 74 years with an ASR of 0.31 compared with the younger population aged 15 to 49 years with an ASR of 0.07. Higher AGC incidence was associated with higher Human Development Index, gross domestic product, and lifestyle-related factors such as physical inactivity, obesity, hypertension, and lipid disorder (β = 0.005-0.052).

CONCLUSION

The overall incidence trend showed a decrease, with 3 countries reporting significant decreases and 1 country reporting a significant increase. Similar patterns were observed by sex and age group, except for an overall increase among the younger population.

Burden of smoking-related stroke in Saudi Arabia: trends from 1990 to 2021

BACKGROUND

Stroke ranks among the top causes of death and disability globally, with smoking being a significant risk factor for its development. This study aims to assess the impact of smoking-related strokes in Saudi Arabia from 1990 to 2021.

METHODS

The data was extracted from the Global Burden of Disease (GBD) 2021 database. We assessed the burden of smoking-related stroke by estimating the age-standardized rate (ASR) of years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life years (DALYs) and deaths related to this disease.

RESULTS

From 1990 to 2021, there was a respective 22.37% and 24.15% absolute decrease in the ASR of DALYs and ASR of YLLs, with average annual percentage changes (AAPCs) of -0.85 (-0.88, -0.83) and -0.92 (-0.94, -0.89) attributable to smoking-related stroke in Saudi Arabia. The ASR of death fell absolutely by 28.48%, with AAPC of -1.08 (-1.11, -1.05) between 1990 and 2021. In contrast, the ASR of YLDs absolutely increased by 5.17% during the same period, with an APCC of 0.15 (0.14, 0.17). Further, the decline in AAPCs of ASR of DALYs (-1.99), ASR of YLLs (-1.79), and ASR of deaths (-1.90) was primarily influenced by the reduction in the female population, p < 0.001, except ASR of YLDs, where the increase in the AAPC was attributed to a rise in the male population, p < 0.001. In 2021, YLLs contributed 93% (157.81/179.02) of total DALYs from smoking-related strokes in Saudi Arabia. Death rates rose in all age groups in 2021, with the most significant increases seen in the younger and middle-aged groups (30-59 years).

CONCLUSION

While the rates of deaths, DALYs, and YLLs attributable to smoking-related stroke decreased in Saudi Arabia between 1990 and 2021, YLDs significantly increased, mainly in males during the same period. This emphasizes the need for targeted intervention focused mainly on the younger and middle-aged males.

Reactivity to Smoking Cues in a Social Context: Virtual Reality Experiment

Background

Social contextual factors influence the onset and maintenance of substance abuse. Virtual reality (VR) provides a standardized method to present social stimuli and is increasingly used in addiction research.

Objective

This study examines the influence of a smoking versus a nonsmoking agent in VR on craving in nicotine-dependent male participants. Our primary hypothesis was that the interaction with a smoking agent is associated with increased craving compared to a nonsmoking agent. We expected higher craving in the presence of an agent regardless of the agent's smoking status.

Methods

Using a head-mounted display (Oculus Rift), 50 nicotine-dependent smokers were exposed to four VR conditions on a virtual marketplace: first without an agent, second and third with an agent who either smoked or did not smoke in randomized order, and fourth without an agent as a follow-up condition. Before the follow-up condition, participants smoked a cigarette. Craving was assessed with the Questionnaire of Smoking Urges and a visual analog scale within VR and after each session. We also examined anxiety and agitation (visual analog scale), immersion and presence with the igroup Presence Questionnaire, and salivary cortisol levels.

Results

Results showed no significant difference in the participants' craving, anxiety, or agitation between the smoking and nonsmoking agent conditions. However, craving, anxiety, and agitation increased from the marketplace without an interacting agent to the conditions with an interacting agent, and decreased after smoking a cigarette. Immersion was low in all conditions and decreased over time. Salivary cortisol levels were highest at baseline and decreased over the course of the experiment.

Conclusions

These findings suggest that the presence of an agent (as a contextual factor) may override the specific influence of proximal stimuli (burning cigarette). The low immersion highlights the challenges in developing effective VR environments for cue exposure.

Global burden of disease related to tobacco products and trends projected: 1990-2021

BACKGROUND

The use of tobacco products is considered to be one of the most serious public health threats worldwide, and this study aims to assess the global burden of various diseases caused by tobacco use, provide the necessary scientific basis for public health authorities, and propose tobacco control policies and interventions.

METHODS

This study analyzed the major burden of disease caused by tobacco products using the Global Burden of Disease (GBD) database from 1990 to 2021. Age Standardization Rate (ASR), annual Percentage Change (EAPC) were calculated using R4.2.3 software. Disease burden prediction analysis with the help of BAPC and INLA software packages.

RESULTS

The study findings indicated that from 1990 to 2021, the number of deaths and disability-adjusted life years (DALYs) attributable to tobacco products increased annually worldwide. Cardiovascular diseases and chronic respiratory diseases are the primary disease types caused by tobacco products, with the disease burden significantly higher in males than females. Significant disparities were observed between regions with different Socio-Demographic Index (SDI) levels. High SDI countries experienced more pronounced reductions in burden, whereas countries with low, middle, and middle-high SDI levels bore higher disease burdens. By 2040, the number of deaths and disease burden attributable to tobacco products globally is projected to continue increasing annually, albeit at a slower rate.

CONCLUSION

Despite a reduction in the global disease burden caused by tobacco, countries with low, middle, and middle-high SDI levels continue to bear a substantial burden.

Global Burden of Pancreatic Cancer Among Individuals Aged 15-59 Years in 204 Countries and Territories, 1990-2021: A Systematic Analysis for the GBD 2021 and Projections to 2045

BACKGROUND

Pancreatic cancer (PC), the third leading cause of cancer-related mortality globally, exhibits a persistently low five-year survival rate (13%). While the global burden of PC among individuals aged 15-59 years has declined, trends in China remain understudied. This study evaluates global and national trends in PC incidence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2021 and projects trajectories to 2045.

METHODS

Using data from the Global Burden of Disease (GBD) 2021 study, we calculated age-standardized rates (ASRs) for 204 countries/territories. Joinpoint (version: 5.3.0.0) regression identified temporal trends via average annual percentage changes (AAPCs), and Bayesian age-period-cohort (BAPC) modeling forecasted future burdens.

RESULTS

Globally, PC burden declined among 15-59-year-olds (AAPC for incidence: -0.8%, 95% UI: -1.2 to -0.4). However, China experienced a significant reversal after 2009, with incidence rising by 1.5% annually (95% UI: 0.9-2.1), disproportionately affecting males. Smoking (contributing to 22.2% of DALYs in China) and high fasting plasma glucose (15%) emerged as key modifiable risk factors, while elevated BMI exacerbated burdens in high SDI regions (3.1% of DALYs). Projections indicate a continued surge in China's PC burden by 2045, particularly among males (incidence projected to increase by 50% from 2010 to 2045).

CONCLUSIONS

High SDI regions exhibit concentrated PC burdens linked to lifestyle factors, whereas China's rising trends align with healthcare expansion and metabolic disease proliferation. Targeted interventions-smoking cessation, glycemic control, and weight management-are imperative to mitigate growing burdens in younger populations. This study highlights the urgent need for region-specific strategies to address evolving epidemiological challenges in PC prevention and control.

Analyzing long-term trends in cotinine concentrations among smokers and non-smokers under South Korea's tobacco control policies

Following the ratification of the Framework Convention on Tobacco Control (FCTC) in 2003, South Korea has implemented various smoking cessation policies. As a result, both smoking rates and secondhand smoke (SHS) exposure rates in Korea have been steadily declining. However, there is a lack of studies analyzing long-term trends in biomarker-assessed SHS exposure across smoking status groups over time, using cotinine concentration (μg/L) as a biomarker. This study employed a repeated cross-sectional design, utilizing data from the First (2009-2011) to Fourth (2018-2020) Waves of the Korean National Environmental Health Survey. A total of 19,741 participants were selected after excluding missing data. The urinary cotinine concentrations of the smoking status groups were presented as geometric means. Multiple regression analysis was conducted to identify factors influencing cotinine concentration. Compared to 2009, cotinine levels decreased by 51.4 % in never smokers (1.40 μg/L in 2009; 0.68 μg/L in 2013), 35.2 % in former smokers (1.93 μg/L in 2009; 1.25 μg/L in 2013), and 28.0 % in current smokers (1302.46 μg/L in 2009; 937.97 μg/L in 2012) in the mid-2010s. However, cotinine levels in never smokers and former smokers have shown a steady increase since then, surpassing pre-policy levels by 2020, at 1.17 μg/L and 1.50 μg/L, respectively. The rise in cotinine levels among current non-smokers, despite FCTC-based policies, likely stems from the spread of novel nicotine products, misconceptions about e-cigarettes, and stealth usage. As urinary cotinine levels are expected to continue rising in the future, addressing these hidden contributors require enhanced surveillance and targeted interventions to ensure more effective tobacco control measures.

