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1. Association of Computed Tomographic Screening Promotion With Lung Cancer Overdiagnosis Among Asian Women

Author

Gao, Wayne, Wen, Chi Pang, Wu, Allison, and Welch, H. Gilbert

Abstract

IMPORTANCE: As smoking continues to decline in many developed countries, the proportion of lung cancers in nonsmokers will rise. This shift may create substantial pressure to further expand lung cancer screening to lower-risk groups. OBJECTIVE: To determine the association of lung cancer incidence with the promotion of screening in a largely nonsmoking population. DESIGN, SETTING, AND PARTICIPANTS: This population-based ecological cohort study of stage-specific lung cancer incidence used the Taiwan Cancer Registry to identify women diagnosed with lung cancer from January 1, 2004, to December 31, 2018. Smoking prevalence among Taiwanese women has been less than 5% since 1980. Data were analyzed from February 13, 2020, to November 10, 2021. EXPOSURES: Low-dose computed tomography (LDCT) screening for lung cancer, initiated during the early 2000s. MAIN OUTCOMES AND MEASURES: Change in stage-specific lung cancer incidence. An effective cancer screening program will not only increase the incidence of early-stage cancer but also decrease the incidence of cancer presenting at a late stage. RESULTS: A total of 57 898 women were diagnosed with lung cancer in a population of approximately 12 million Taiwanese women. After the introduction of LDCT screening, the incidence of early-stage (stages 0-I) lung cancer in women increased more than 6-fold, from 2.3 to 14.4 per 100 000 population (absolute difference, 12.1 [95% CI, 11.3-12.8]) from 2004 to 2018. There was no change, however, in the incidence of late-stage (stages II-IV) lung cancer, from 18.7 to 19.3 per 100 000 (absolute difference, 0.6 [95% CI, –0.5 to 1.7]). Because the additional 12.1 per 100 000 early-stage cancers were not accompanied by a concomitant decline in late-stage cancers, virtually all the additional cancers detected represent overdiagnosis. Despite stable mortality, 5-year survival more than doubled from 2004 to 2013, from 18% to 40%, which is arguably the highest lung cancer survival rate in the world. CONCLUSIONS AND RELEVANCE: This population-based ecological cohort study found that low-dose computed tomographic screening of mostly nonsmoking Asian women was associated with considerable lung cancer overdiagnosis. Five-year survival is biased by the increased LDCT detection of indolent early-stage lung cancers. Unless randomized trials can demonstrate some value to low-risk groups, LDCT screening should remain targeted only to heavy smokers.

Published
2022
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2. Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990–2015: a novel analysis from the Global Burden of Disease Study 2015

