{"paper_id":"4d02a917-e77c-44eb-8ee1-89d6879848db","body_text":"Global burden of smoking-related cancers from 1990 to 2021: insights from the Global Burden of Disease study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Global burden of smoking-related cancers from 1990 to 2021: insights from the Global Burden of Disease study Ao Zeng, Zhilong Xu, Jiarui Wang, Abudumijiti Abuduwayiti, Yanze Yin, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6861637/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background The global cancer mortality burden was exceptionally high, especially due to smoking-related cancers. This study aimed to analyze the global burden of smoking-related cancers from 1990 to 2021. Method Epidemiological data from the 2021 Global Burden of Disease (GBD) study was used to analyze the burden of smoking-related cancers across different ages, genders, and regions. The Joinpoint regression model was applied to evaluate trends in cancer burden during 1990-2021, while decomposition analysis visually represented the contributions of aging, population growth, and epidemiological changes to the variation of burden. Additionally, autoregressive integrated moving average (ARIMA) model was used to predict the burden over the next 15 years. Result Smoking was the leading level 4 risk factor contributing to cancer deaths. The global smoking-related cancer death number increased from 1328875 [95% uncertainty interval (UI): 1154027, 1511048)] to 2012845 (95%UI: 1682778, 2369033) during 1990-2021. The top four smoking-related cancer death number were tracheal, bronchus, and lung cancer; esophageal cancer; stomach cancer; and larynx cancer in 2021. The global age-standardized mortality rate (ASMR) of smoking-related cancers decreased from 33.76 (95%UI: 29.23, 38.45) in 1990 to 23.31 (95%UI: 19.49, 27.43) in 2021, which declined most rapidly in high socio-demographic index (SDI) region [average annual percentage change (AAPC): -1.80)] and males (AAPC: -1.28). Stomach cancer had the steepest decline of ASMR, with an AAPC of -2.60 (p<0.001). There was a positive correlation between ASMR and SDI in 2021 (R=0.60). The age group with the highest death number of smoking-related cancer shifted from 65-69 years old to 70-74 years old during 1990-2021. In addition, ASMRs of smoking-related cancers is predicted to continue to decline in both genders and across all SDI regions over the next 15 years. Conclusions Smoking-related cancers are a significant global public health issue. Despite the decline in ASMR of smoking-related cancers, the absolute death number of smoking-related cancers continued to rise. Therefore, making specific tobacco control policies is crucial to address the smoking-related health challenges. smoking-related cancers age-standardized mortality rate socio-demographic index average annual percent change disability-adjusted life-years Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 1. Introduction The absolute global burden of cancers was enormous and exhibited a persistent increasing trend (1) . Smoking was a major contributor to the development of various cancers, including lung, larynx, esophagus, and stomach cancers (2-4) . According to the global action plan for the prevention and control of noncommunicable diseases 2013-2020 (5) , World Health Organization (WHO) has set a target to reduce global tobacco use. However, the latest WHO global report on trends in the prevalence of tobacco use estimated that there were 1.245 billion smokers worldwide in 2022 (6) . Consequently, the burden of smoking-related cancers remained substantial and required urgent attention. The Global Burden of Disease (GBD) database served as a high-quality tool for health assessment, offering long-term data at global, national, and regional levels (7) . The GBD 2019 Tobacco Collaborators reported that smoking tobacco use resulted in 7.69 million deaths and 200 million disability-adjusted life-years (DALYs) in 2019 (8) . In 2021, smoking was responsible for more than one in ten global deaths and nearly 142 million years of life lost (YLLs) (7) . Furthermore, the GBD 2021 Tobacco Forecasting Collaborators indicated that there would be 1040 million male smokers and 201 million female smokers by 2050, with projections of 1040 million and 816 million YLLs in 2050, respectively (9) . However, as a major health-related consequence by smoking, few studies have assessed the burden of mortality and DALYs about smoking-related cancers. This study provided a standardized assessment of the burden of smoking-related cancers across different regions and time periods and projected the burden trends from 2022 to 2036. The findings will present quantitative evidence to guide tobacco control policies, contributing to substantial health benefits to citizens. 