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Global Effects of Smoking, of Quitting, and of Taxing Tobacco

Prabhat Jha, M.D., D.Phil., and Richard Peto, F.R.S.

N Engl J Med 2014; 370:60-68January 2, 2014DOI: 10.1056/NEJMra1308383

On the basis of current smoking patterns, with a global average of about 50% of young men and 10% of young women becoming smokers and relatively few stopping, annual tobacco-attributable deaths will rise from about 5 million in 2010 to more than 10 million a few decades hence,1-3 as the young smokers of today reach middle and old age. This increase is due partly to population growth and partly to the fact that, in some large populations, generations in which few people smoked substantial numbers of cigarettes throughout adult life are being succeeded by generations in which many people did so. There were about 100 million deaths from tobacco in the 20th century, most in developed countries.2,3 If current smoking patterns persist, tobacco will kill about 1 billion people this century, mostly in low- and middle-income countries. About half of these deaths will occur before 70 years of age.1-4

The 2013 World Health Assembly called on governments to reduce the prevalence of smoking by about a third by 2025,5 which would avoid more than 200 million deaths from tobacco during the remainder of the century.2,3 Price is the key determinant of smoking uptake and cessation.6-9 Worldwide, a reduction of about a third could be achieved by doubling the inflation-adjusted price of cigarettes, which in many low- and middle-income countries could be achieved by tripling the specific excise tax on tobacco. Other interventions recommended by the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) and the WHO six-point MPOWER initiative4 could also help reduce consumption7,8 and could help make substantial increases in specific excise taxes on tobacco politically acceptable. Without large price increases, a reduction in smoking by a third would be difficult to achieve.

The WHO has also called for countries to achieve a 25% reduction between 2008 and 2025 in the probability of dying from noncommunicable disease between 30 and 70 years of age.10 Widespread cessation of smoking is the most important way to help achieve this goal, because smoking throughout adulthood substantially increases mortality from several major noncommunicable diseases (and from tuberculosis).1-3,11-19

To help achieve a large reduction in smoking in the 2010s or 2020s, governments, health professionals, journalists, and other opinion leaders should appreciate the full eventual hazards of smoking cigarettes from early adulthood, the substantial benefits of stopping at various ages, the eventual magnitude of the epidemic of tobacco-attributable deaths if current smoking patterns persist, and the effectiveness of tax increases and other interventions to reduce cigarette consumption.

Three Key Messages for Smokers in the 21st Century
First, the risk is big. Large studies in the United Kingdom, the United States, Japan, and India have examined the eventual effects on mortality in populations of men and of women in which many began to smoke in early adult life and did not quit.11-16 All these studies showed that in middle age (about 30 to 69 years of age), mortality among cigarette smokers was two to three times the mortality among otherwise similar persons who had never smoked, leading to a reduction in life span by an average of about 10 years (Figure 1Figure 1Loss of a Decade of Life Expectancy from Smoking Cigarettes throughout Adulthood.). This average reduction combines zero loss for those not killed by tobacco with an average loss of well over a decade for those who are killed by it.

Second, many of those killed are still in middle age, losing many years of life. Some of those killed in middle age might have died soon anyway, but others might have lived on for decades. On average, those killed in middle age by smoking lose about 20 years of life expectancy as compared with persons who have never smoked.1

Third, stopping smoking works. Those who have smoked cigarettes since early adulthood but stop at 30, 40, or 50 years of age gain about 10, 9, and 6 years of life expectancy, respectively, as compared with those who continue smoking.

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copia integrale del testo si può trovare al seguente link:
http://www.nejm.org/doi/full/10.1056/NEJMra1308383?query=TOC

(Articolo pubblicato dal CUFRAD sul sito www.alcolnews.it)