Bridging approaches to facilitate innovation: building an approach for heated tobacco products from case studies in the food and drug domains a comparative review

An increasing number of heated tobacco products (HTPs) have been commercialized in several countries over the last decade. To benefit public health, these products should have a lower health risk profile than cigarettes. This includes the need to be sufficiently acceptable to adults who smoke so that a reasonable proportion of those who do not want to quit smoking are persuaded to switch completely. Additionally, the product should not increase the likelihood of non-smokers starting to use tobacco or smokers increasing their total consumption of tobacco products. Part of this process involves iterative development of new product versions, leveraging lessons learned from consumer experiences with marketed products, and applying novel technologies to improve the consumer product offering. Risk assessment for these products may include pre-clinical quality, analytical and toxicity evaluations, pre-market clinical studies, and post-market surveillance studies. In recent years, approaches to bridge the assessment for modified or new products to data generated for reference products by comparing their equivalence were proposed. Here, we review the approaches taken for such bridging studies and relate them to product comparability and bridging approaches established in a diverse range of consumer and pharmaceutical products. This leads to a proposal for a logical, stepwise, and tiered bridging approach to effectively manage the introduction of new HTPs through scientific substantiation and have potential to increase the public health benefit by reducing risk and improving product acceptability for adult smokers without attracting non-smokers by new innovations.

Global Burden and Risk Factors of Stroke in Young Adults, 1990 to 2021: A Systematic Analysis of the Global Burden of Disease Study 2021

BACKGROUND

This study aimed to estimate the disease burden of ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and overall stroke among young adults (aged 15-49 years) in 204 countries and territories from 1990 to 2021, along with the associated risk factors.

METHODS

GBD (Global Burden of Disease Study) 2021 data were used to assess the burden and trends via age-standardized rates and their estimated annual percentage changes.

RESULTS

Although age-standardized rates generally declined from 1990 to 2021, the number of incident and prevalent stroke cases among young adults increased by 36% (95% uncertainty interval, 31%-41%) and 41% (95% uncertainty interval, 38%-43%), respectively. Notably, from 2015 to 2021, the age-standardized incidence of ischemic stroke and subarachnoid hemorrhage among young adults increased, with estimated annual percentage changes of 0.65 (95% CI, 0.39-0.92) and 0.58 (95% CI, 0.47-0.69), respectively. High systolic blood pressure was the primary risk factor for stroke-related disability-adjusted life-years among young adults. However, other risk factors varied by region, with higher proportions of smoking, high low-density lipoprotein cholesterol, and high body mass index in high sociodemographic index regions, and higher proportions of household air pollution from solid fuels and diet low in vegetable in low sociodemographic index regions. From 1990 to 2021, the total number of stroke-related disability-adjusted life-years among young adults due to risk factors increased by 12% (95% uncertainty interval, 2%-22%), driven principally by high systolic blood pressure, ambient particulate matter pollution, high body mass index, high low-density lipoprotein cholesterol, and high fasting blood glucose.

CONCLUSIONS

Since 2015, there has been a concerning rebound in the age-standardized incidence rates of ischemic stroke and subarachnoid hemorrhage among young adults globally. Given regional and sociodemographic index variations in risk factors, targeted and cost-effective policies and interventions are urgently needed to reduce stroke burden in this demographic.

The second Health Inequalities Module in the European Social Survey (ESS): Methodology and research opportunities

The European Social Survey (ESS) is a pan-European social survey that has mapped and explained stability and change in the attitudes, beliefs, and behaviour patterns of European populations since 2002. In 2013/14, the ESS introduced a rotating module on health and its social determinants. With this Health Inequalities module, the ESS contributed substantially to social epidemiological research and inquiry into social inequalities in health and it became a vital data source for public health research, advancing knowledge of why social inequalities in health exist in Europe and how they vary between countries and welfare states. With the second rotating Health Inequalities module in 2023/24, the ESS enables new research opportunities, primarily by generating robust and cross-national comparative data on stability and change of social inequalities in health in times of various economic, demographic, public health, and political developments. The aims of the current paper are threefold. First, we summarize key insights on health inequalities in Europe provided by data from the first ESS Health Inequalities Module. Second, we describe the methodology of the second ESS Health Inequalities Module. Third, we point to future research opportunities and offer some critical reflections. By describing in detail the analytical opportunities that the two ESS Health Inequalities Modules provide, we aim to increase engagement with the survey from a wide range of health-focused disciplines including anthropology, geography, health economics, psychology and sociology.

Risk and survival of third primary cancers in a population-based cohort of prostate cancer survivors

OBJECTIVE

To estimate the long-term risk and survival of third primary cancers (TPCs) among prostate first primary cancer (FPC) survivors.

METHODS

A population-based cohort of 13 222 males with a prostate FPC diagnosed between 2000 and 2009, registered by the North Region Cancer Registry of Portugal, was followed until 2021 for TPCs and vital status. We estimated the cumulative incidence of TPCs and the risk of death among TPCs. TPCs were compared to matched patients with a second primary cancer (SPC) only (1:1, by age group, the time between FPC and SPC, and SPC site) for risk and adjusted hazard of death.

RESULTS

For a period of up to 22 years after a prostate cancer diagnosis, 169 TPCs were identified, predominantly, in digestive, intrathoracic, and urinary tract organs; this corresponds to 15- and 20-year cumulative incidences [95% confidence interval (CI)] of 1.2% (1.0-1.4%) and 1.5% (1.2-1.8%), respectively, among the FPCs, and 9.1% (7.6-10.5%) and 12.0% (8.2-15.9%), respectively, among the SPCs. The 15-year all-cause cumulative mortality was 88.2% (82.2-94.3%) among TPCs and 75.7% (69.6-81.7%) among SPC only patients; the corresponding age-adjusted hazard ratio (95% CI) was 1.79 (1.37-2.34).

CONCLUSIONS

Among males with a prostate FPC that are diagnosed with an SPC, just over 10% are expected to be diagnosed with a TPC within 20 years, and these have a nearly two-fold higher death hazard than those with an SPC only.

Global, regional, and national burden of atrial fibrillation/flutter attributable to metabolic, behavioral, and environmental risk factors, 1990-2021: a longitudinal observational study

Background

Atrial fibrillation/flutter (AF/AFL) remains a significant global public health issue, with its development influenced by metabolic, behavioral, and environmental risk factors However, comprehensive analyses of temporal and geographic variations in AF/AFL burden attributed to risk factors remain lacking.

Objective

This study reveals the geographic and temporal distribution of the burden of AF/AFL attributable to specific risk factors at global, regional, and national levels from 1990 to 2021, providing a scientific basis for developing targeted prevention and control policies.

Methods

We extracted data on AF/AFL risk-attributable deaths, disability-adjusted life years (DALYs), age-standardized mortality rates (ASMRs), and age-standardized DALY rates (ASDRs) from the Global Burden of Disease (GBD) database for the years 1990 to 2021. The burden of AF/AFL caused by metabolic, behavioral, and environmental risk factors stratified by age, sex, region, and country. Long-term trends in the AF/AFL burden associated with specific risk factors were assessed using the average annual percentage change (AAPC).

Results

Over the past 32 years, high body mass index has been the primary contributor to the rising AF/AFL burden, with AAPCs of ASMR and ASDR at 1.66 (95% CI: 1.63-1.68) and 1.68 (95% CI: 1.67-1.70), respectively. The most significant increase occurred in males aged 30-34. The burden related to high sodium diets and lead exposure is also rising, particularly in females aged 65-69. Smoking showed the greatest decrease, with AAPCs of ASMR and ASDR at -0.66 (95% CI: -0.68 to -0.65) and -0.72 (95% CI: -0.72 to -0.71), most significantly in women aged 30-34. High systolic blood pressure decreased overall, but increased in individuals aged 34-49. East Asia saw the largest increase in burden from high body mass index, with AAPCs of ASMR at 8.28 (95% CI: 8.18-8.37) and ASDR at 8.22 (95% CI: 8.18-8.26). In 2021, China had the highest AF/AFL deaths and DALYs attributed to high systolic blood pressure, high sodium diets, smoking, and lead exposure.