2. Method 2.1 Data sources GBD 2021 database includes information about 371 diseases and injuries, and 88 risk factors across 204 countries and regions (7, 10) . In the study, mortality and DALYs data of smoking-related cancers were extracted from the GBD study tools, covering 204 countries and regions between 1990 and 2021. The data is available at https://vizhub.healthdata.org/gbd-results. 2.2 Overview and definitions Cancer was a multifactorial disease with numerous potential risk factors. This study specifically investigated smoking-related cancers, excluding those caused by chewing tobacco and second-hand smoke (11) . The socio-demographic index (SDI) was a composite indicator of a country's development status, ranging from 0 to 1, where 0 represented the lowest level of development and 1 represented the highest level (12) . The age-standardized rate was the rate per 100,000 population following standardization to the global age structure, with differences across regions and over time independent of population size and age structure. DALYs represented the sum of years lost due to premature death and years living with disability due to the disease. The study obtained the mortality and DALYs from 16 types of smoking-related cancers. 2.3 Statistical analysis The Joinpoint regression model was a collection of linear statistical models, and was used to assess trends in cancer burden over time. The software tracked the trend of data over time and fited the simplest model to the data by connecting several different segments on a logarithmic scale. The average annual percentage change (AAPC) was calculated, and the statistical significance of the fluctuation trends in different parts is investigated by comparing the AAPC to 0 (13, 14) . Decomposition analysis was used to visually display the contributions of three factors (i.e., aging, population, and epidemiological changes) to the variation of cancer burden between 1990 and 2021. Epidemiological changes referred to age and population-adjusted mortality and morbidity rates (14, 15) . Autoregressive integrated moving average (ARIMA) model was composed of the autoregressive model and the moving average model. The basic assumption was that the data sequence was a transient random variable whose autocorrelation can be represented by the ARIMA model, and future values can be predicted based on past values. In this study, the ARIMA model was used to predict the cancer burden for the next 15 years (16) . Uncertainty interval (UI) was calculated from the distribution of 500 draws through the multistage computational pipeline, with the 95% UI based on the 2.5th and 97.5th percentiles (9) . All statistical analyses and graphics were performed using R version 4.21 or GraphPad Prism 9, with p<0.05 considered statistically significant. 3. Result 3.1 Smoking was the leading level 4 risk factor contributing to cancer deaths The risk factors contributing to cancer deaths were numerous. In 1990, the leading level 4 risk factor contributing to cancer deaths was smoking, accounting for 22.77% (95%UI: 19.74%, 25.68%). Smoking remained the leading level 4 risk factor, with a percent of 20.00% (95%UI: 17.02%, 22.69%) in 2021(Figure 1A). Smoking contributed to deaths from 16 types of cancers. In 2021, 66.23% (95%UI: 60.63%, 70.91%) of larynx cancer deaths and 58.89% (95%UI: 54.52%, 62.69%) of tracheal, bronchus, and lung cancer deaths were attributed to smoking (Figure 1B). 3.2 The burden of smoking-related cancers in the global The global death number of smoking-related cancers increased from 1328875 (95%UI: 1154027, 1511048) to 2012845 (95%UI: 1682778, 2369033) during 1990-2021. During the same period, the DALYs of smoking-related cancers increased from 35581636 (95%UI: 30900964, 40450855) to 47976550 (95%UI: 40135805, 56484931). The age-standardized mortality rate (ASMR) of smoking-related cancer decreased from 33.76 (95%UI: 29.23, 38.45) to 23.31 (95%UI: 19.49, 27.43), with an AAPC of -1.22 (P < 0.001) (Table 1; Figure 2A). The age-standardized disability-adjusted life year rate (ASDR) also decreased from 863.94 (95%UI: 749.97, 982.52) to 546.86 (95%UI: 456.92, 643.93) (Table 1; Figure S1). In 2021, the top four smoking-related cancer death number were tracheal, bronchus, and lung cancer; esophageal cancer; stomach cancer; and larynx cancer (Table 1). Stomach cancer had the steepest decline of ASMR, with an AAPC of -2.60 (p<0.001) (Figure S2). From 1990 to 2021, the death number from smoking-related cancers among males increased from 1119129 (95%UI: 977622, 1265839) to 1686857 (95%UI: 1403744, 1987301). For females, it