Global, regional, and national prevalence of second-hand smoke and attributable disease burden in 204 countries and territories, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023
Abstract
BACKGROUND: Second-hand smoke (SHS) exposure remains a major source of morbidity and mortality among non-smokers. This study presents the first dedicated Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) publication to systematically quantify SHS prevalence and evaluate its effect as a global risk factor across a broader range of outcomes. METHODS: Using the GBD 2023 comparative risk assessment framework, we estimated SHS exposure prevalence and attributable disease burden across 204 countries and territories from 1990 to 2023, stratified by age and sex. Exposure estimates were derived by synthesising population-based surveys and household composition data through spatiotemporal Gaussian process regression. Relative risks for nine health outcomes, now including asthma, were estimated using the Burden of Proof methodology, and applied to calculate attributable deaths and disability-adjusted life-years (DALYs). FINDINGS: In 2023, an estimated 2·71 billion (95% UI 2·44-3·02) people worldwide were exposed to SHS, including 767 million (687-858) children aged 0-14 years. Age-standardised prevalence was highest in southeast Asia, east Asia, and Oceania (48·4% [44·0-53·4]), with female individuals in some countries experiencing nearly 1·8 times the exposure prevalence of male individuals. Despite a 22·2% (10·6-32·4) decline in global age-standardised prevalence since 1990, this progress has not been sufficient to reduce the absolute number of exposed individuals, which has remained stable globally and has risen sharply in sub-Saharan Africa (98·5% [62·0-144·4] increase) and North Africa and the Middle East (72·1% [47·8-101·8] increase). In 2023, SHS exposure accounted for 1·66 million (1·33-2·07) deaths and 44·8 million (35·8-54·3) DALYs globally. Ischaemic heart disease was the leading contributor to SHS-attributable DALYs (12·0 million [9·31-15·2]) overall, while lower respiratory infections predominated among children (5·16 million [3·48-7·12]). INTERPRETATION: We estimated that SHS remains a substantial driver of global health loss, particularly through cardiovascular and paediatric respiratory diseases. Persistent geographical disparities and growing absolute numbers of exposed individuals in several regions underscore the urgent need for accelerated implementation and enforcement of comprehensive tobacco control measures, particularly to protect women and children in both public and domestic environments. FUNDING: Bloomberg Philanthropies and the Gates Foundation.
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BibTeX
@article{flor2026global,
title = {{Global, regional, and national prevalence of second-hand smoke and attributable disease burden in 204 countries and territories, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023}},
author = {Luisa Flor and Jason Anderson and Brooks Morgan and Marie Ng and Bhoomadevi a C and Hasan Aalruz and Ukachukwu Abaraogu and Samar Abd Elhafeez and Michael Abdelmasseh and Meriem Abdoun and Zinat Abdrakhmanova and Rashad Abdul-Ghani and Toufik Abdul-Rahman and Asrat Agalu Abejew and Olugbenga Olusola Abiodun and Olumide Abiodun and Richard Gyan Aboagye and Nagah Abourashed and Dariush Abtahi and Fuad Hamdi A Abuadas and Aminu Kende Abubakar and Bilyaminu Abubakar and Rana Kamal Abu-Farha and Hana Abukhadijah and Aseel Aburub and Salahdein Aburuz and Apurba Acharya and Kiran Acharya and Lisa Adams and Tajudeen Adesanmi Adebisi and Babatope Oluwadamilare Adebiyi and Oluwatobi Adegbile and Adekola George Adepoju and Daniel Adeyemi Adepoju and Miracle Ayomikun Adesina and Wirawan Adikusuma and Bereket Alemayehu Admasu and Aanuoluwapo Adeyimika Afolabi and Mahnaz Afshari and Muhammad Sohail Afzal and Saira Afzal and Dhiraj Motilal Agarwal and Feleke Doyore Agide and Antonella Agodi and Abdul Momin Rizwan Ahmad and Aqeel Ahmad and Danish Ahmad and Khabir Ahmad and Saheem Ahmad and Sajjad Ahmad and Suhaib Ahmad and Ali Ahmed and Ayman Ahmed and Haroon Ahmed and Jahanzaib Mian Ahmed and Khalid Ahmed and Md Faisal Ahmed and Mohamed Mustaf Ahmed and Mohamed Sherif Ali Ahmed and Shahzaib Ahmed},
journal = {The Lancet Public Health},
year = {2026},