Conclusion

From 1990 to 2021, high body mass index became the primary driver of the rising global AF/AFL burden, particularly affecting East Asia and young and middle-aged adults. In contrast, the burden associated with smoking showed the greatest decline. In 2021, China had the highest AF/AFL burden due to various risk factors. Given the regional variations and characteristics of high-risk populations, policymakers should develop targeted yet comprehensive prevention strategies. These measures should include promoting healthy dietary habits, strengthening global surveillance systems, and fostering data-sharing collaborations to mitigate this growing epidemic.

Global, regional, and national trends in tobacco-induced cardiovascular disease burden for 1990-2021 with projections to 2045: A comprehensive analysis based on the Global Burden of Disease Study 2021

INTRODUCTION

Tobacco use is a major risk factor for cardiovascular disease (CVD), and its global disease burden trends require further clarification. This study aims to analyze trends in global CVD burden attributable to tobacco in 1990-2021 and project mortality rates and disease burden through 2045.

METHODS

Using Global Burden of Disease Study (GBD) 2021 data, we analyzed temporal trends using age-period-cohort models, evaluated change points with Joinpoint regression, and conducted forecasting using Bayesian age-period-cohort (BAPC) models.

RESULTS

In 2021, tobacco-attributable CVD deaths reached 2.147 million globally (71.3% increase from 1990), although age-standardized mortality rates decreased to 25.36 per 100000 (83.3% reduction). Mortality rates were lowest in high SDI regions (326.71 per 100000) and highest in low-middle sociodemographic index (SDI) regions (788.05 per 100000). The proportion of deaths among those aged ≥80 years increased from 19.2% to 26.2%. Global mortality rates decreased by 1.8% annually, with a greater decline in females (-2.6%) than males (-1.6%). Projections suggest that by 2045, global CVD deaths may reach approximately 3.267 million (52.1% potential increase), although age-standardized mortality rates are expected to decrease to around 38.6 per 100000 (15.9% estimated reduction). Disability-adjusted life years (DALYs) are projected to potentially increase to 75.755 million (39.9% estimated increase), while age-standardized DALY rates could decline to approximately 1008.02 per 100000.

CONCLUSIONS

Between 1990 and 2021, global tobacco-attributable CVD mortality rates showed a declining trend, with notable regional, sex, and age disparities. Projections indicate that while age-standardized rates will continue to decrease, absolute numbers of deaths and disease burden will increase. The findings emphasize the need to strengthen tobacco control and CVD prevention in low-middle SDI regions.

Global Sociodemographic Disparities in Ischemic Heart Disease Mortality According to Sex, 1980 to 2021

BACKGROUND

Mortality due to ischemic heart disease (IHD) has declined in countries with high socioeconomic development. Whether these declines extend to other settings, and whether socioeconomic development influences IHD mortality among men and women differently, is unknown.

METHODS

We obtained annual data on sex-specific IHD mortality rates for countries/territories in the GBD study (Global Burden of Disease) from 1980 to 2021. The sociodemographic index (SI), a measure of socioeconomic development, was retrieved for each country/territory. Age-adjusted IHD mortality rates were modeled as a smooth function of sex, year, and SI.

RESULTS

From 1980 to 2021, IHD mortality rates did not decrease in low SI settings for men or women. In contrast, mortality rates relative to 1980 declined by >25% in average SI settings (age-adjusted mortality per 100 000, 153-107 for women and 218-161 for men) and >50% in high SI settings (age-adjusted mortality per 100 000, 162-69 for women and 258-114 for men). Comparing the 20th versus 80th percentile of SI in 2021 (corresponding to lower versus higher socioeconomic development), mortality rates were 81% higher for men and 111% higher for women living in socioeconomically deprived settings (P for difference by sex: 0.01), although absolute differences were larger in men. The association of low SI with higher IHD mortality was especially pronounced for mortality attributable to environmental/occupational risk factors (eg, particulate matter air pollution, lead exposure, and extremes of temperature), with mortality rates being 174% higher among women and 199% higher among men.

CONCLUSIONS

Across the past 4 decades, low socioeconomic development was associated with no improvement in IHD mortality rates for men or women, in contrast to the large reductions observed in settings with high socioeconomic development. In contemporary settings, socioeconomic deprivation is associated with larger relative excess mortality in women and larger absolute excess mortality in men.

Rapid quantitative analysis of urinary nicotine metabolites via a high-performance nanoconcentrator

Tobacco use is a widespread public health issue. The detection of smoke metabolites in body fluids using in vitro assays can offer a rapid, efficient and non-invasive approach to measure human exposure to smoke and assess its associated health risks, enabling the development of more impactful follow-up strategies. In this study, we prepared a high-performance nanoconcentrator to construct a rapid magnetic response-based integrated enrichment and detection platform, ELDI-TOF-MS, for the purpose of enriching nicotine metabolites in conjunction with successive LDI-TOF-MS analysis. Concurrently functioning as both a pre-enrichment unit and an LDI-TOF-MS matrix, the nanoconcentrator possesses a number of advantageous properties, including a rapid magnetic response within 1 s, a substantial specific surface area as high as 862 m2 g-1, high UV-vis absorption capacity, and high reproducibility in MS analysis. With these advantages, the nanoconcentrator-based ELDI-TOF-MS platform demonstrates high sensitivity and linearity for low concentration samples, rendering it suitable for both qualitative and quantitative analysis. Also, ELDI-TOF-MS responds to samples at low concentrations down to 2.5 ng mL-1. For the analysis of two metabolites of nicotine, cotinine and norcotinine, the concentrations can be enriched by 2700 and 260 times. Furthermore, the rapid and efficient process facilitates batch analysis of up to 20 samples, with each batch requiring only 40 min. It is anticipated that the platform will enhance clinical efforts to detect nicotine use and augment the depth and breadth of testing.

Hearts apart: exploring sex disparity in the global and regional burden of ischemic heart disease; a systematic analysis from the global burden of disease study 1990-2021

BACKGROUND

Worldwide, ischemic heart disease is less prevalent in women than in men, but this gap has narrowed in recent decades. This study aims to evaluate trends and gender differences in the global burden of ischemic heart disease (IHD) across demographics and regions from 1990 to 2021.

METHODS

We utilized the data of the Global Burden of Disease Study from 1990 to 2021. The standard epidemiological measurements, including incidence, prevalence, mortality rates, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs), were obtained to estimate the burden of IHD concerning age, sex, and the sociodemographic index, allowing for comparisons over time.

RESULTS

The sex parity ratio (SPR), defined as the ratio of females to males, has increased globally. The SPR of age-standardized prevalence (ASPR) and age-standardized incidence (ASIR) rose from 0.610 to 0.631 in 1990 to 0.653 and 0.670 in 2021, respectively. From 1990 to 2021, the SPRs for ASPR and ASIR of IHD increased across all age groups. However, the SPRs for the age-standardized mortality rate (ASMR) and the age-standardized DALY rates (ASDR) of IHD declined. This decrease in the SPR for both ASMR and ASDR of IHD was observed in most regions of this study.

CONCLUSIONS

While progress has been made in reducing the burden of IHD, the increasing sex disparities in specific regions and age groups emphasize the need for continuous monitoring, adaptive health policies, and sex-specific healthcare practices to ensure equitable health outcomes for all populations.

CLINICAL TRIAL NUMBER

not applicable.

Global burden of colon and rectal cancer and attributable risk factors in 204 countries and territories from 1990 to 2021

OBJECTIVE

Colon and rectal cancers (CRCs) are among the most common malignancies worldwide. While previous studies have examined the disease burden and risk factors of CRC at regional levels, they lack the granularity needed for country-specific policy development. Using updated data from the Global Burden of Disease (GBD) 2021 study, this research explores the national-level spatial distribution of CRC burdens linked to key risk factors and analyzes temporal trends in their contributions. The findings aim to support the formulation of precise public health policies to effectively reduce CRC incidence.