rose from 209746 (95%UI: 171307, 248222) to 325987 (95%UI: 264154, 392322) (Table 2). However, the ASMR declined in both males and females (Table 2), with an AAPC of -1.28 (P<0.001) and -1.14 (P<0.001) for males and females, respectively (Figure 2A). Esophageal cancer was the second-highest ASMR in males, while cervical cancer was the second-highest ASMR in females (Figure 3B). Stomach cancer had the steepest decline of ASMR, with an AAPC of -2.55 (P<0.001) and -3.57 (P<0.001) for males and females, respectively (Figure S3-S4). The ASDR for both males and females also showed a downward trend from 1990 to 2021 (Figure S1). The age group with the highest death number of smoking-related cancer shifted from 65-69 years old to 70-74 years old during 1990-2021 (Figure 4A-B). Similarly, the age group with the highest DALYs of smoking-related cancers moved from 60-64 years old in 1990 to 65-69 years old in 2021 (Figure 4C-D). Age-specific death rates showed an increasing trend with advancing age (Figure 4A-B). 3.3 The burden of smoking-related cancers in regions and countries According to the data of WHO global report on trends in prevalence of tobacco use 2000-2030 (6) , Nauru has the highest smoking age-standardized prevalence (ASP) at 45.2%, while Ghana has the lowest smoking ASP at 2.4% worldwide (Figure 5A). The death number of smoking-related cancer increased from 1990 to 2021 in all 21 GBD sub-regions except for Western Europe, Eastern Europe, and Central Asia, however, the ASMR of all 21 GBD sub-regions declined (Table 2). The top 3 sub-regions with highest ASMR of smoking-related cancers was East Asia [40.05 (95%UI: 31.26, 50.64)], Central Europe, and High-income North America among the 21 GBD sub-regions in 2021. The lowest ASMR were found in Western Sub-Saharan Africa [2.87 (95%UI: 2.04, 3.73)], Eastern Sub-Saharan Africa, and Central Sub-Saharan Africa (Table 2; Figure 5B-C). Greenland had the highest ASMR of smoking-related cancers among 204 countries and regions, with a decrease from 119.13 (95%UI: 101.88, 137.84) to 62.96 (95%UI: 49.85, 77.96) during 1990-2021, while Nigeria had the lowest ASMR, decreasing from 1.63 (95%UI: 1.07, 2.28) to 1.19 (95%UI: 0.76, 1.71) (Table S1; Figure 5B-C). The global distribution of the burden of ASDR was shown in Figure 5D-E. 3.4 Burden of smoking-related cancers and SDI Notably, while the absolute death number of smoking-related cancer increased across all five SDI regions from 1990 to 2021, ASMRs declined during this period (Table 2). The ASMR of smoking-related cancer in high-middle SDI [33.3 (95%UI: 27.54, 39.95)] and high SDI [25.14 (95%UI: 21.23, 29.01)] regions were higher than in low-middle SDI [11.35 (95%UI: 9.31, 13.39)] and low SDI [6.18 (95%UI: 4.7, 7.74)] regions in 2021 (Table 2). The ASMR declined most rapidly in high SDI region (AAPC: -1.80, P<0.001), and most slowly in low-middle SDI region (AAPC: -0.57, P < 0.001) (Figure 2B-F). Esophageal cancer was the second-highest ASMR in high SDI, high-middle SDI, and middle SDI regions, while larynx cancer was the second-highest ASMR in low-middle SDI and low SDI regions in 2021 (Figure 3A). The ASDRs of the five SDI regions also decreased from 1990 to 2021 (Figure S1). In addition, the positive correlation was observed between ASMR of smoking-related cancers and SDI in both 1990 (R = 0.77, P < 0.001) and 2021 (R = 0.60, P < 0.001) (Figure 6A-B). Similar positive correlations also existed between ASDR of smoking-related cancers and SDI (Figure 6C-D). 3.5 Contributions and predictions of the burden of smoking-related cancers The death number and DALYs of smoking-related cancers increased from 1990 to 2021. Decomposition analysis revealed that the increasing death number and DALYs were primarily attributed to aging and population growth, while epidemiological changes was the factor that reduced the burden (Figure 7A). It was noteworthy that the DALYs declined in high SDI region, mainly due to a reduction of epidemiological changes, which outweighed the combined effects of aging and population growth (Table 2; Figure 7B). Starting from 2022, it is predicted that the ASMRs of smoking-related cancers in both genders and across SDI regions will continue to decline over the next 15 years (Figure 3A-B), and the ASDRs showed similar declining trends (Figure S5A-B). 