Author

Barber, Ryan M, Fullman, Nancy, Sorensen, Reed J D, Bollyky, Thomas, McKee, Martin, Nolte, Ellen, Abajobir, Amanuel Alemu, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbas, Kaja M, Abd-Allah, Foad, Abdulle, Abdishakur M, Abdurahman, Ahmed Abdulahi, Abera, Semaw Ferede, Abraham, Biju, Abreha, Girmatsion Fisseha, Adane, Kelemework, Adelekan, Ademola Lukman, Adetifa, Ifedayo Morayo O, Afshin, Ashkan, Agarwal, Arnav, Agarwal, Sanjay Kumar, Agarwal, Sunilkumar, Agrawal, Anurag, Kiadaliri, Aliasghar Ahmad, Ahmadi, Alireza, Ahmed, Kedir Yimam, Ahmed, Muktar Beshir, Akinyemi, Rufus Olusola, Akinyemiju, Tomi F, Akseer, Nadia, Al-Aly, Ziyad, Alam, Khurshid, Alam, Noore, Alam, Sayed Saidul, Alemu, Zewdie Aderaw, Alene, Kefyalew Addis, Alexander, Lily, Ali, Raghib, Ali, Syed Danish, Alizadeh-Navaei, Reza, Alkerwi, Ala'a, Alla, François, Allebeck, Peter, Allen, Christine, Al-Raddadi, Rajaa, Alsharif, Ubai, Altirkawi, Khalid A, Martin, Elena Alvarez, Alvis-Guzman, Nelson, Amare, Azmeraw T, Amini, Erfan, Ammar, Walid, Amo-Adjei, Joshu, Amoako, Yaw Ampem, Anderson, Benjamin O, Androudi, Sofia, Ansari, Hossein, Ansha, Mustafa Geleto, Antonio, Carl Abelardo T, Ärnlöv, Johan, Artaman, Al, Asayesh, Hamid, Assadi, Reza, Astatkie, Ayalew, Atey, Tesfay Mehari, Atique, Suleman, Atnafu, Niguse Tadele, Atre, Sachin R, Avila-Burgos, Leticia, Avokpaho, Euripide Frinel G Arthur, Quintanilla, Beatriz Paulina Ayala, Awasthi, Ashish, Ayele, Nebiyu Negussu, Azzopardi, Peter, Saleem, Huda Omer Ba, Bärnighausen, Till, Bacha, Umar, Badawi, Alaa, Banerjee, Amitava, Barac, Aleksandra, Barboza, Miguel A, Barker-Collo, Suzanne L, Barrero, Lope H, Basu, Sanjay, Baune, Bernhard T, Baye, Kaleab, Bayou, Yibeltal Tebekaw, Bazargan-Hejazi, Shahrzad, Bedi, Neeraj, Beghi, Ettore, Béjot, Yannick, Bello, Aminu K, Bennett, Derrick A, Bensenor, Isabela M, Berhane, Adugnaw, Bernabé, Eduardo, Bernal, Oscar Alberto, Beyene, Addisu Shunu, Beyene, Tariku Jibat, Bhutta, Zulfiqar A, Biadgilign, Sibhatu, Bikbov, Boris, Birlik, Sait Mentes, Birungi, Charles, Biryukov, Stan, Bisanzio, Donal, Bizuayehu, Habtamu Mellie, Bose, Dipan, Brainin, Michael, Brauer, Michael, Brazinova, Alexandra, Breitborde, Nicholas J K, Brenner, Hermann, Butt, Zahid A, Cárdenas, Rosario, Cahuana-Hurtado, Lucero, Campos-Nonato, Ismael Ricardo, Car, Josip, Carrero, Juan Jesus, Casey, Daniel, Caso, Valeria, Castañeda-Orjuela, Carlos A, Rivas, Jacqueline Castillo, Catalá-López, Ferrán, Cecilio, Pedro, Cercy, Kelly, Charlson, Fiona J, Chen, Alan Z, Chew, Adrienne, Chibalabala, Mirriam, Chibueze, Chioma Ezinne, Chisumpa, Vesper Hichilombwe, Chitheer, Abdulaal A, Chowdhury, Rajiv, Christensen, Hanne, Christopher, Devasahayam Jesudas, Ciobanu, Liliana G, Cirillo, Massimo, Coggeshall, Megan S, Cooper, Leslie Trumbull, Cortinovis, Monica, Crump, John A, Dalal, Koustuv, Danawi, Hadi, Dandona, Lalit, Dandona, Rakhi, Dargan, Paul I, das Neves, Jose, Davey, Gail, Davitoiu, Dragos V, Davletov, Kairat, De Leo, Diego, Del Gobbo, Liana C, del Pozo-Cruz, Borja, Dellavalle, Robert P, Deribe, Kebede, Deribew, Amare, Des Jarlais, Don C, Dey, Subhojit, Dharmaratne, Samath D, Dicker, Daniel, Ding, Eric L, Dokova, Klara, Dorsey, E Ray, Doyle, Kerrie E, Dubey, Manisha, Ehrenkranz, Rebecca, Ellingsen, Christian Lycke, Elyazar, Iqbal, Enayati, Ahmadali, Ermakov, Sergey