METHODS

Based on data from the GBD study 2021, we examined CRC-related incidence, prevalence, mortality, disability-adjusted life years (DALYs), and associated risk factors. Age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and DALY rate (ASDR) were obtained and analyzed from 1990 to 2021. We used regression analysis and stratification across the four World Bank regions to assess geographical variations and the effect of economic development levels. We further assessed the contribution of various risk factors to CRC-related deaths and DALYs, while analyzing the distribution and temporal trends of the top three contributing risk factors.

RESULTS

On a global scale, the ASDR for CRC declined from 357.33 per 100,000 in 1990 to 283.24 per 100,000 in 2021 (95% confidence interval [CI]: -0.82 to -0.64). In 2021, the regions classified by the World Bank as high income exhibited the highest ASDR in 2021, at 347.35 per 100,000, while the lower-middle-income regions reported the lowest ASDR, at 179.48 per 100,000. During this period, the global ASMR fell from 15.56 to 12.40 per 100,000, while the ASIR rose from 24.04 to 25.60 per 100,000. However, these trends were not consistent across different World Bank income regions. Key risk factors contributing to CRC included high red meat consumption, obesity, insufficient calcium intake, and alcohol consumption, with variations observed among the World Bank income groups.

CONCLUSION

Although the global burden of colorectal cancer (CRC) has declined from 1990 to 2021, particularly in high-income regions, the incidence rate continues to rise. The increase is more pronounced among individuals aged 50 years and older, who also bear a higher absolute incidence than younger populations. High red meat consumption, high body mass index (BMI), and low calcium intake remain the leading global risk factors for CRC. Effective weight management and the promotion of healthy lifestyles are essential strategies for reducing CRC risk across sexes, while smoking and alcohol control are particularly critical for alleviating the burden among males.

Global, regional, and national burden of asthma and atopic dermatitis, 1990-2021, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021

BACKGROUND

Asthma and atopic dermatitis are common allergic conditions that contribute to substantial health loss, economic burden, and pain across individuals of all ages worldwide. Therefore, as a component of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, we present updated estimates of the prevalence, disability-adjusted life-years (DALYs), incidence, and deaths due to asthma and atopic dermatitis and the burden attributable to modifiable risk factors, with forecasted prevalence up to 2050.

METHODS

Asthma and atopic dermatitis prevalence, incidence, DALYs, and mortality, with corresponding 95% uncertainty intervals (UIs), were estimated for 204 countries and territories from 1990 to 2021. A systematic review identified data from 389 sources for asthma and 316 for atopic dermatitis, which were further pooled using the Bayesian meta-regression tool. We also described the age-standardised DALY rates of asthma attributable to four modifiable risk factors: high BMI, occupational asthmagens, smoking, and nitrogen dioxide pollution. Furthermore, as a secondary analysis, prevalence was forecasted to 2050 using the Socio-demographic Index (SDI), air pollution, and smoking as predictors for asthma and atopic dermatitis. To assess trends in the burden of asthma and atopic dermatitis before (2010-19) and during (2019-21) the COVID-19 pandemic, we compared their average annual percentage changes (AAPCs).

FINDINGS

In 2021, there were an estimated 260 million (95% UI 227-298) individuals with asthma and 129 million (124-134) individuals with atopic dermatitis worldwide. Asthma cases declined from 287 million (250-331) in 1990 to 238 million (209-272) in 2005 but increased to 260 million in 2021. Atopic dermatitis cases consistently rose from 107 million (103-112) in 1990 to 129 million (124-134) in 2021. However, age-standardised prevalence rates decreased-by 40·0% (from 5568·3 per 100 000 to 3340·1 per 100 000) for asthma and 8·3% (from 1885·4 per 100 000 to 1728·5 per 100 000) for atopic dermatitis. In 2021, there were substantial variations in the burden of asthma and atopic dermatitis across different SDI groups, with the highest age-standardised DALY rate found in south Asia for asthma (465·0 [357·2-648·9] per 100 000) and the high-income super-region for atopic dermatitis (3552·5 [3407·2-3706·1] per 100 000). During the COVID-19 pandemic, the decline in asthma prevalence had stagnated (AAPC pre-pandemic -1·39% [-2·07 to -0·71] and during the pandemic 0·47% [-1·86 to 2·79]; p=0·020); however, there was no significant difference in atopic dermatitis prevalence in the same period (pre-pandemic -0·28% [-0·33 to -0·22] and during the pandemic -0·35% [-0·78 to 0·08]; p=0·20). Modifiable risk factors were responsible for 29·9% of the global asthma DALY burden; among them, high BMI was the greatest contributor (39·4 [19·6-60·2] per 100 000), followed by occupational asthmagens (20·8 [16·7-26·5] per 100 000) across all regions. The age-standardised DALY rate of asthma attributable to high BMI was highest in high-SDI settings, whereas the contribution of occupational asthmagens was highest in low-SDI settings. According to our forecasting models, we expect 275 million (224-330) asthma cases and 148 million (140-158) atopic dermatitis cases in 2050, with population growth driving this increase. However, age-standardised prevalence rates are expected to remain stable (-23·2% [-44·4 to 5·3] for asthma and -1·4% [-9·1 to 7·0] for atopic dermatitis) from 2021 to 2050.

INTERPRETATION

Although the increases in the total number of asthma and atopic dermatitis cases will probably continue until 2050, age-standardised prevalence rates are expected to remain stable. A considerable portion of the global burden could be managed through efforts to address modifiable risk factors. Additionally, the contribution of risk factors to the burden substantially varied by SDI, which suggests the need for tailored initiatives for specific SDI settings. The growing number of individuals expected to be affected by asthma and atopic dermatitis in the future suggests that it is essential to improve our understanding of risk factors for asthma and atopic dermatitis and collect disease prevalence data that are globally generalisable.

FUNDING

Gates Foundation.

Trends in cardiometabolic risk factors according to body mass index in Peru between 2015 and 2023

BACKGROUND

Global evidence has shown rising trends in the prevalence of cardiometabolic risk factors. Whether the same trends are observed according to body mass index (BMI) cut-offs is unknown, though critical to focus on specific BMI populations.

METHODS

We conducted a pooled analysis of national health surveys in Peru, grouped into three-year periods (2015-17 [n = 97,079], 2018-20 [n = 98,540], 2021-23 [n = 94,850]). BMI (kg/m²) was classified into four categories: normal weight (18-24.9), overweight (25-29.9), obesity I (30-34.9), and obesity II (≥35). For each period-BMI category, we computed the age-sex-standardized prevalence of cardiometabolic risk factors: raised blood pressure with and without self-reported antihypertensive treatment, self-reported diabetes with and without treatment, daily smoking, alcohol consumption in the last month, and fruits/vegetables consumption in the last week.

RESULTS

The proportion of people with raised blood pressure increased in the overweight and obesity groups, with the largest increase observed in the obesity II group (22 % relative increase). Diabetes prevalence rose substantially among normal weight (89 %) and overweight individuals (58 %). Smoking, alcohol, and fruit/vegetable consumption showed no major changes across BMI categories.

CONCLUSIONS

The prevalence of raised blood pressure has increased between 2015 and 17 and 2020-23, with greater increases observed in the overweight and obesity groups; conversely, the prevalence of self-reported diabetes has increased across BMI categories. These findings highlight the need for tailored interventions targeting both overweight/obese individuals and normal weight populations with diabetes risk.

Cigarette taxation and socioeconomic inequalities in under-5 mortality across 94 low-income and middle-income countries: a longitudinal ecological study

BACKGROUND

Although increasing cigarette taxes is known to improve child survival, there are few data on their effect on socioeconomic inequalities in child mortality. We investigated the association between cigarette taxation and socioeconomic inequalities in mortality in children younger than 5 years (hereafter referred to as under-5 mortality) in low-income and middle-income countries (LMICs).

METHODS

This was a longitudinal ecological study. We linked country-level annual data on 94 LMICs, as defined by the World Bank, and annual data on under-5 mortality by wealth quintile from the UN Inter-agency Group for Child Mortality Estimation from 2008 to 2020. We used fixed-effect panel regression models to assess the association of cigarette taxes with absolute and relative inequalities in under-5 mortality by wealth quintile.

