Intended for healthcare professionals

Education And Debate

Smoking and death: the past 40 years and the next 40

BMJ 1994; 309 doi: (Published 08 October 1994) Cite this as: BMJ 1994;309:937
  1. R Peto
  1. Imperial Cancer Research Fund Cancer Studies Unit, Nuffield Department of Clinical Medicine, Radcliffe Infirmary, Oxford OX2 6HE.

    Smoking already kills about two million people a year in developed countries, half in middle age (35-69) and half in old age.1, 2 This number is still increasing as the death rate among women increases and populations grow larger and older (fig 1). Already smoking accounts for one sixth of the 11 million adult deaths each year in these populations. There are 1.2 billion people living in developed countries. If one sixth of their deaths continue to be caused by tobacco about 200 million of the adults and children now living in developed countries will eventually be killed by tobacco, and about 100 million of these will die while still in middle age.2

    FIG 1

    Annual number of deaths attributed to tobacco in developed countries. If current smoking patterns continue, when the children of today reach middle age the annual number of deaths will have increased from 2 million to about 3 million, but in less developed countries the increase will be far larger, from about 1 million to about 7 million in around 2025, leading to a world total of about 10 million deaths a year from tobacco1, 2

    In developing countries there has recently been a large increase in the number of young men smoking. People in China, for example, now smoke about 30% of the world's cigarettes. This will have catastrophic effects next century as most other causes of death are likely to continue to decrease and the effects of tobacco to increase. If current smoking patterns persist - that is, if the smoking uptake rate among young adults continues to be substantial and the rate of stopping smoking at older ages continues to be low - by the time the children of today reach middle age smoking will be one of the largest …

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