Petrovich, Eshrati, Babak, Esteghamati, Alireza, Estep, Kara, Fürst, Thomas, Faghmous, Imad D A, Fanuel, Fanuel Belayneh Bekele, Faraon, Emerito Jose Aquino, Farid, Talha A, Farinha, Carla Sofia e Sa, Faro, Andre, Farvid, Maryam S, Farzadfar, Farshad, Feigin, Valery L, Feigl, Andrea B, Fereshtehnejad, Seyed-Mohammad, Fernandes, Jefferson G, Fernandes, João C, Feyissa, Tesfaye Regassa, Fischer, Florian, Fitzmaurice, Christina, Fleming, Thomas D, Foigt, Nataliya, Foreman, Kyle J, Forouzanfar, Mohammad H, Franklin, Richard C, Frostad, Joseph, G/hiwot, Tsegaye Tewelde, Gakidou, Emmanuela, Gambashidze, Ketevan, Gamkrelidze, Amiran, Gao, Wayne, Garcia-Basteiro, Alberto L, Gebre, Teshome, Gebremedhin, Amanuel Tesfay, Gebremichael, Mengistu Welday, Gebru, Alemseged Aregay, Gelaye, Amha Admasie, Geleijnse, Johanna M, Genova-Maleras, Ricard, Gibney, Katherine B, Giref, Ababi Zergaw, Gishu, Melkamu Dedefo, Giussani, Giorgia, Godwin, William W, Gold, Audra, Goldberg, Ellen M, Gona, Philimon N, Goodridge, Amador, Gopalani, Sameer Vali, Goto, Atsushi, Graetz, Nicholas, Greaves, Felix, Griswold, Max, Guban, Peter Imre, Gugnani, Harish Chander, Gupta, Prakash C, Gupta, Rahul, Gupta, Rajeev, Gupta, Tanush, Gupta, Vipin, Habtewold, Tesfa Dejenie, Hafezi-Nejad, Nima, Haile, Demewoz, Hailu, Alemayehu Desalegne, Hailu, Gessessew Bugssa, Hakuzimana, Alex, Hamadeh, Randah Ribhi, Hambisa, Mitiku Teshome, Hamidi, Samer, Hammami, Mouhanad, Hankey, Graeme J, Hao, Yuantao, Harb, Hilda L, Hareri, Habtamu Abera, Haro, Josep Maria, Hassanvand, Mohammad Sadegh, Havmoeller, Rasmus, Hay, Roderick J, Hay, Simon I, Hendrie, Delia, Heredia-Pi, Ileana Beatriz, Hoek, Hans W, Horino, Masako, Horita, Nobuyuki, Hosgood, H Dean, Htet, Aung Soe, Hu, Guoqing, Huang, Hsiang, Huang, John J, Huntley, Bethany M, Huynh, Chantal, Iburg, Kim Moesgaard, Ileanu, Bogdan Vasile, Innos, Kaire, Irenso, Asnake Ararsa, Jahanmehr, Nader, Jakovljevic, Mihajlo B, James, Peter, James, Spencer Lewis, Javanbakht, Mehdi, Jayaraman, Sudha P, Jayatilleke, Achala Upendra, Jeemon, Panniyammakal, Jha, Vivekanand, John, Denny, Johnson, Catherine, Johnson, Sarah C, Jonas, Jost B, Juel, Knud, Kabir, Zubair, Kalkonde, Yogeshwar, Kamal, Ritul, Kan, Haidong, Karch, Andre, Karema, Corine Kakizi, Karimi, Seyed M, Kasaeian, Amir, Kassebaum, Nicholas J, Kastor, Anshul, Katikireddi, Srinivasa Vittal, Kazanjan, Konstantin, Keiyoro, Peter Njenga, Kemmer, Laura, Kemp, Andrew Haddon, Kengne, Andre Pascal, Kerbo, Amene Abebe, Kereselidze, Maia, Kesavachandran, Chandrasekharan Nair, Khader, Yousef Saleh, Khalil, Ibrahim, Khan, Abdur Rahman, Khan, Ejaz Ahmad, Khan, Gulfaraz, Khang, Young-Ho, Khoja, Abdullah Tawfih Abdullah, Khonelidze, Irma, Khubchandani, Jagdish, Kibret, Getiye Dejenu, Kim, Daniel, Kim, Pauline, Kim, Yun Jin, Kimokoti, Ruth W, Kinfu, Yohannes, Kissoon, Niranjan, Kivipelto, Miia, Kokubo, Yoshihiro, Kolk, Anneli, Kolte, Dhaval, Kopec, Jacek A, Kosen, Soewarta, Koul, Parvaiz A, Koyanagi, Ai, Kravchenko, Michael, Krishnaswami, Sanjay, Krohn, Kristopher J, Defo, Barthelemy Kuate, Bicer, Burcu Kucuk, Kuipers, Ernst J, Kulkarni, Veena S, Kumar, G Anil, Kumsa, Fekede Asefa, Kutz, Michael, Kyu, Hmwe H, Lager, Anton Carl Jonas, Lal, Aparna, Lal, Dharmesh Kumar, Lalloo, Ratilal, Lallukka, Tea, Lan, Qing, Langan, Sinead M, Lansingh, Van C, Larson, Heidi J, Larsson, Anders, Laryea, Dennis Odai, Latif, Asma Abdul, Lawrynowicz, Alicia