FINDINGS

Increasing total cigarette tax by 10-percentage-points was associated with reduced under-5 mortality rates in all wealth quintiles. Raising total cigarette tax from 0·0-24·9% to 25·0-74·9% and 75·0% or more of their total retail value was associated with 3·8% (95% CI 0·2 to 7·3) and 7·6% (1·4 to 13·4) decreases in absolute inequality in under-5 mortality, respectively. This finding was mainly attributable to specific tax, which was associated with a 1·4% (0·3 to 2·6) reduction in absolute inequality for each 10-percentage-point increase. We estimated that raising total cigarette taxes to 75·0% or more in all 94 LMICs could have averted 281 017 (196 916 to 362 301) under-5 deaths in 2021.

INTERPRETATION

High cigarette taxes are associated with a large decrease in absolute inequality in child mortality in LMICs. These findings support raising cigarette taxes to the WHO-recommended 75% or more of the retail value to protect the poorest children.

FUNDING

Swedish Research Council for Health, Working Life, and Welfare; Stiftelsen Riksbankens Jubileumsfond; European Union's Horizon 2020 Research and Innovation; and UK National Institute for Health and Care Research.

Global Burden of Lip and Oral Cavity Cancer From 1990 to 2021 and Projection to 2040: Findings From the 2021 Global Burden of Disease Study

BACKGROUND

The aim of this study was to estimate the global burden of lip and oral cavity cancer (LOC) and its trends in different genders, age groups, regions, and countries globally.

METHODS

Data were sourced from the Global Burden of Disease 2021 study.

RESULTS

During the 32-year period, a 92.92% and 113.94% increase was estimated in the absolute counts of LOC deaths and disability-adjusted life years (DALYs), respectively. Throughout the 32-year period, males exhibited higher age-standardized rates (ASRs) of incidence (ASIRs), prevalence (ASPRs), mortality (ASMRs), and DALYs (ASDRs) related to LOC. The age group of 60-64 years consistently recorded the highest numbers of new and prevalent cases across the years 1990, 2019, and 2021. In 2019 and 2021, the highest ASMR and ASDR were observed in individuals aged 95 years and older. Regions with low-middle and low socio-demographic index (SDI) consistently showed higher ASMRs and ASDRs associated with LOC from 1990 to 2021. Eastern Europe, South, North, and Southeast Asia exhibited a concentration of countries with higher ASIRs, ASPRs, ASMRs, and ASDRs in 2021. South Asia maintained high levels of ASIRs, ASPRs, ASMRs, and ASDRs in 2021. In 2021, Palau recorded the highest ASIR, ASPR, ASMR, and ASDR, followed by Pakistan. Projections indicate that ASIR, ASPR, ASMR, and ASDR are expected to increase by 7.40%, 10.10%, 2.85%, and 4.60%, respectively, from 2021 to 2040.

CONCLUSION

LOC remains a critical public health concern that requires immediate attention, particularly among certain demographics such as males, aged 60-64 or 95 and older, as well as in low- and middle-SDI regions, particularly Eastern Europe, South Asia (notably Pakistan), North Asia, and Southeast Asia.

Tobacco smoking in Sub-Saharan Africa: A systematic review and meta-analysis

INTRODUCTION

Population-level smoking (cigarette or tobacco or nicotine use) has reduced in high-income nations, but not proportionally compared to less developed regions. This study aimed to estimate smoking prevalence in Sub-Saharan Africa (SSA).

APPROACH

Databases searched included PubMed, EMBASE, PsycINFO, African Journal Online, the Global Health Data Exchange and Google Scholar. The search terms included 'cigarette', 'smoking', 'tobacco', 'nicotine', 'prevalence' and 'Sub-Saharan Africa'. Prevalence data on smoking was extracted separately for adolescents (10-17) and adults (18+). Prevalence of lifetime, past 12- and 6-month smoking was included. Weighted pooled prevalence was calculated using MetaXL, while meta-regression analysis was conducted with Stata version 17. For the estimation of pooled prevalence, we employed a DerSimonian-Laird estimation method. The risk of bias tool was utilised to assess the quality of the studies.

KEY FINDINGS

We included 195 papers. Overall, between 2018 and 2023, the weighted lifetime smoking prevalence was 8.8% (95% confidence interval [CI] 5.1, 13.4%), with a past-year prevalence of 10.8% (CI 4.0%, 19.9%), and daily smoking was 3.5% (CI 0.0%, 9.5%) in SSA. Among adolescents, the lifetime prevalence was 4.5% (CI 2.0%, 8.0%), with a past-year prevalence of 4.1% (CI 0.0%, 13.4%) and daily smoking was 4.7% (CI 1.0%, 10.6%). Among adults, the lifetime prevalence of smoking was 12.7% (CI 6.6%, 20.4%), 12.1% (CI 2.6%, 26.2%) in the past year and daily smoking was 3.3% (CI 0.0%, 9.8%).

IMPLICATIONS

These findings highlight the importance of maintaining consistent monitoring and ensuring timely follow-up in implementing smoking prevention measures and regulations in SSA countries.

A cross-national analysis of demographic variation in daily smoking across 22 countries

Cigarette use, a leading cause of preventable disease and millions of deaths worldwide each year, is not often studied separately from other tobacco use, and global data and previous studies on cigarette smoking are based mostly on its prevalence rather than quantity. To address these oversights, we analyze the first wave of data from Global Flourishing Study, a study of over 200,000 adults nationally representative of 22 countries. We measured cigarette smoking by daily consumption per capita (mean) and per individual who smoked (intensity) as well as prevalence. The mean of daily smoking was positively correlated with the prevalence, whereas the intensity was not significantly related to the prevalence. Similarly, we found that random effects meta-analysis results of country-specific means of daily smoking in each category of demographic variables (age, gender, marital status, employment, religious service attendance, education, and immigration status) were more consistent with the results of prevalence than was the case with intensity, though there was variation across countries. Overall findings indicate the importance of studying the intensity as well as prevalence of smoking, as they are distinct and thus both required in order to assess tobacco-associated health risks and establish informed tobacco control policies.

A global perspective on smoking's impact on peptic ulcer disease: DALY trends and projections

Objective

This study aims to analyze global trends in smoking-attributable peptic ulcer disease (PUD) disability-adjusted life years (DALYs) from 1990 to 2021 and project future trends to 2046.

Methods

Data were obtained from the Global Burden of Disease Study 2021. We calculated age-standardized DALYs rates (ASDR) and estimated annual percentage changes (EAPC) for smoking-attributable PUD DALYs. Bayesian Age-Period-Cohort models were used to project future trends.

Results

From 1990 to 2021, global smoking-attributable PUD DALYs decreased significantly, with the age-standardized rate declining from 35.4 to 9.4 per 100,000 (EAPC: -4.45%). High-income regions showed faster declines, while some low- and middle-income countries experienced slower progress or even increases. Gender disparities were observed, with males consistently showing higher ASDR. Projections suggest a continued global decline in smoking-attributable PUD DALYs to 2046, with persistent regional disparities. By 2046, the global ASDR is expected to decrease to approximately 3.2 per 100,000, with higher rates persisting in certain regions such as Kiribati (44.6 per 100,000) and Cambodia (45.1 per 100,000).

Conclusion

While global smoking-attributable PUD DALYs have significantly decreased and are projected to continue declining, substantial regional and gender disparities persist. These findings underscore the need for targeted tobacco control interventions, particularly in high-risk regions and among vulnerable populations, to further reduce the global burden of smoking-attributable PUD.

Modifiable factors affects cancer-specific survival: findings from a large population-based prospective cohort study

BACKGROUND

Modifiable factors affect cancer's survival but literature did not differentiate prior to versus after cancer diagnosis. It is essential to provide references for the intervention prioritized at different stages.

METHODS

In this prospective cohort study, we analyzed national data from the UK Biobank, including 121,399 participants, to assess the association of modifiable factors with cancer-specific survival (CSS) in two independent cohorts: a pre-cancer cohort (n = 78,027) and a post-cancer cohort (n = 43,372). Additionally, a weighted standardized score was derived to evaluate the joint effects across different domains. Interactions between the six domains and age at diagnosis, sex, and cancer site were evaluated using likelihood ratio tests. Subgroup analyses were then performed for factors showing significant effect modification. Population-attributable fractions (PAF) of different domains on 5-year cancer-specific death were calculated.

