Second-Hand Smoke Linked to 1.66 Million Global Deaths

SECOND-HAND smoke exposed 2.71 billion people globally in 2023 and contributed to an estimated 1.66 million deaths.

The analysis quantified second-hand smoke exposure and its attributable disease burden across 204 countries and territories from 1990–2023. Researchers used the Global Burden of Disease 2023 comparative risk assessment framework, combining population surveys, household composition data, and estimates of nine associated health outcomes.

Second-Hand Smoke Burden Persists Despite Progress

Global age-standardized exposure prevalence declined by 22.2% between 1990 and 2023, falling from 43.6% to 33.9%. However, population growth meant that the absolute number of people exposed remained broadly stable.

Exposure increased substantially in some regions. The number of people exposed rose by 98.5% in sub-Saharan Africa and 72.1% in North Africa and the Middle East. Southeast Asia, East Asia, and Oceania had the highest age-standardized prevalence in 2023 at 48.4%.

Women experienced greater exposure than men, with an estimated 1.49 billion women exposed globally. The analysis also identified 767 million exposed children ages 0–14 years.

Cardiovascular and Respiratory Diseases Drive Burden

Second-hand smoke accounted for 44.8 million disability-adjusted life years, representing years of healthy life lost through disability or premature death. Although the age-standardized disease burden declined by 53.1% since 1990, the number of years lived with disability increased by 74.5%.

Ischemic heart disease was the leading contributor, accounting for 12.0 million disability-adjusted life years and 537,000 deaths. Other major contributors included lower respiratory infections, COPD, stroke, and lung cancer.

Children and adolescents accounted for 5.55 million disability-adjusted life years, more than 12% of the total second-hand smoke burden. Lower respiratory infections contributed the greatest burden in this group, followed by asthma and otitis media.

Findings Reinforce Clinical Prevention Priorities

For clinicians, the findings support routinely assessing household and workplace smoke exposure, particularly among children, women, and people with cardiovascular or respiratory disease. Counseling household members about smoking cessation and maintaining smoke-free homes and vehicles may help address exposure in settings that legislation cannot readily reach.

The estimates captured current exposure at home or work but excluded exposure occurring exclusively in vehicles, restaurants, and other public settings. Reliance on self-reported data and the inability to measure exposure intensity may also have led to misclassification.

Reference

GBD 2023 Second-hand smoke Collaborators. 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. Lancet Public Health. 2026;10.1016/S2468-2667(26)00168-4.

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