Elena Beatriz, Leasher, Janet L, Leigh, James, Leinsalu, Mall, Leshargie, Cheru Tesema, Leung, Janni, Leung, Ricky, Levi, Miriam, Liang, Xiaofeng, Lim, Stephen S, Lind, Margaret, Linn, Shai, Lipshultz, Steven E, Liu, Patrick, Liu, Yang, Lo, Loon-Tzian, Logroscino, Giancarlo, Lopez, Alan D, Lorch, Scott A, Lotufo, Paulo A, Lozano, Rafael, Lunevicius, Raimundas, Lyons, Ronan A, Macarayan, Erlyn Rachelle King, Mackay, Mark T, El Razek, Hassan Magdy Abd, El Razek, Mohammed Magdy Abd, Mahdavi, Mahdi, Majeed, Azeem, Malekzadeh, Reza, Malta, Deborah Carvalho, Mantovani, Lorenzo G, Manyazewal, Tsegahun, Mapoma, Chabila C, Marcenes, Wagner, Marks, Guy B, Marquez, Neal, Martinez-Raga, Jose, Marzan, Melvin Barrientos, Massano, João, Mathur, Manu Raj, Maulik, Pallab K, Mazidi, Mohsen, McAlinden, Colm, McGrath, John J, McNellan, Claire, Meaney, Peter A, Mehari, Alem, Mehndiratta, Man Mohan, Meier, Toni, Mekonnen, Alemayehu B, Meles, Kidanu Gebremariam, Memish, Ziad A, Mengesha, Melkamu Merid, Mengiste, Desalegn Tadese, Mengistie, Mubarek Abera, Menota, Bereket Gebremichael, Mensah, George A, Mereta, Seid Tiku, Meretoja, Atte, Meretoja, Tuomo J, Mezgebe, Haftay Berhane, Micha, Renata, Millear, Anoushka, Mills, Edward J, Minnig, Shawn, Mirarefin, Mojde, Mirrakhimov, Erkin M, Mock, Charles N, Mohammad, Karzan Abdulmuhsin, Mohammed, Shafiu, Mohanty, Sanjay K, Mokdad, Ali H, Mola, Glen Liddell D, Molokhia, Mariam, Monasta, Lorenzo, Montico, Marcella, Moradi-Lakeh, Maziar, Moraga, Paula, Morawska, Lidia, Mori, Rintaro, Moses, Mark, Mueller, Ulrich O, Murthy, Srinivas, Musa, Kamarul Imran, Nachega, Jean B, Nagata, Chie, Nagel, Gabriele, Naghavi, Mohsen, Naheed, Aliya, Naldi, Luigi, Nangia, Vinay, Nascimento, Bruno Ramos, Negoi, Ionut, Neupane, Sudan Prasad, Newton, Charles R, Ng, Marie, Ngalesoni, Frida Namnyak, Ngunjiri, Josephine Wanjiku, Nguyen, Grant, Ningrum, Dina Nur Anggraini, Nolte, Sandra, Nomura, Marika, Norheim, Ole F, Norrving, Bo, Noubiap, Jean Jacques N, Obermeyer, Carla Makhlouf, Ogbo, Felix Akpojene, Oh, In-Hwan, Okoro, Anselm, Oladimeji, Olanrewaju, Olagunju, Andrew Toyin, Olivares, Pedro R, Olsen, Helen E, Olusanya, Bolajoko Olubukunola, Olusanya, Jacob Olusegun, Opio, John Nelson, Oren, Eyal, Ortiz, Alberto, Osborne, Richard H, Osman, Majdi, Owolabi, Mayowa O, PA, Mahesh, Pain, Amanda W, Pakhale, Smita, Castillo, Elizabeth Palomares, Pana, Adrian, Papachristou, Christina, Parsaeian, Mahboubeh, Patel, Tejas, Patton, George C, Paudel, Deepak, Paul, Vinod K, Pearce, Neil, Pereira, David M, Perez-Padilla, Rogelio, Perez-Ruiz, Fernando, Perico, Norberto, Pesudovs, Konrad, Petzold, Max, Phillips, Michael Robert, Pigott, David M, Pillay, Julian David, Pinho, Christine, Polinder, Suzanne, Pond, Constance D, Prakash, V, Purwar, Manorama, Qorbani, Mostafa, Quistberg, D Alex, Radfar, Amir, Rafay, Anwar, Rahimi, Kazem, Rahimi-Movaghar, Vafa, Rahman, Mahfuzar, Rahman, Mohammad Hifz Ur, Rai, Rajesh Kumar, Ram, Usha, Rana, Saleem M, Rankin, Zane, Rao, Paturi Vishnupriya, Rao, Puja C, Rawaf, Salman, Rego, Maria Albertina Santiago, Reitsma, Marissa, Remuzzi, Giuseppe, Renzaho, Andre M N N, Resnikoff, Serge, Rezaei, Satar, Rezai, Mohammad Sadegh, Ribeiro, Antonio L, Roba, Hirbo Shore, Rokni, Mohammad Bagher, Ronfani, Luca, Roshandel, Gholamreza, Roth, Gregory A, Rothenbacher, Dietrich, Roy, Nawal K, Sachdev, Perminder