RESULTS

Our study comprehensively presented the differential patterns of modifiable factors' impact on CSS among pre-cancer and post-cancer cohorts, sexes and different cancer sites. In the pre-cancer cohort, CSS were predominantly attributable to smoking/alcohol consumption (PAF 9·2%) and daily activity (PAF 10·6%). Men exhibited a higher risk than women for dietary habits (HR:1·25 versus 1·18), daily activity (HR:1·50 versus 1·29) and living environment (HR:1·13 versus 1·03). The impact of modifiable factors, including daily activity, smoking/alcohol consumption, and physical measures, on CSS varied across different cancer sites. In the post-cancer cohort, 18·6% of 5-year cancer-specific deaths were attributable to unfavourable mental health. In subgroup analysis, the risk of CSS in the domain of smoking/alcohol consumption was higher in men than that in women (HR: 1·58 versus 1·34). The impact of modifiable factors, including smoking/alcohol consumption, mental health and physical measures, on CSS varied across different cancer sites.

CONCLUSIONS

Our findings suggested that targeted prevention and early intervention strategies should be implemented to reduce the risk of cancer-related deaths.

Predictors of cigarette smoking and physical inactivity among teachers during the SARS-CoV-2 pandemic in Germany: a cross-sectional analysis of a nationwide online survey

Background

The SARS-CoV-2 pandemic significantly impacted professional and private lives, which influenced social and health-related behavior. Schools in particular were greatly affected as restrictions made teaching more challenging, leading to new stresses and additional workloads. Prior to the pandemic, teachers were already facing many physical and psychological stressors that were exacerbated by the pandemic. This may have resulted in a deterioration in the teachers' health behaviors. Therefore, the aim of this study was to examine the prevalence of cigarette smoking and physical activity among German teachers during the SARS-CoV-2 pandemic, to assess possible changes considering cigarette smoking and physical activity habits during the pandemic compared to the pre-pandemic period, and to identify predictors of teachers' cigarette smoking and physical inactivity during the pandemic.

Methods

In March 2021, a nationwide online survey was conducted among teachers in Germany. A total of 31,089 participants entered the analysis. Data on cigarette smoking and physical activity as well as sociodemographic, workplace-related, psychological, SARS-CoV-2-related, and health-related items were collected using established instruments and, if necessary, self-developed items. Two binary logistic regressions with stepwise inclusion of six different variable groups were performed to predict cigarette smoking and physical inactivity.

Results

Among all surveyed teachers, 13.9% reported smoking cigarettes, and 76.6% did not meet the physical activity recommendations. The regression analyses revealed 16 significant predictors of cigarette smoking and six significant predictors of physical inactivity.

Conclusions

The predictors revealed in the present study can help target interventions for teachers who are at higher risk for unhealthy behaviors during the SARS-CoV-2 pandemic and potential future pandemics. In particular, the alarming finding that more than three-quarters of teachers were physically inactive during the pandemic should place special emphasis on improving physical activity.

Association of the "life's crucial 9" cardiovascular health with all-cause and cardiovascular disease mortality: a national cohort study

BACKGROUND

In 2022, the American Heart Association launched an updated algorithm for quantifying cardiovascular health (CVH), termed Life's Essential 8 (LE8). This new approach has been shown to be associated with various noncommunicable chronic diseases and mortality. However, LE8 did not take into consideration the importance of psychological health on CVH. Recently, a perspective article proposed Life's Crucial 9 (LC9), which would add psychological health as another component to LE8, as a novel metric to assess CVH. This study aims to investigate the association of LC9 with all-cause and cardiovascular disease (CVD) mortality.

METHODS

This study included 23,080 adults from National Health and Nutrition Examination Survey 2005-2018, and mortality was ascertained by linkage to National Death Index records through 31 December 2019. The LC9 scoring algorithm was categorized into low (0-49), moderate (50-79), and high (80-100) CVH. Weighted Cox proportional hazards regression models and restricted cubic spline analysis were applied to evaluate the association of LC9 with mortality.

RESULTS

During a median follow-up of 7.8 years, a total of 2,388 overall deaths were identified, covering 613 CVD deaths. Compared with adults with a low CVH score, those with a high CVH score had 52% (hazard ratio, 0.48; 95% confidence interval, 0.38-0.60) and 64% (0.36; 0.23-0.56) reduced risk of all-cause and CVD mortality. Similarly, a moderate CVH score was associated with 33% (0.67; 0.58-0.78) and 49% (0.51; 0.40-0.64) reduced risk of all-cause and CVD mortality. The population-attributable fractions of high vs. moderate or low CVH score were 46.0% for all-cause mortality and 75.8% for CVD mortality. Elevated blood lipids, high body mass index, and poor sleep quality were the three major contributors to all-cause mortality, whereas nicotine exposure, unhealthy psychology, and elevated blood lipids were the three significant ones to CVD mortality. There were approximately negative linear dose-response relationships of total LC9 score with all-cause and CVD mortality.

CONCLUSIONS

Adhering to a high LC9 score is related to a reduced risk of all-cause and CVD mortality. This new CVH definition shows promise as a primordial preventive strategy to reduce mortality rates.

Estimating the Direct Medical Costs of Smoking-Attributable Non-communicable Diseases in Northeastern Iran From 2015 to 2023

Introduction: Smoking remains a significant public health issue, leading to severe non-communicable diseases (NCDs) and a considerable economic burden, particularly in low- and middle-income countries. In Iran, smoking-attributable diseases account for substantial healthcare costs. This study aims to estimate the direct medical costs of smoking-attributable NCDs in hospitals affiliated with Mashhad University of Medical Sciences from 2015 to 2023. Methods: A descriptive-analytical study was conducted using a cross-sectional design, analyzing hospital records from 2015 to 2023. The study population included all patients aged 35 and older with smoking-attributable NCDs hospitalized during this period. The smoking-attributable fraction (SAF) was calculated using prevalence data for current and former smokers and relative risk estimates for various NCDs. Direct medical costs were extracted from the hospital information system and analyzed using Microsoft Excel 2019 and STATA 14 software. Results: The total direct medical costs of smoking-related NCDs averaged $10.5 million annually, with male patients accounting for 93.4% of these costs. Cardiovascular diseases were the largest cost driver, comprising 74.1% of the total expenses, followed by respiratory diseases (15.2%) and cancers (10.7%). The attributable risk for smoking-related diseases was consistently higher in men, particularly for lung cancer (76.9%) and chronic obstructive pulmonary disease (68.3%). Conclusion: Smoking imposes a significant financial burden on the healthcare system, particularly for male patients. Targeted tobacco control interventions, such as increased taxation and public awareness campaigns, are urgently needed to reduce smoking prevalence and mitigate its economic impact on healthcare systems. Comprehensive policies could alleviate the strain on Iran's healthcare system and improve public health outcomes.

Prevalence of smoking and smoking cessation and associated factors in diabetes population aged 50 years and over in Europe

The aim of this study was to determine prevalence of smokers and ex-smokers in the older diabetes population in Europe and to evaluate the relationship with various sociodemographic and lifestyle risk factors. This epidemiological study used Wave 8 of the multidisciplinary and cross-national SHARE database, which includes cross-sectional data on health, socio-economic status and social and family networks of individuals aged 50 and over from 27 European countries. Among the 6,903 participants with diabetes, 12.2% were current smokers, 29.9% were former smokers and 57.9% had never smoked. Among countries' diabetes populations, the highest prevalence of ex-smokers (57.6%) with a low prevalence of smokers (9.5%) was seen in the Netherlands. The highest prevalence of never-smokers (84.2%) was found in Latvia, with the lowest prevalence of ex-smokers (7.9%). Austria had the highest prevalence of current smokers (17.9%) along with a below-average prevalence of ex-smokers (26.5%) was seen in Austria. Normal weight, being overweight, lower education, living without a partner, living in larger cities, drinking alcohol in the last 7 days, lower age, and being male were associated with a higher risk of being a current smoker. The study shows high prevalence of smoking among the older diabetes population in Europe and provides data on the association of smoking with several risk factors and country-specific differences in smoking prevalence.

Latent Structure of Past 12-Month Tobacco Use in Wave 6 of the Population Assessment of Tobacco and Health: Examining for Differential Substructure by Generational Status

INTRODUCTION

Tobacco product usage patterns vary significantly across different segments of the population. Combustible tobacco product usage decreased from 19.3% to 12.5%, while electronic cigarette (ECIG) use rose from 1.8% to 3.7% for the US population from 2010 to 2020. However, age-specific estimates differ between younger and older adults. It is possible there are latent subpopulations within American adults.