4. Discussion Smoking was the leading level 4 risk factor of deaths from smoking-related cancers. The death number and DALYs of smoking-related cancers increased from 1990 to 2021. Tracheal, bronchus, and lung cancer; esophageal cancer; stomach cancer; and larynx cancer were the top four types of smoking-related cancers in terms of death number in 2021. However, the ASMR of smoking-related cancers decreased in 2021, especially in high SDI region and males, with stomach cancer showing the most significant decline. In addition, the positive correlation existed between ASMR and SDI. The age group with the highest death number of smoking-related cancers shifted to older ages from 1990 to 2021. Recently, Wu et al. reported that 4.06 million cancer-related deaths were attributable to various risk factors in 2021. Tobacco emerged as the leading level 2 risk factor for cancer DALYs in males, and the second primary level 2 risk factor in females (17) . Similarly, our study found that smoking was the leading level 4 risk factor of cancer-related deaths in both males and females. In addition, smoking-related cancer death number increased from 1328875 to 2012845 during 1990-2021. Tracheal, bronchus, and lung cancer exhibited the highest death number among the 16 types of smoking-related cancers, which was consistent with some previous studies (18-22) . Nevertheless, the cancers with the second-highest ASMR exhibited gender-specific variations. Notably, esophageal cancer ranked second in males, whereas cervical cancer occupied this position in females. Stomach cancer has the most significant decline in ASMR, which was influenced by the interaction between smoking and helicobacter pylori. This decline may be attributed to a decrease in the prevalence of helicobacter pylori infections (23, 24) . The death number and DALYs in males remained substantially higher than in females, possibly due to historical factors such as higher smoking rates and long-term exposure to tobacco risks among males (25) . Currently, the ASMR of smoking-related cancers was declining annually for both males and females, with males showing a faster trend. A possible explanation was that, despite the current lower smoking rates in femles compared to males, making rates of females were expected to rise in many low- and middle-income countries as society developed and women's status improved (26) . The age-specific mortality rate of smoking-related cancers continued to rise with increasing age. In addition, the age group with the highest death number of smoking-related cancers shifted from 65-69 years old to 70-74 years old during 1990-2021. This was mainly due to the cumulative effects of long-term smoking and the decline in immunity associated with aging (27, 28) . The decline in ASMR of smoking-related cancers varied across different regions, with the most rapid decline in high SDI region and the slowest decline in low-middle SDI region. This was mainly attributed to the strict tobacco control policies, health education, and robust medical support systems in developed regions (29) . Additionally, population growth and aging were the main contributing factors to the DALYs of smoking-related cancers. However, epidemiological changes significantly alleviated the DALYs of cancer, especially in high-SDI region. This further emphasized the effectiveness of tobacco control policies in high-SDI region (30) . These indicated that to reduce the global burden of smoking-related cancers, it was essential to enhance tobacco control policies, elevate public health awareness, and boost the accessibility of medical services. Our study also had several limitations. Fisrtly, based on the GBD database, we were unable to present the incidence of smoking-related cancers. Secondly, the causes of smoking-related cancer death were certainly multifactorial, and analyzing smoking as the sole factor contributing to cancer mortality may introduce bias. Finally, the COVID-19 pandemic introduced significant uncertainty into mortality estimates for all diseases, particularly in regions most severely affected by the pandemic. 5. Conclusions This study highlighted the increasing global death number of smoking-related cancers in 2021 compared to 1990. Tracheal, bronchus, and lung cancer had the leading ASMR, while the cancer with second-highest ASMR varied by different regions and gender. Fortunately, the global ASMR of smoking-related cancers declined, however, the rate of decline in ASMR varied across different regions and genders. These findings underscore the need for special tobacco control measures to address the specific needs of different regions and genders. Abbreviations GBD Global Burden of Disease ARIMA Autoregressive integrated moving average UI uncertainty interval ASMR age-standardized mortality rate SDI socio-demographic index AAPC average annual percentage change DALYs disability-adjusted life-years YLLs years of life lost WHO World Health Organization ASDR age-standardized disability-adjusted life year rate ASP age-standardized prevalence APC annual percent change Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Availability