S, Sackey, Ben Benasco, Saeedi, Mohammad Yahya, Safiri, Saeid, Sagar, Rajesh, Sahraian, Mohammad Ali, Saleh, Muhammad Muhammad, Salomon, Joshua A, Samy, Abdallah M, Sanabria, Juan Ramon, Sanchez-Niño, Maria Dolores, Sandar, Logan, Santos, Itamar S, Santos, João Vasco, Milicevic, Milena M Santric, Sarmiento-Suarez, Rodrigo, Sartorius, Benn, Satpathy, Maheswar, Savic, Miloje, Sawhney, Monika, Saylan, Mete I, Schöttker, Ben, Schutte, Aletta E, Schwebel, David C, Seedat, Soraya, Seid, Abdulbasit Musa, Seifu, Canaan Negash, Sepanlou, Sadaf G, Serdar, Berrin, Servan-Mori, Edson E, Setegn, Tesfaye, Shackelford, Katya Anne, Shaheen, Amira, Shahraz, Saeid, Shaikh, Masood Ali, Shakh-Nazarova, Marina, Shamsipour, Mansour, Islam, Sheikh Mohammed Shariful, Sharma, Jayendra, Sharma, Rajesh, She, Jun, Sheikhbahaei, Sara, Shen, Jiabin, Shi, Peilin, Shigematsu, Mika, Shin, Min-Jeong, Shiri, Rahman, Shoman, Haitham, Shrime, Mark G, Sibamo, Ephrem Lejore Sibamo, Sigfusdottir, Inga Dora, Silva, Diego Augusto Santos, Silveira, Dayane Gabriele Alves, Sindi, Shireen, Singh, Abhishek, Singh, Jasvinder A, Singh, Om Prakash, Singh, Prashant Kumar, Singh, Virendra, Sinke, Abiy Hiruye, Sinshaw, Aklilu Endalamaw, Skirbekk, Vegard, Sliwa, Karen, Smith, Alison, Sobngwi, Eugene, Soneji, Samir, Soriano, Joan B, Sousa, Tatiane Cristina Moraes, Sposato, Luciano A, Sreeramareddy, Chandrashekhar T, Stathopoulou, Vasiliki, Steel, Nicholas, Steiner, Caitlyn, Steinke, Sabine, Stokes, Mark Andrew, Stranges, Saverio, Strong, Mark, Stroumpoulis, Konstantinos, Sturua, Lela, Sufiyan, Muawiyyah Babale, Suliankatchi, Rizwan Abdulkader, Sun, Jiandong, Sur, Patrick, Swaminathan, Soumya, Sykes, Bryan L, Tabarés-Seisdedos, Rafael, Tabb, Karen M, Taffere, Getachew Redae, Talongwa, Roberto Tchio, Tarajia, Musharaf, Tavakkoli, Mohammad, Taveira, Nuno, Teeple, Stephanie, Tegegne, Teketo Kassaw, Tehrani-Banihashemi, Arash, Tekelab, Tesfalidet, Tekle, Dejen Yemane, Shifa, Girma Temam, Terkawi, Abdullah Sulieman, Tesema, Azeb Gebresilassie, Thakur, JS, Thomson, Alan J, Tillmann, Taavi, Tiruye, Tenaw Yimer, Tobe-Gai, Ruoyan, Tonelli, Marcello, Topor-Madry, Roman, Tortajada, Miguel, Troeger, Christopher, Truelsen, Thomas, Tura, Abera Kenay, Uchendu, Uche S, Ukwaja, Kingsley N, Undurraga, Eduardo A, Uneke, Chigozie Jesse, Uthman, Olalekan A, van Boven, Job F M, Van Dingenen, Rita, Varughese, Santosh, Vasankari, Tommi, Venketasubramanian, Narayanaswamy, Violante, Francesco S, Vladimirov, Sergey K, Vlassov, Vasiliy Victorovich, Vollset, Stein Emil, Vos, Theo, Wagner, Joseph A, Wakayo, Tolassa, Waller, Stephen G, Walson, Judd L, Wang, Haidong, Wang, Yuan-Pang, Watkins, David A, Weiderpass, Elisabete, Weintraub, Robert G, Wen, Chi-Pang, Werdecker, Andrea, Wesana, Joshua, Westerman, Ronny, Whiteford, Harvey A, Wilkinson, James D, Wiysonge, Charles Shey, Woldeyes, Belete Getahun, Wolfe, Charles D A, Won, Sungho, Workicho, Abdulhalik, Workie, Shimelash Bitew, Wubshet, Mamo, Xavier, Denis, Xu, Gelin, Yadav, Ajit Kumar, Yaghoubi, Mohsen, Yakob, Bereket, Yan, Lijing L, Yano, Yuichiro, Yaseri, Mehdi, Yimam, Hassen Hamid, Yip, Paul, Yonemoto, Naohiro, Yoon, Seok-Jun, Younis, Mustafa Z, Yu, Chuanhua, Zaidi, Zoubida, El Sayed Zaki, Maysaa, Zambrana-Torrelio, Carlos, Zapata, Tomas, Zenebe, Zerihun Menlkalew, Zodpey, Sanjay, Zoeckler, Leo, Zuhlke, Liesl Joanna, and Murray, Christopher J L