METHOD

Data from Wave 6 of the Population Assessment of Tobacco and Health survey (PATH, N = 30,516) were analyzed. Participants were classified as a member of Generation Z (N = 10,920), Millennials (N = 10,450), Generation X (N = 6122), or Baby Boomers (N = 3024) via a 6-level ordinal variable collected by PATH. Latent class analysis (LCA) identified distinct groups based on 8 tobacco use variables.

RESULTS

Analysis suggests that a 4-class solution provides the optimal solution for the entire sample. These classes comprised of a low-use class, a high-use class, ECIG Plus (defined as ECIG use with less probability of other tobacco product use), and a conventional user class, defined as high probability on conventional tobacco products. A 4-class solution also provided optimal fit for each generation, though the classes were defined differently.

DISCUSSION

Understanding tobacco use patterns across different classes is crucial for public health interventions. The discovery of a possible class of social users among Generation Z and Millennials suggests that targeted interventions tailored to the social contexts and behaviors of younger generations may be effective while pharmacological treatments may be more efficacious for Baby Boomers.

Differential Associations Between Individual Time Poverty and Smoking Behavior by Gender, Marital Status, and Childrearing Status Among Japanese Metropolitan Adults

Time availability has been recognized as a social determinant of health. However, the association between time poverty and smoking behavior remains to be fully investigated. The aim of this current study was to examine the association between time poverty and smoking behavior by gender, marital status, and childrearing status, which differentially affect time resource availability. We used data from a population-based survey in the greater Tokyo metropolitan area. Participants were men and women aged 25-50 years (N = 2500). Time poverty was defined as a shortage of preferred leisure time compared to actual scheduled leisure time. Descriptive statistics and modified Poisson regression analyses were conducted, and stratified by gender. The study revealed that time poverty may relate to the prevalence of current smoking among single mothers with preschool-age children. However, this trend was not found for men. The findings suggest that time poverty may be heterogeneously associated with smoking propensity depending on gender-bound social roles and resources, which deserves further research for targeting appropriate interventions for health equity.

Renal Hyperfiltration as a New Mechanism of Smoking-Related Mortality

INTRODUCTION

Renal hyperfiltration (RHF), an established risk factor for mortality, is prevalent among tobacco smokers. The aim of this study was to assess the mediating role of RHF in the association between smoking and mortality.

AIMS AND METHODS

Data of this study were retrieved from the cohort of the Kuopio Ischemic Heart Disease Risk Factor Study (KIHD), including 2064 males from Finland. Study participants were followed over a 35-year period. Using classic and counterfactual mediation analysis approaches, we estimated the mediative effect of RHF in the association between smoking and each of the following outcomes: All-cause mortality, cardiovascular disease (CVD) mortality, and non-CVD mortality.

RESULTS

The risk of all-cause mortality in smokers was twice that in nonsmokers (hazard ratio [HR], 2.06; 95% confidence interval [CI]: 1.84 to 2.31). Under the counterfactual framework the direct effect of smoking on all-cause mortality, controlled for RHF, corresponded to an HR of 2.00 (95% CI: 1.78 to 2.30). Of the effect of smoking on mortality, 5% (p-value = .016) was mediated by RHF. This finding concerned particularly non-CVD mortality.

CONCLUSIONS

RHF mediated the effect of smoking on non-CVD and all-cause mortality, but not on CVD mortality. The generalizability of our study results is however limited by its focus on a Finnish male cohort, underscoring the need for further investigation into RHF's broader implications across diverse populations.

IMPLICATIONS

This study elucidates the complex interplay between smoking, renal hyperfiltration (RHF), and mortality, offering novel insights into the mediating role of RHF. Our findings demonstrate that RHF significantly mediates the relationship between smoking and non-cardiovascular disease (non-CVD), but not CVD mortality. This distinction underscores the multifaceted role of RHF beyond its established association with cardiovascular events. By highlighting the specific pathways through which RHF mediates some of the smoking-attributed mortality, this research contributes to our understanding of the mechanisms linking smoking to mortality.

A Stop-Smoking Strategy After Cervical Cancer Screening: Results of a Cluster-Randomized Controlled Trial in Dutch General Practice

INTRODUCTION

This study aimed to assess whether brief stop-smoking advice given to women who smoke and visit their general practice for cervical cancer screening improves smoking cessation outcomes.

AIMS AND METHODS

This two-arm cluster-randomized controlled trial was conducted in 75 Dutch general practices. Participants in the intervention group received brief stop-smoking advice based on the Ask-Advise-Connect method, delivered by a practice assistant. Patient-reported outcomes were measured at 6 months: undertaking a serious quit attempt of at least 24 hours during follow-up (primary outcome), 7-day point prevalence abstinence at 6 months, reduction in number of cigarettes smoked, increase in motivation to quit smoking, exposure to advice or support, and other psychological and behavioral measurements.

RESULTS

There was no significant difference in undertaking a serious quit attempt between the intervention (39.8% of n = 266) and control group (36.0% of n = 214), odds ratio 1.18 (95% confidence intervals: 0.80-1.72, p = .41). Neither did the point prevalence abstinence significantly differ between groups: 21.1% versus 16.3%, odds ratio 1.38 (95% confidence interval: 0.83-2.29, p = .21). Although nonsignificant, the direction of effects for the aforementioned outcomes was in favor of the intervention group. The reduction in the number of cigarettes smoked and increase in motivation to quit did not differ between groups. The uptake of cessation counseling was higher in the intervention (14.7%) than in the control group (2.8%).

CONCLUSIONS

A brief stop-smoking strategy after the smear test for cervical screening might encourage women who smoke to attempt quitting and seek cessation counseling, but a significant effect could not be demonstrated in this trial.

IMPLICATIONS

The results of this cluster-randomized trial suggest that brief advice to stop-smoking delivered by a practice assistant after routine cervical screening in general practice might encourage women who smoke to attempt quitting, but a significant effect could not be proven. Also, women who receive advice show a higher uptake of professional cessation counseling compared to their controls. Providing brief advice after the cervical smear might therefore be a useful opportunistic approach to stimulate cessation in women who smoke.

Indirect adjustment of tobacco smoking in occupational studies of lung cancer: A systematic review of the available methods and their applications

Tobacco smoking is an important risk factor and potentially a major confounding factor in occupational lung cancer studies. However, as individual information on tobacco smoking is often not available, indirect adjustment methods may be used to account for potential confounding from smoking. Therefore, we aimed at providing an overview of the available indirect adjustment methods for smoking in studies of occupational exposures and lung cancer risk. We conducted a systematic search of relevant studies that applied statistical methods for indirect adjustment of tobacco smoking and were published between 1-Jan-2000 and 2-Apr-2025 to capture developments in recent decades. Studies were retrieved from Embase, MEDLINE, and Web of Science. Fifteen studies fulfilled our inclusion criteria and were included. We grouped the studies into four methods of indirect smoking adjustment: (1) without distributions for adjusted data; (2) distributions for adjusted data; (3) negative control outcomes; (4) factor analysis models. For studies with an external comparison group, percentage change in estimates from before to after indirect adjustment ranged -36.1 %_to_+ 17.3 %, while the corresponding range for those with internal comparison was -16.2 %_to_+ 47.8 %. The choice of indirect adjustment method depends on the use of reference group (external vs. internal) and the data available. Adjustment methods 1 and 2 use partial cohort data or ancillary data from other similar workers and may be preferable over methods 3 and 4, if such data are available. Methods 3 and 4 may be well suited if such data are lacking but have stronger assumptions.

