The tobacco epidemic curve in Brazil: Where are we going?

• Published in: Cancer epidemiology Vol. 67; p. 101736
• Main Authors: Carvalho de Souza, Mirian, Giunta, Diego H., Szklo, André S., Almeida, Liz Maria de, Szklo, Moyses
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.08.2020; Elsevier Limited
• Subjects: Adenomatous polyposis coli; Adult; Age; Age groups; Aged; Aged, 80 and over; Brazil - epidemiology; Cancer; Cardiovascular disease; Codes; Databases, Factual; Epidemics; Epidemiology; Ethical standards; Female; Females; Forecast; Gender; Humans; Logistic models; Lung cancer; Lung neoplasms; Lung Neoplasms - epidemiology; Lung Neoplasms - etiology; Lung Neoplasms - mortality; Male; Males; Middle Aged; Mortality; Mortality - trends; Population; Prevalence; Prevention; Public policy; Sex; Smoking; Smoking - adverse effects; Tobacco; Tobacco use disorder; Trends; Brazil; Tobacco use disorder; Logistic models; Mortality trends; Forecast; Lung neoplasms
• ISSN: 1877-7821; 1877-783X
• DOI: 10.1016/j.canep.2020.101736

•Number of deaths by lung cancer will increase from 46,886 in 1981–1985 to 264,172 in 2036–2040.•Observed lung cancer age-standardized mortality rate in men decreased from 2005 to 2017.•From 2016–2040 males age-standardized lung cancer mortality rate are predict to decrease.•From 2031–2040 females age-standardized lung cancer mortality rate are predict to stop rising.•Male:female lung cancer mortality ratio markedly diminished between 1981–2040. Brazil experienced a robust decline in smoking prevalence rates as a consequence of public policies. Since lung cancer is strongly associated with smoking, trends in lung cancer mortality rates may be used as a delayed effectiveness indicator of smoking prevention interventions. The aim of this study was to estimate lung cancer mortality trends from 1980 through 2017 and to predict temporal trends in lung cancer mortality rates, in Brazil from 2016 through 2040. Time trends in lung cancer mortality rates were evaluated using data from available public databases. Crude and age-standardized mortality rates were calculated for each year sex-specific mortality predictions were made for each five-year period from 2016 to 2020 through 2036–2040 using an age-period-cohort (APC) model. Sex ratios were estimated using age-standardized lung cancer mortality rates. A decline in age-standardized lung cancer mortality rates has been observed for males since 2005 and for all predicted periods. It is expected that females aged 55 or younger will experience a reduction in lung cancer mortality from 2021 to 2026 onwards, but for those aged 75 or over rates are predicted to continue increasing through 2036–2040. Smoking prevention and cessation policies are essential, and it is important to commit to an ethical framework whereby equity in tobacco control activities between genders is achieved. This will avert many premature and preventable smoking-related deaths in the next decades.