Abstract

National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015.

Published
2024
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4. Are e-cigarettes reviving the popularity of conventional smoking among Taiwanese male adolescents? A time-trend population-based analysis for 2004-2017

Author

Gao, Wayne, Sanna, Mattia, Chuluunbaatar, Enkhzaya, Tsai, Min-Kuang, Levy, David T, and Wen, Chi Pang

Abstract

IntroductionIn Taiwan, national tobacco use surveys show that e-cigarette use has increased since 2014 among youth, while, at the same time, conventional cigarette smoking has continuously decreased. The purpose of this study is to examine whether the increased popularity of e-cigarettes has undermined this favourable declining trend for cigarette smoking.MethodsWe examined conventional cigarette and e-cigarette prevalence among male high school students (aged 16–18 years) and adults from 2004 to 2017, using data from cross-sectional nationally representative surveys. Applying interrupted time series analysis, we assessed whether there was a change in trend in 2014, when e-cigarette use started to gain popularity from long-term trends in prior years (2004–2013).ResultsE-cigarette use prevalence increased from 2.5% in 2014 to 6.4% in 2017 among male high school students but was negligible among male adults, declining from 1.4% in 2015 to 0.8% in 2017. The annual relative decline in the cigarette smoking rate after e-cigarettes started to gain popularity was greater (−10%) than the long-term trend (−2%) among high school students. Among adults, the change in trend over time after e-cigarettes started to gain popularity was not significant (ie, not significantly different from 0).ConclusionsThe increased popularity of e-cigarettes since 2014 is associated with a greater decline in youth smoking, compared with previous years. On the contrary, e-cigarette use has remained very low among Taiwanese male adults and no additional impact on the conventional smoking trend is found.

Published
2021
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5. Air pollution is not ‘the new smoking’: comparing the disease burden of air pollution and smoking across the globe, 1990–2017

Author

Gao, Wayne, Sanna, Mattia, Hefler, Marita, and Wen, Chi Pang

Abstract

Air pollution has been labelled the ‘new smoking’, with news articles bearing titles such as ‘If You Live in a Big City You Already Smoke Every Day’ and ‘The Air Is So Bad in These Cities, You May As Well Be Smoking’. Dr Tedros Adhanom Ghebreyesus, WHO Director-General, highlighted this attention-catching comparison, saying, ‘The world has turned the corner on tobacco. Now it must do the same for the ‘new tobacco’ – the toxic air that billions breathe every day’ and ‘Globally, with smoking on the decline, air pollution now causes more deaths annually than tobacco’ at the First Global Conference on Air Pollution and Health in 2018. The suggestion that the world has turned the corner on tobacco control and the reference to air pollution as the ‘new smoking’ raise a number of concerns. We generate outputs from GBD Compare (the online data visualisation tool of the Global Burden of Diseases and Injuries (GBD) Study) to demonstrate historical disease burden trends in terms of disability-adjusted life years and age-standardised mortality attributable to air pollution and tobacco use from 1990 to 2017 across the globe. We find that the disease burden caused by ambient air pollution declined significantly faster than the burden caused by tobacco use. We conclude that the world is still far from turning the corner on the tobacco endemic. Further, the suggestion that air pollution is as bad as actual smoking is not only inaccurate but also potentially dangerous to public health.

Published
2020
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6. Tobacco control within and beyond WHO MPOWER: outcomes from Taiwan SimSmoke

Author

Sanna, Mattia, Gao, Wayne, Chiu, Ya-Wen, Chiou, Hung-Yi, Chen, Yi-Hua, Wen, Chi-Pang, and Levy, David Theodore

Abstract

IntroductionAdult smoking prevalence in Taiwan rapidly declined from 26.5% in 2005 to 20.0% in 2015. Nevertheless, future projections on smoking-attributable deaths and current per capita consumption do not paint an equally bright picture.MethodsWe used SimSmoke, a tobacco control simulation model to assess the impact of tax increases and other policies by predicting past and projecting over future decades smoking rates and smoking-attributable mortality.ResultsThe model accurately depicts the decline in smoking prevalence observed in Taiwan from 2000 to 2015. Nonetheless, under the ‘status quo’ scenario, smoking-attributable mortality is projected to continue growing, peaking at 26 602 annual deaths in 2039 and cumulative deaths >1 million by 2044. By comparing projections with current policies with a counterfactual scenario based on the 2000 policy levels, SimSmoke estimates that tobacco control in Taiwan has been able to reduce smoking prevalence by 30% in 2015 with 450 000 fewer smoking-attributable deaths by 2060. Modified scenarios show that doubling the retail price of cigarettes and fully implementing the remaining MPOWER measures would avert approximately 45 000 lives by 2040 and 130 000 by 2060.ConclusionsTobacco will be a leading cause of death in Taiwan for the coming decades, showing yet again the long-term consequences of smoking on public health. The MPOWER package, even if adopted at the highest level with a large tax increase, is unlikely to reduce smoking prevalence to the endgame goal of 5% in the next five decades.