of data and materials The datasets of the current study are available in the Global Health Data Exchange query tool (https://vizhub.healthdata.org/gbd-results). Competing interests The authors declare that they have no competing interests. Funding: This study was supported by the National Natural Science Foundation of China (Grant No. 82172848) and Shanghai Municipal Health Commission Special Clinical Research Project for the Hygiene Industry (20234Y0248). Authors' contributions: Ao Zeng, Zhilong Xu, Xiao Zhou, and Jie Dai contributed to conceptualisation. Ao Zeng, Zhilong Xu, Keyi Chen, and Mengtao Wang contributed to data curation, formal analysis, investigation, methodology, and resources. Ao Zeng, Zhilong Xu, Jiarui Wang, Abudumijiti Abuduwayiti, Yanze Yin contributed to software, supervision, validation, project administration, and visualisation. Ao Zeng, Zhilong Xu, Xiao Zhou, and Jie Dai contributed to writing – original draft, and writing – review & editing. Jie Dai contributed to funding acquisition. All authors read and approved the final manuscript. Acknowledgements: Not applicable. 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Tables Table 1 Global burden of smoking-related cancers from 1990 to 2021 Type of cancers Deaths (95%UI) ASMR/10^5 (95%UI) DALYs (95%UI) ASDR/10^5 (95%UI) 1990 2021 1990 2021 1990 2021 1990 2021 Neoplasms 1328875 (1154027, 1511048) 2012845 (1682778, 2369033) 33.76 (29.23,38.45) 23.31 (19.49,27.43) 35581636 (30900964,40450855) 47976550 (40135805,56484931) 863.94 (749.97,982.52) 546.86 (456.92,643.93) Tracheal, bronchus, and lung cancer 737926 (686229, 791982) 1195796 (1054670 ,1359223) 18.72 (17.37,20.12) 13.85 (12.22,15.74) 19356963 (18071733,20777680) 27713689 (24404593,31596581) 471.15 (438.8, 505.43) 315.67 (278.19,359.86) Stomach cancer 109818 (89441, 131513) 107926 (84603, 138448) 2.81 (2.29, 3.36) 1.25 (0.98, 1.61) 2929437 (2380225, 3509272) 2537998 (1991161, 3270229) 71.17 (58.04, 85.11) 29.01 (22.75, 37.32) Prostate cancer 9937 (4652, 15975) 12992 (5893, 21582) 0.28 (0.13, 0.45) 0.15 (0.07, 0.26) 218511 (102373, 342894) 281979 (131119, 458053) 5.73 (2.68, 9.06) 3.26 (1.52, 5.33) Pancreatic cancer 38431 (34758, 42214) 72170 (62853, 82937) 0.98 (0.89, 1.08) 0.83 (0.73, 0.96) 1030312 (935957, 1124872) 1789503 (1567221, 2042057) 24.98 (22.66, 27.32) 20.38 (17.84, 23.25) Other pharynx cancer 20279 (16847, 23682) 36033 (28368, 43169) 0.49 (0.41, 0.57) 0.41 (0.32, 0.49) 625853 (520372, 729929) 1032570 (809600, 1231276) 14.79 (12.29, 17.25) 11.68 (9.16, 13.93) Nasopharynx cancer 11942 (8939, 15073) 13410 (9832, 17103) 0.29 (0.22, 0.36) 0.15 (0.11, 0.2) 375819 (282167, 472216) 389614 (286016, 495582) 8.79 (6.59, 11.04) 4.43 (3.25, 5.64) Liver cancer 31744 (11068, 51200) 53054 (18268, 88111) 0.77 (0.27, 1.24) 0.61 (0.21, 1.01) 991836 (348072, 1595195) 1482896 (505000, 2478906) 23.19 (8.13, 37.31) 16.9 (5.76, 28.26) Lip and oral cavity cancer 30582 (21972, 38805) 48773 (33622, 63367) 0.77 (0.55, 0.98) 0.56 (0.39, 0.73) 887464 (641443, 1120445) 1312511 (910638, 1697046) 21.29 (15.35, 26.91) 14.91 (10.34, 19.27) Leukemia 23738 (9151, 38473) 34151 (12152, 57975) 0.64 (0.24, 1.06) 0.4 (0.14, 0.69) 565148 (225129, 905446) 719825 (263395, 1207483) 14.24 (5.61, 22.93) 8.34 (3.04, 14) Larynx cancer 64528 (58868, 69741) 77951 (69554, 86284) 1.61 (1.47, 1.74) 0.89 (0.8, 0.99) 1848004 (1688370, 1995684) 2061113 (1838588, 2281339) 44.42 (40.58, 47.99) 23.38 (20.84, 25.89) Kidney cancer 9673 (6072, 13617) 16216 (9663, 23217) 0.25 (0.16, 0.35) 0.19 (0.11, 0.27) 251336 (159401, 348868) 382927 (233635, 536755) 6.17 (3.9, 8.61) 4.37 (2.66, 6.14) Esophageal cancer 136450 (109956, 163495) 205463 (156544, 257209) 3.46 (2.79, 4.13) 2.38 (1.81, 2.98) 3640952 (2931006, 4386515) 4765032 (3626148, 5973195) 88.47 (71.26, 106.51) 54.26 (41.29, 68.02) Colon and rectum cancer 31090 (19792, 42082) 47613 (29670, 66040) 0.8 (0.51, 1.09) 0.55 (0.34, 0.77) 850250 (541714, 1141631) 1235667 (773606, 1708237) 20.64 (13.14, 27.74) 14.12 (8.84, 19.5) Cervical cancer 22655 (13935, 31928) 22614 (13558, 33567) 0.55 (0.34, 0.78) 0.26 (0.16, 0.39) 766894 (477363, 1073011) 723320 (437008, 1059888) 17.71 (10.99, 24.84) 8.29 (5, 12.13) Breast cancer 8967 (6931, 11032) 9916 (7481, 12405) 0.22 (0.17, 0.28) 0.11 (0.09, 0.14) 297373 (229374, 364980) 309601 (236543, 388913) 7 (5.4, 8.59) 3.54 (2.7, 4.45) Bladder cancer 41114 (35100, 46965) 58767 (49381, 70892) 1.13 (0.96, 1.29) 0.7 (0.59, 0.84) 945486 (805856, 1076451) 1238303 (1044303, 1478221) 24.2 (20.63, 27.6) 14.33 (12.09, 17.14) ASMR, age-standardized mortality rate; UI, uncertainty interval; DALYs, disability-adjusted life years; ASDR, age-standardized disability-adjusted