ORCID

Document Type

Article

Abstract

SummaryBackground Second-hand smoke (SHS) exposure remains a major source of morbidity and mortality among nonsmokers. 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 broaderrange of outcomes.Methods Using the GBD 2023 comparative risk assessment framework, we estimated SHS exposure prevalence andattributable disease burden across 204 countries and territories from 1990 to 2023, stratified by age and sex. Exposureestimates were derived by synthesising population-based surveys and household composition data throughspatiotemporal Gaussian process regression. Relative risks for nine health outcomes, now including asthma, wereestimated using the Burden of Proof methodology, and applied to calculate attributable deaths and disability-adjustedlife-years (DALYs).Findings In 2023, an estimated 2·71 billion (95% UI 2·44–3·02) people worldwide were exposed to SHS, including767 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 theexposure prevalence of male individuals. Despite a 22·2% (10·6–32·4) decline in global age-standardised prevalencesince 1990, this progress has not been sufficient to reduce the absolute number of exposed individuals, which hasremained stable globally and has risen sharply in sub-Saharan Africa (98·5% [62·0–144·4] increase) and North Africaand 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 toSHS-attributable DALYs (12·0 million [9·31–15·2]) overall, while lower respiratory infections predominated amongchildren (5·16 million [3·48–7·12]).Interpretation We estimated that SHS remains a substantial driver of global health loss, particularly throughcardiovascular and paediatric respiratory diseases. Persistent geographical disparities and growing absolute numbersof exposed individuals in several regions underscore the urgent need for accelerated implementation and enforcementof comprehensive tobacco control measures, particularly to protect women and children in both public and domesticenvironments.

Publication Date

2026-09-07

Publication Title

The Lancet Public Health

Deposit Date

2026-09-22

Funding

Bloomberg Philanthropies and the Gates Foundation.

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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