Published
2020
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8. Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: a systematic analysis from the Global Burden of Disease Study 2015

Author

Reitsma, Marissa B, Fullman, Nancy, Ng, Marie, Salama, Joseph S, Abajobir, Amanuel, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abera, Semaw Ferede, Abraham, Biju, Abyu, Gebre Yitayih, Adebiyi, Akindele Olupelumi, Al-Aly, Ziyad, Aleman, Alicia V, Ali, Raghib, Al Alkerwi, Ala'a, Allebeck, Peter, Al-Raddadi, Rajaa Mohammad, Amare, Azmeraw T, Amberbir, Alemayehu, Ammar, Walid, Amrock, Stephen Marc, Antonio, Carl Abelardo T, Asayesh, Hamid, Atnafu, Niguse Tadela, Azzopardi, Peter, Banerjee, Amitava, Barac, Aleksandra, Barrientos-Gutierrez, Tonatiuh, Basto-Abreu, Ana Cristina, Bazargan-Hejazi, Shahrzad, Bedi, Neeraj, Bell, Brent, Bello, Aminu K, Bensenor, Isabela M, Beyene, Addisu Shunu, Bhala, Neeraj, Biryukov, Stan, Bolt, Kaylin, Brenner, Hermann, Butt, Zahid, Cavalleri, Fiorella, Cercy, Kelly, Chen, Honglei, Christopher, Devasahayam Jesudas, Ciobanu, Liliana G, Colistro, Valentina, Colomar, Mercedes, Cornaby, Leslie, Dai, Xiaochen, Damtew, Solomon Abrha, Dandona, Lalit, Dandona, Rakhi, Dansereau, Emily, Davletov, Kairat, Dayama, Anand, Degfie, Tizta Tilahun, Deribew, Amare, Dharmaratne, Samath D, Dimtsu, Balem Demtsu, Doyle, Kerrie E, Endries, Aman Yesuf, Ermakov, Sergey Petrovich, Estep, Kara, Faraon, Emerito Jose Aquino, Farzadfar, Farshad, Feigin, Valery L, Feigl, Andrea B, Fischer, Florian, Friedman, Joseph, G/hiwot, Tsegaye Tewelde, Gall, Seana L, Gao, Wayne, Gillum, Richard F, Gold, Audra L, Gopalani, Sameer Vali, Gotay, Carolyn C, Gupta, Rahul, Gupta, Rajeev, Gupta, Vipin, Hamadeh, Randah Ribhi, Hankey, Graeme, Harb, Hilda L, Hay, Simon I, Horino, Masako, Horita, Nobuyuki, Hosgood, H Dean, Husseini, Abdullatif, Ileanu, Bogdan Vasile, Islami, Farhad, Jiang, Guohong, Jiang, Ying, Jonas, Jost B, Kabir, Zubair, Kamal, Ritul, Kasaeian, Amir, Kesavachandran, Chandrasekharan Nair, Khader, Yousef S, Khalil, Ibrahim, Khang, Young-Ho, Khera, Sahil, Khubchandani, Jagdish, Kim, Daniel, Kim, Yun Jin, Kimokoti, Ruth W, Kinfu, Yohannes, Knibbs, Luke D, Kokubo, Yoshihiro, Kolte, Dhaval, Kopec, Jacek, Kosen, Soewarta, Kotsakis, Georgios A, Koul, Parvaiz A, Koyanagi, Ai, Krohn, Kristopher J, Krueger, Hans, Defo, Barthelemy Kuate, Bicer, Burcu Kucuk, Kulkarni, Chanda, Kumar, G Anil, Leasher, Janet L, Lee, Alexander, Leinsalu, Mall, Li, Tong, Linn, Shai, Liu, Patrick, Liu, Shiwei, Lo, Loon-Tzian, Lopez, Alan D, Ma, Stefan, El Razek, Hassan Magdy Abd, Majeed, Azeem, Malekzadeh, Reza, Malta, Deborah Carvalho, Manamo, Wondimu Ayele, Martinez-Raga, Jose, Mekonnen, Alemayehu Berhane, Mendoza, Walter, Miller, Ted R, Mohammad, Karzan Abdulmuhsin, Morawska, Lidia, Musa, Kamarul Imran, Nagel, Gabriele, Neupane, Sudan Prasad, Nguyen, Quyen, Nguyen, Grant, Oh, In-Hwan, Oyekale, Abayomi Samuel, PA, Mahesh, Pana, Adrian, Park, Eun-Kee, Patil, Snehal T, Patton, George C, Pedro, Joao, Qorbani, Mostafa, Rafay, Anwar, Rahman, Mahfuzar, Rai, Rajesh Kumar, Ram, Usha, Ranabhat, Chhabi Lal, Refaat, Amany H, Reinig, Nickolas, Roba, Hirbo Shore, Rodriguez, Alina, Roman, Yesenia, Roth, Gregory, Roy, Ambuj, Sagar, Rajesh, Salomon, Joshua A, Sanabria, Juan, de Souza Santos, Itamar, Sartorius, Benn, Satpathy, Maheswar, Sawhney, Monika, Sawyer, Susan, Saylan, Mete, Schaub, Michael P, Schluger, Neil, Schutte, Aletta Elisabeth, Sepanlou, Sadaf G, Serdar, Berrin, Shaikh, Masood Ali, She, Jun, Shin, Min-Jeong, Shiri, Rahman, Shishani, Kawkab, Shiue, Ivy, Sigfusdottir, Inga Dora, Silverberg, Jonathan I, Singh, Jasvinder, Singh, Virendra, Slepak, Erica Leigh, Soneji, Samir, Soriano, Joan B, Soshnikov, Sergey, Sreeramareddy, Chandrashekhar T, Stein, Dan J, Stranges, Saverio, Subart, Michelle L, Swaminathan, Soumya, Szoeke, Cassandra E I, Tefera, Worku Mekonnen, Topor-Madry, Roman, Tran, Bach, Tsilimparis, Nikolaos, Tymeson, Hayley, Ukwaja, Kingsley Nnanna, Updike, Rachel, Uthman, Olalekan A, Violante, Francesco Saverio, Vladimirov, Sergey K, Vlassov, Vasiliy, Vollset, Stein Emil, Vos, Theo, Weiderpass, Elisabete, Wen, Chi-Pan, Werdecker, Andrea, Wilson, Shelley, Wubshet, Mamo, Xiao, Lin, Yakob, Bereket, Yano, Yuichiro, Ye, Penpeng, Yonemoto, Naohiro, Yoon, Seok-Jun, Younis, Mustafa Z, Yu, Chuanhua, Zaidi, Zoubida, El Sayed Zaki, Maysaa, Zhang, Anthony Lin, Zipkin, Ben, Murray, Christopher J L, Forouzanfar, Mohammad H, and Gakidou, Emmanuela