Global Prevalence of Mitral Regurgitation: A Systematic Review and Meta-Analysis of Population-Based Studies

Background/Objectives: Mitral regurgitation (MR) is the most common left heart valve disease, but its exact prevalence remains uncertain. To estimate the prevalence of MR we conducted a systematic review and meta-analysis of population-based studies. Methods: We searched the Medline/PubMed, Embase, and Scopus databases, in January 2023, for studies reporting or allowing for the calculation of the prevalence of moderate-to-severe MR in the general population. Eligible studies included those using echocardiography or primary care databases from countries with universal healthcare. Studies where echocardiography was performed for medical indications were excluded. Random-effects meta-analysis was used to calculate the pooled estimates. Subgroup and meta-regression analyses were employed to investigate the reasons for heterogeneity. Mixed-model multivariable meta-regression was used to estimate age- and sex-specific prevalence. Results: After screening 13,847 records, we identified 20 eligible studies (22 study populations) including 6,036,691 individuals. The global prevalence of moderate-to-severe MR was 0.67% (95% CI, 0.33-1.11). Prevalence increased greatly with age, and it was estimated to be approximately 0.63% (0.25-1.16) at age 50, 2.85% (1.96-3.90) at 70, and 6.45% (4.17-9.16) by 90 years. North America showed the largest crude prevalence (1.11%; 0.52-1.88), followed by Europe (0.60%; 0.34-0.92), Asia (0.24%; 0.00-0.92), and Africa (0.16%; 0.03-0.37). Differences in prevalence by geographic region and ethnic group were primarily attributable to population age. Prevalence did not differ by sex, study year, or diagnostic criteria. Conclusions: Moderate-to-severe MR is a prevalent condition, particularly among elderly people. With rising life expectancy worldwide, ensuring universal access to interventions will be vital to reduce morbidity and mortality.

Mapping indicators of tobacco and related product use: Unveiling challenges and variations in the Eurobarometer surveys over three decades

INTRODUCTION

The European Commission's Special Eurobarometer surveys on tobacco are widely used as comparable and representative data across the European Union for monitoring consumption patterns. Despite their broad use, certain challenges persist, including inconsistencies in survey timelines and variations in the collected information across waves. This study aims to identify available tobacco and related product indicators, and assess their temporal comparability, to support researchers to better understand the potential uses of these data and their alignment with other sources.

METHODS

We explored questionnaires and reports in these surveys on tobacco from the Eurobarometer official website since its inception (1992, 2002, 2005, 2006, 2008, 2009, 2012, 2014, 2017, 2020 and 2023 waves). We extracted and compared questions and responses on use of tobacco and related products, as well as on sociodemographic variables. Finally, we compared all indicators, including frequency and wording, and further mapped the consistency of the indicators and type of product used across the different waves.

RESULTS

Current, daily, former and never use of conventional cigarettes has been consistently assessed across all waves, enabling temporal comparisons. From 2009, the surveys have expanded to include e-cigarette use; since 2012, the surveys include various combusted products such as cigars, pipes, cigarillos, and waterpipes, and from 2020, heated tobacco products. By contrast, detailed data on product-specific use intensity and initiation remain limited. While indicators for secondhand smoke exposure and smoking cessation were present in multiple waves, their comparability is hindered by variations in question-wording and responses.

CONCLUSIONS

Some challenges exist in using Eurobarometer surveys for temporal estimation of tobacco-related burden. Nonetheless, these surveys remain a valuable and unique tool for monitoring tobacco and related product use across the European Union. To further enhance their utility, periodic re-evaluation by tobacco control experts is recommended to ensure that the surveys maintain comparability with past data while capturing effectively emerging products and trends.

Double Jeopardy: Does Intersectional Discrimination Moderate the Relationship Between Acculturation and Cigarette Dependence Among Latinx Sexual Minority Men Current Smokers?

INTRODUCTION

The Double Jeopardy Hypothesis posits that sexual minority people of color may have a greater risk of substance use because of dealing with heterosexism and racism. We sought to test this hypothesis by examining whether appraisal of intersectional forms of discrimination predict greater cigarette dependence and whether acculturation attenuates that relationship among Latinx sexual minority men (SMM) who smoke.

METHODS

Participants were 258 Latinx SMM who identified as current smokers recruited via Amazon Mechanical Turk (MTurk). OLS regressions tested (1) the relationship between appraisal of intersectional forms of discrimination (total and subscales) and Hispanic/non-Hispanic acculturation on cigarette dependence, and (2) the moderating effects of appraisal of intersectional discrimination (total and subscales) on the relationship between Hispanic/non-Hispanic acculturation and cigarette dependence.

RESULTS

In line with our hypotheses, non-Hispanic acculturation was associated with lower cigarette dependence. Appraisal of intersectional discrimination and subscales moderated the relationship between non-Hispanic acculturation and cigarette dependence. Simple slopes tests showed that the effects of non-Hispanic acculturation on cigarette dependence were strongest for those who experience lower intersectional discrimination.

CONCLUSION

Our findings suggest that Latinx SMM may have resilience that helps them deal with the negative effects of discrimination on cigarette dependence, especially for those who are more acculturated to the U.S. These findings may point to Latinx SMM taking on U.S. negative views towards smoking. However, future studies should use a more nuanced assessment of acculturation that does not rely on a language-based acculturation measure.

Identifying roles in smoking cessation care for different types of healthcare providers: a qualitative study with people who smoke

Objective

This study aimed to explore how people who smoke, in particular those with a lower socioeconomic position, perceive the roles of different healthcare providers in smoking cessation care.

Methods

Three semi-structured focus groups were held with a total of 15 people who smoke in community centres situated in low socioeconomic position neighbourhoods in the Netherlands. The focus groups were part of a larger study aimed at improving the delivery of smoking cessation care within primary care. Focus group transcripts were thematically analysed.

Results

Participants believed it is the role of the general practitioner to initiate a conversation about smoking and inform them about the options for quitting. A quit advice from a medical specialist carried most weight for several participants. Participants felt that pharmacists and doctor's assistants are insufficiently qualified to advise on quitting smoking.

Conclusion

People who smoke and have a lower socioeconomic position seem to have clear ideas about the roles of different healthcare providers in smoking cessation care. These ideas appear to be tied to the perception of whether a healthcare provider is qualified to address smoking.

Practice implications

Doctors can use their authority to address smoking and provide advice. Actions are needed to improve people's perceptions of non-physicians in smoking cessation care.

Global burden and future trends of head and neck cancer: a deep learning-based analysis (1980-2030)

BACKGROUND

Head and neck cancer (HNC) becomes a vital global health burden. Accurate assessment of the disease burden plays an essential role in setting health priorities and guiding decision-making.

METHODS

This study explores data from the Global Burden of Disease (GBD) 2021 study, involving totally 204 countries during the period from 1980 to 2021. The analysis focuses on age-standardized incidence, mortality, and disability-adjusted life years (DALYs) for HNC. A Transformer-based model, HNCP-T, is used for the prediction of future trends from 2022 to 2030, quantified based on the estimated annual percentage change (EAPC).

RESULTS

The global age-standardized incidence rate (ASIR) for HNC has escalated between 1980 and 2021, with men bearing a higher burden than women. In addition, the burden rises with age and exhibits regional disparities, with the greatest impact on low-to-middle sociodemographic index (SDI) regions. Additionally, the model predicts a continued rise in ASIR (EAPC = 0.22), while the age-standardized death rate (ASDR) is shown to decrease more sharply for women (EAPC = -0.92) than men (EAPC = -0.54). The most rapid increase in ASIR is projected for low-to-middle SDI countries, while ASDR and DALY rates are found to decrease in different degrees across regions.

CONCLUSIONS

The current work offers a detailed analysis of the global burden of HNC based on the GBD 2021 dataset and demonstrates the accuracy of the HNCP-T model in predicting future trends. Significant regional and gender-based differences are found, with incidence rates rising, especially among women and in low-middle SDI regions. Furthermore, the results underscore the value of deep learning models in disease burden prediction, which can outperform traditional methods.

A blood- and brain-based EWAS of smoking

DNA methylation offers an objective method to assess the impact of smoking. In this work, we conduct a Bayesian EWAS of smoking pack years (n = 17,865, ~850k sites, Illumina EPIC array) and extend it by analysing whole genome data of smokers and non-smokers from Generation Scotland (n = 46, ~4-21 million sites via TWIST and Oxford Nanopore sequencing). We develop mCigarette, an epigenetic biomarker of smoking, and test it in two British cohorts. Results of brain- and blood-based EWAS (nbrain=14, nblood = 882, >450k sites, Illumina arrays) reveal several loci with near-perfect discrimination of smoking status, but which do not overlap across tissues. Furthermore, we perform a GWAS of epigenetic smoking, identifying several smoking-related loci. Overall, we improve smoking-related biomarker accuracy and enhance the understanding of the effects of smoking by integrating DNA methylation data from multiple tissues and cohorts.