life year rate </td> </tr> </tbody> Table 2 Burden of smoking-related cancers by 21 sub-regions and genders from 1990 to 2021 Regions Deaths (95%UI) ASMR/10^5 (95%UI) DALYs (95%UI) ASDR/10^5 (95%UI) 1990 2021 1990 2021 1990 2021 1990 2021 Male 1119129 (977622,1265839) 1686857 (1403744, 1987301) 63 (54.85,71.36) 42.68 (35.53, 50.34) 30194060 (26320867,34138230) 40546882 (33800933,47818086) 1560.43 (1360.02,1765.84) 978.15 (813.34, 1154.36) Female 209746 (171307,248222) 325987 (264154, 392322) 9.97 (8.15, 11.83) 7.01 (5.68, 8.44) 5387575 (4425834, 6393069) 7429667 (6062302, 8976648) 250.15 (205.37, 296.81) 161.3 (131.54, 195.01) High SDI 484231 (422913, 543887) 536575 (451337, 622891) 43.71 (38.17,49.09) 25.14 (21.23, 29.01) 12013110 (10534041,13444665) 11558601 (9809912, 13307474) 1114.78 (978.04, 1247.33) 585.58 (499.71, 671.61) High-middle SDI 438840 (383088, 497157) 669478 (554119, 802846) 43.49 (37.93,49.41) 33.3 (27.54, 39.95) 12175781 (10627645,13763814) 16167592 (13389562,19420388) 1173.55 (1022.99,1328.37) 807.39 (668.07, 970.42) Middle SDI 304080 (254707, 359336) 614004 (497356, 750467) 30 (25.18,35.4) 23.17 (18.72, 28.4) 8498331 (7047437, 10082826) 15049536 (12122220,18482496) 764.47 (637.51, 904.15) 539.33 (435.78, 661.11) Low-middle SDI 81966 (66508, 97454) 160677 (132041, 189112) 13.69 (11.08,16.28) 11.35 (9.31, 13.39) 2326194 (1880622, 2769330) 4311086 (3525445, 5087370) 353.94 (286.72, 421.24) 284.93 (233.55, 335.9) Low SDI 18101 (13844, 22635) 30129 (22816, 37880) 8.14 (6.21, 10.16) 6.18 (4.7, 7.74) 522508 (398700, 655807) 840567 (631090, 1064186) 211.99 (162.09, 265.34) 154.29 (116.57, 194.78) Western Sub-Saharan Africa 2781 (1927, 3752) 5515 (3836, 7193) 3.21 (2.23, 4.3) 2.87 (2.04, 3.73) 79180 (54107, 107903) 156944 (106957, 207089) 83.65 (57.65, 113.16) 72.33 (50.13, 94.52) Southern Sub-Saharan Africa 6025 (4829, 7135) 9902 (8041, 11968) 22.4 (17.89,26.64) 16.93 (13.63, 20.71) 175821 (142190, 208148) 285133 (231486, 343325) 601.47 (484.73, 711.58) 452.03 (367.15, 546.75) Eastern Sub-Saharan Africa 5606 (4138, 6989) 8988 (6544, 11668) 7.7 (5.72, 9.61) 5.5 (4.05, 7.06) 161169 (118015, 203109) 258312 (186429, 336766) 198.78 (146.29, 249.13) 139.22 (101.28, 181.34) Central Sub-Saharan Africa 1697 (1227, 2316) 3288 (2370, 4528) 7.4 (5.38, 10.07) 5.85 (4.25, 8.03) 50513 (36386, 68956) 99513 (70835, 138057) 198.02 (143.51, 270.36) 155.81 (112.42, 214.72) South Asia 71369 (57454, 84676) 135798 (107683, 164447) 12.59 (10.06,14.93) 9.31 (7.37, 11.31) 2064157 (1652574, 2451802) 3646256 (2882362, 4427010) 328.22 (263.59, 389.77) 234.61 (185.95, 284.4) North Africa and Middle East 35741 (29397, 42593) 74148 (60784, 87985) 21.68 (17.78,25.8) 17.06 (13.95, 20.26) 1003132 (827345, 1197617) 1955461 (1601415, 2316680) 552.68 (455.43, 659.67) 407.53 (333.72, 483.02) Tropical Latin America 25870 (21792, 30052) 41388 (34235, 49317) 28.7 (24.14,33.46) 16.06 (13.24, 19.16) 722179 (608807, 835189) 1037982 (860872, 1236175) 739.18 (624.22, 856.28) 394.51 (327.06, 470.13) Central Latin America 12108 (10094, 14175) 16043 (12561, 19507) 15.33 (12.77,17.96) 6.49 (5.09, 7.89) 315584 (262071, 371252) 392437 (304452, 482334) 366.17 (304.95, 429.46) 153.89 (119.59, 188.77) Andean Latin America 1788 (1410, 2176) 3397 (2544, 4494) 9.12 (7.21, 11.09) 5.86 (4.41, 7.73) 45799 (36007, 56202) 80490 (60012, 106483) 218.77 (172.45, 267.27) 134.9 (100.67, 178.52) Caribbean 6101 (5188, 7039) 9923 (8094, 11921) 23.88 (20.26,27.6) 18.32 (14.95, 22.02) 153518 (131234, 177323) 241235 (197613, 288506) 584.24 (499.5, 674.44) 445.42 (364.92, 532.63) High-income North America 169887 (149101, 190775) 172503 (143741, 201022) 48.95 (43.04,54.8) 25.63 (21.4, 29.79) 4237690 (3723063, 4725098) 3841710 (3240095, 4440966) 1278.57 (1124.29,1422.18) 600.21 (507.72, 693.41) Southern Latin America 15351 (13096, 17485) 16147 (13358, 18839) 32.74 (27.9, 37.31) 18.63 (15.42, 21.71) 432044 (370234, 488828) 413660 (345940, 481002) 917.68 (785.23, 1038.9) 489.99 (409.73, 570.4) Western Europe 251376 (220631, 280529) 232664 (193454, 270795) 43.71 (38.44,48.67) 25.27 (21.38, 29.11) 6080164 (5383550, 6785402) 5063564 (4314320, 5822117) 1114.55 (987.42, 1242.71) 609.21 (519.97, 697.13) Australasia 7761 (6694, 8869) 8275 (6746, 9992) 32.54 (28.05,37.19) 15.36 (12.62, 18.5) 192378 (166411, 217959) 184927 (152891, 221849) 824.46 (712.97, 933.47) 369.28 (306.07, 441.42) High-income Asia Pacific 71776 (60911, 82287) 103244 (85262, 121386) 35.76 (30.38,40.97) 20.49 (16.99, 23.97) 1762761 (1477226, 2039266) 1896336 (1571770, 2214874) 853 (715.59, 986.32) 437 (366.09, 509.06) Eastern Europe 111403 (101596, 120655) 85651 (72859, 98166) 38.53 (35.05,41.82) 24.25 (20.63, 27.8) 3294362 (3011196, 3562144) 