month = oct,
doi = {10.1016/s2468-2667(26)00168-4},
url = {https://hal.science/hal-05804462v1},
note = {CC BY},
}
RIS
TY - JOUR
TI - Global, regional, and national prevalence of second-hand smoke and attributable disease burden in 204 countries and territories, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023
AU - Luisa Flor
AU - Jason Anderson
AU - Brooks Morgan
AU - Marie Ng
AU - Bhoomadevi a C
AU - Hasan Aalruz
AU - Ukachukwu Abaraogu
AU - Samar Abd Elhafeez
AU - Michael Abdelmasseh
AU - Meriem Abdoun
AU - Zinat Abdrakhmanova
AU - Rashad Abdul-Ghani
AU - Toufik Abdul-Rahman
AU - Asrat Agalu Abejew
AU - Olugbenga Olusola Abiodun
AU - Olumide Abiodun
AU - Richard Gyan Aboagye
AU - Nagah Abourashed
AU - Dariush Abtahi
AU - Fuad Hamdi A Abuadas
AU - Aminu Kende Abubakar
AU - Bilyaminu Abubakar
AU - Rana Kamal Abu-Farha
AU - Hana Abukhadijah
AU - Aseel Aburub
AU - Salahdein Aburuz
AU - Apurba Acharya
AU - Kiran Acharya
AU - Lisa Adams
AU - Tajudeen Adesanmi Adebisi
AU - Babatope Oluwadamilare Adebiyi
AU - Oluwatobi Adegbile
AU - Adekola George Adepoju
AU - Daniel Adeyemi Adepoju
AU - Miracle Ayomikun Adesina
AU - Wirawan Adikusuma
AU - Bereket Alemayehu Admasu
AU - Aanuoluwapo Adeyimika Afolabi
AU - Mahnaz Afshari
AU - Muhammad Sohail Afzal
AU - Saira Afzal
AU - Dhiraj Motilal Agarwal
AU - Feleke Doyore Agide
AU - Antonella Agodi
AU - Abdul Momin Rizwan Ahmad
AU - Aqeel Ahmad
AU - Danish Ahmad
AU - Khabir Ahmad
AU - Saheem Ahmad
AU - Sajjad Ahmad
AU - Suhaib Ahmad
AU - Ali Ahmed
AU - Ayman Ahmed
AU - Haroon Ahmed
AU - Jahanzaib Mian Ahmed
AU - Khalid Ahmed
AU - Md Faisal Ahmed
AU - Mohamed Mustaf Ahmed
AU - Mohamed Sherif Ali Ahmed
AU - Shahzaib Ahmed
PY - 2026
DA - 2026/10/17
JO - The Lancet Public Health
DO - 10.1016/s2468-2667(26)00168-4
UR - https://hal.science/hal-05804462v1
AB - BACKGROUND: Second-hand smoke (SHS) exposure remains a major source of morbidity and mortality among non-smokers. This study presents the first dedicated Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) publication to systematically quantify SHS prevalence and evaluate its effect as a global risk factor across a broader range of outcomes. METHODS: Using the GBD 2023 comparative risk assessment framework, we estimated SHS exposure prevalence and attributable disease burden across 204 countries and territories from 1990 to 2023, stratified by age and sex. Exposure estimates were derived by synthesising population-based surveys and household composition data through spatiotemporal Gaussian process regression. Relative risks for nine health outcomes, now including asthma, were estimated using the Burden of Proof methodology, and applied to calculate attributable deaths and disability-adjusted life-years (DALYs). FINDINGS: In 2023, an estimated 2·71 billion (95% UI 2·44-3·02) people worldwide were exposed to SHS, including 767 million (687-858) children aged 0-14 years. Age-standardised prevalence was highest in southeast Asia, east Asia, and Oceania (48·4% [44·0-53·4]), with female individuals in some countries experiencing nearly 1·8 times the exposure prevalence of male individuals. Despite a 22·2% (10·6-32·4) decline in global age-standardised prevalence since 1990, this progress has not been sufficient to reduce the absolute number of exposed individuals, which has remained stable globally and has risen sharply in sub-Saharan Africa (98·5% [62·0-144·4] increase) and North Africa and the Middle East (72·1% [47·8-101·8] increase). In 2023, SHS exposure accounted for 1·66 million (1·33-2·07) deaths and 44·8 million (35·8-54·3) DALYs globally. Ischaemic heart disease was the leading contributor to SHS-attributable DALYs (12·0 million [9·31-15·2]) overall, while lower respiratory infections predominated among children (5·16 million [3·48-7·12]). INTERPRETATION: We estimated that SHS remains a substantial driver of global health loss, particularly through cardiovascular and paediatric respiratory diseases. Persistent geographical disparities and growing absolute numbers of exposed individuals in several regions underscore the urgent need for accelerated implementation and enforcement of comprehensive tobacco control measures, particularly to protect women and children in both public and domestic environments. FUNDING: Bloomberg Philanthropies and the Gates Foundation.
SN - 2468-2667
ER -