Abstract

The scale-up of tobacco control, especially after the adoption of the Framework Convention for Tobacco Control, is a major public health success story. Nonetheless, smoking remains a leading risk for early death and disability worldwide, and therefore continues to require sustained political commitment. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) offers a robust platform through which global, regional, and national progress toward achieving smoking-related targets can be assessed.

Published
2017
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9. Associations of Prolonged Occupational Sitting with the Spectrum of Kidney Disease: Results from a Cohort of a Half-Million Asian Adults

Author

Tsai, Min-Kuang, Gao, Wayne, Chien, Kuo-Liong, Baw, Chin-Kun, Hsu, Chih-Cheng, and Wen, Chi-Pang

Abstract

Background: Kidney diseases are viewed as continuously progressing diseases from microalbuminuria and chronic kidney disease (CKD), to end-stage renal disease (ESRD) and its mortality including deaths. The report on the association between prolonged sitting and kidney diseases is limited. Methods: We examined a cohort of 455,506 participants in a screening program in Taiwan conducted between 1996 and 2017. Data on occupational sedentary behavior and physical activity were collected with a standardized questionnaire. The outcomes of ESRD and death were identified by linking with the Catastrophic Illness Dataset and Cause of Death Data. The association between prolonged sitting and CKD, the incidence of ESRD, and death were assessed using logistic regression models to compute odds ratios (ORs) and Cox proportional hazards models for hazard ratios (HRs). Results: More than half of the participants, i.e., 265,948 (58.4%), were categorized as “prolonged sitting” during their work. During a median of 13 years of follow-up, we identified 2227 individuals undergoing dialysis and 25,671 deaths. Prolonged occupational sitting was significantly associated with a higher risk of CKD (OR: 1.26, 95% confidence interval: 1.21, 1.31), ESRD (HR: 1.19, 95% CI 1.03, 1.38), and kidney-specific mortality (HR: 1.43, 95% CI 1.07, 1.91) compared to mostly standing participants after controlling for physical activity and other risk factors. Inactive prolonged sitting carries a significantly higher risk of ESRD than physically active mostly standing participants (HR: 1.34, 95% CI 1.04, 1.73). However, active prolonged sitting decreased the risk of ESRD (HR: 1.03, 95% CI 0.79, 1.34) compared to inactive prolonged sitting. Conclusion: The results suggest that prolonged occupational sitting is associated with a greater risk of the spectrum of kidney disease, proteinuria, CKD, dialysis (ESRD), and mortality for all causes and kidney diseases. Physical activity, even at a minimal level of 15 min/day (90 min/week) of moderate-intensity exercise, was associated with a reduction in these risks.

Published
2022
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