2327903 (1973209, 2663793) 1143.64 (1043.57,1238.38) 681 (577.03, 778.37) Central Europe 69711 (62259, 77106) 79581 (67907, 90591) 45.62 (40.67,50.53) 36.49 (31.18, 41.47) 1992923 (1784200, 2197243) 1988345 (1703852, 2251840) 1305.39 (1167.31,1441.04) 965.5 (827.14, 1094.03) Central Asia 14197 (12432, 16067) 12332 (10240, 14580) 29.06 (25.38,32.99) 14.78 (12.34, 17.5) 426914 (374368, 481826) 346670 (286286, 410207) 844.29 (737.89, 953.92) 386.37 (319.77, 457.17) Oceania 431 (311, 588) 920 (674, 1268) 14.68 (10.74,19.93) 12.19 (9.01, 16.87) 13053 (9119, 17951) 27860 (20238, 38414) 388.92 (280.03, 530.89) 322.26 (235.58, 443.65) Southeast Asia 51080 (42354, 60667) 115265 (94722, 137359) 20.84 (17.31,24.75) 17.99 (14.83, 21.36) 1402126 (1155372, 1673213) 3026068 (2460232, 3643820) 519.22 (430.79, 618.29) 434.27 (354.27, 520.58) East Asia 396816 (320954, 478786) 877873 (682843, 1109437) 47.11 (38.55,56.48) 40.05 (31.26, 50.64) 10976168 (8776756, 13268730) 20705743 (15931876,26397507) 1181.07 (952.71, 1423.83) 915.7 (708.44, 1165.28) ASMR, age-standardized mortality rate; UI, uncertainty interval; DALYs, disability-adjusted life years; ASDR, age-standardized disability-adjusted life year rate; SDI, socio-demographic index Additional Declarations No competing interests reported. Supplementary Files Supplementaryfiguresandtables.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 21 Jul, 2025 Reviewers agreed at journal 21 Jul, 2025 Reviewers invited by journal 03 Jul, 2025 Editor invited by journal 12 Jun, 2025 Editor assigned by journal 10 Jun, 2025 Submission checks completed at journal 10 Jun, 2025 First submitted to journal 10 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-6861637\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":480121269,\"identity\":\"ea7fa374-3e35-4c41-903b-db8bec096737\",\"order_by\":0,\"name\":\"Ao Zeng\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, 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09:53:21\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-6861637/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-6861637/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":86150563,\"identity\":\"fb7baad2-069e-463b-b170-ac81a283f193\",\"added_by\":\"auto\",\"created_at\":\"2025-07-07 09:58:50\",\"extension\":\"jpg\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":1228530,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eSmoking: the major level 4 risk factors contributing to deaths from neoplasms. (A) The top three level 4 risk factors contributing to neoplasm deaths in 1990 or 2021. (B) The percent of deaths from various smoking-related cancers.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure1.tif.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6861637/v1/011fcd365e5c9595a0dcabbd.jpg\"},{\"id\":86150557,\"identity\":\"af9714dd-253e-4651-be69-a0b5dbbbc04c\",\"added_by\":\"auto\",\"created_at\":\"2025-07-07 09:58:50\",\"extension\":\"jpg\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":1206367,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eThe APC of ASMR for smoking-related cancers from 1990 to 2021. (A) Global; (B) High SDI; (C) High-middle SDI; (D) Middle SDI; (E) Low-middle SDI; (F) Low SDI. APC, annual percent change; ASMR, age-standardized mortality rate; SDI, socio-demographic index\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure2.tif.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6861637/v1/10fefb5d79b414aa984210be.jpg\"},{\"id\":86150560,\"identity\":\"e2533255-f2a0-45ce-99cb-e4d1cc7c0939\",\"added_by\":\"auto\",\"created_at\":\"2025-07-07 09:58:50\",\"extension\":\"jpg\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":1132196,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eThe trend prediction of ASMR for smoking-related tumors over the next 15 years. (A) Global and 5 SDI regions (B) Males and Females in global. The dashed vertical line indicates 2022 (the first forecast year). ASMR, age-standardized mortality rate; SDI, socio-demographic index\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure3.tif.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6861637/v1/462dafbd6215ff2aa104974b.jpg\"},{\"id\":86150787,\"identity\":\"a744f6ae-024f-4e57-af11-bf42364332b3\",\"added_by\":\"auto\",\"created_at\":\"2025-07-07 10:06:50\",\"extension\":\"jpg\",\"order_by\":4,\"title\":\"Figure 4\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":461265,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eAge-specific death or DALYs (bar plot) and rates (line plot) of smoking-related cancers in 1990 or 2021 by genders and ages. (A) Deaths in 1990; (B) Deaths in 2021; (C) DALYs in 1990; (D) DALYs in 2021. DALYs, disability-adjusted life-years.