Second-hand smoke still burdens global health
A GBD 2023 analysis estimates that 2.71 billion people were exposed to second-hand smoke in 2023, including 767 million children, while the absolute total has not fallen with age-standardized prevalence.
The 60-second version
A GBD 2023 analysis estimates that 2.71 billion people were exposed to second-hand smoke in 2023, including 767 million children.
Key points
- Age-standardized prevalence fell 22.2% from 1990, but the absolute number exposed stayed broadly stable worldwide.
- The model attributes 1.66 million deaths and 44.8 million DALYs to second-hand smoke in 2023.
- The figures are modeled population estimates, not individual diagnoses, but they support smoke-free environments and stronger tobacco control.
Verdict. The global burden remains large; policy action is justified, while the headline numbers are not personal risk estimates.
The estimate2.71 billion people exposed in 2023
A The Lancet Public Health analysis used the GBD 2023 comparative-risk framework to estimate second-hand smoke exposure across 204 countries and territories. The 2023 estimate is 2.71 billion people, with a 95% uncertainty interval of 2.44 to 3.02 billion, including an estimated 767 million children aged 0–14.
The trendLower rates did not mean fewer people
The age-standardized exposure prevalence was estimated to be 22.2% lower in 2023 than in 1990. But the absolute number exposed stayed broadly stable globally and rose sharply in sub-Saharan Africa and in North Africa and the Middle East. Population growth and regional differences can offset progress in the rate.
Health burdenHeart disease and childhood infections dominate the model
The analysis attributes an estimated 1.66 million deaths and 44.8 million disability-adjusted life-years to second-hand smoke in 2023. Ischaemic heart disease contributed the most DALYs overall; among children, lower respiratory infections were the leading contributor.
| What was estimated | Exposure prevalence and attributable disease burden across 204 countries and territories |
|---|---|
| How it was estimated | GBD 2023 surveys, household data, statistical models and relative risks for nine outcomes |
| What it cannot tell one person | A precise personal risk or whether a particular illness was caused by smoke |
What followsSmoke-free environments remain the actionable layer
The study does not rank one intervention for every country, but its population-level signal supports comprehensive tobacco control and enforcement of smoke-free homes and public spaces. The groups needing particular protection include children and women in settings where exposure remains high.
A falling rate is progress, but it is not the same as fewer exposed people.