Exposure to second-hand smoke is common in many countries but the magnitude of the
problem worldwide is poorly described. We aimed to estimate the worldwide exposure
to second-hand smoke and its burden of disease in children and adult non-smokers in
The burden of disease from second-hand smoke was estimated as deaths and disability-adjusted
life-years (DALYs) for children and adult non-smokers. The calculations were based
on disease-specific relative risk estimates and area-specific estimates of the proportion
of people exposed to second-hand smoke, by comparative risk assessment methods, with
data from 192 countries during 2004.
Worldwide, 40% of children, 33% of male non-smokers, and 35% of female non-smokers
were exposed to second-hand smoke in 2004. This exposure was estimated to have caused
379,000 deaths from ischaemic heart disease, 165,000 from lower respiratory infections,
36,900 from asthma, and 21,400 from lung cancer. 603,000 deaths were attributable
to second-hand smoke in 2004, which was about 1·0% of worldwide mortality. 47% of
deaths from second-hand smoke occurred in women, 28% in children, and 26% in men.
DALYs lost because of exposure to second-hand smoke amounted to 10·9 million, which
was about 0·7% of total worldwide burden of diseases in DALYs in 2004. 61% of DALYs
were in children. The largest disease burdens were from lower respiratory infections
in children younger than 5 years (5,939,000), ischaemic heart disease in adults (2,836,000),
and asthma in adults (1,246,000) and children (651,000).
These estimates of worldwide burden of disease attributable to second-hand smoke suggest
that substantial health gains could be made by extending effective public health and
clinical interventions to reduce passive smoking worldwide.
Swedish National Board of Health and Welfare and Bloomberg Philanthropies.
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