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure4.tif.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6861637/v1/31d6b41c335705a23610e394.jpg\"},{\"id\":86150558,\"identity\":\"bb7e3d9b-9964-4092-9043-d83b8abe9615\",\"added_by\":\"auto\",\"created_at\":\"2025-07-07 09:58:50\",\"extension\":\"jpg\",\"order_by\":5,\"title\":\"Figure 5\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":994181,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eGlobal burden of smoking-related cancers from 1990 to 2021. (A) Global ASP of smoking. (B) ASMR of smoking-related cancers in 1990. (C) ASMR of smoking-related cancers in 2021. (D) ASDR of smoking-related cancers in 1990. (E) ASDR of smoking-related cancers in 2021. ASP, age-standardized prevalence (%); ASMR, age-standardized mortality rate; ASDR, age-standardized disability-adjusted life year rate\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure5.tif.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6861637/v1/5ef683ede2cc1c075f425f03.jpg\"},{\"id\":86150562,\"identity\":\"e845663d-d6df-4895-8932-9099e5ab19e3\",\"added_by\":\"auto\",\"created_at\":\"2025-07-07 09:58:50\",\"extension\":\"jpg\",\"order_by\":6,\"title\":\"Figure 6\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":1295384,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eCorrelation of ASMR and ASDR with SDI. (A) Correlation of ASMR with SDI in 1990. (B) Correlation of ASMR with SDI in 2021. (C) Correlation of ASDR with SDI in 1990. (D) Correlation of ASMR with SDI in 2021. ASMR, age-standardized mortality rate; ASDR, age-standardized disability-adjusted life year rate; SDI, socio-demographic index\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure6.tif.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6861637/v1/56e6a0a5ee704d88cf71b0b3.jpg\"},{\"id\":86150561,\"identity\":\"32b2e12c-e3c2-4ce6-97a4-1c48721b6ab6\",\"added_by\":\"auto\",\"created_at\":\"2025-07-07 09:58:50\",\"extension\":\"jpg\",\"order_by\":7,\"title\":\"Figure 7\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":451276,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003ePopulation, epidemiological change, and aging on the number of deaths and DALYs from smoking-related cancers in from 1990 to 2021. (A) Different genders in global; (B) 5 SDI regions. DALYs, disability-adjusted life-years; SDI, socio-demographic index\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure7.tif.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6861637/v1/212b92b6ebffcdd13c8fc7a1.jpg\"},{\"id\":86151910,\"identity\":\"e80e1df6-04d8-4e11-8717-4f8daaa176f0\",\"added_by\":\"auto\",\"created_at\":\"2025-07-07 10:14:53\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":8244862,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6861637/v1/b2277598-859a-4570-af5b-a0af29ca8622.pdf\"},{\"id\":86150788,\"identity\":\"ccf761ed-8880-4377-8f1d-1454372611fe\",\"added_by\":\"auto\",\"created_at\":\"2025-07-07 10:06:50\",\"extension\":\"docx\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":3263433,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"Supplementaryfiguresandtables.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6861637/v1/3ba543f6054f6383dc55488b.docx\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Global burden of smoking-related cancers from 1990 to 2021: insights from the Global Burden of Disease study\",\"fulltext\":[{\"header\":\"1. Introduction\",\"content\":\"\\u003cp\\u003eThe absolute global burden of cancers was enormous and exhibited a persistent increasing trend\\u003csup\\u003e(1)\\u003c/sup\\u003e. Smoking was a major contributor to the development of various cancers, including lung, larynx, esophagus, and stomach cancers\\u003csup\\u003e(2-4)\\u003c/sup\\u003e.\\u0026nbsp;According to the\\u0026nbsp;global action plan for the prevention and control of noncommunicable diseases 2013-2020\\u003csup\\u003e(5)\\u003c/sup\\u003e,\\u0026nbsp;World Health Organization (WHO) has set a target to reduce global tobacco use.\\u0026nbsp;However,\\u0026nbsp;the latest WHO global report on trends in the prevalence of tobacco use estimated that there were 1.245 billion smokers worldwide in 2022\\u003csup\\u003e(6)\\u003c/sup\\u003e. Consequently, the burden of smoking-related cancers remained substantial and required urgent attention.\\u003c/p\\u003e\\n\\u003cp\\u003eThe Global Burden of Disease (GBD) database served as a high-quality tool for health assessment, offering long-term data at global, national, and regional levels\\u003csup\\u003e(7)\\u003c/sup\\u003e. The GBD 2019 Tobacco Collaborators reported that smoking tobacco use resulted in 7.69 million deaths and 200 million disability-adjusted life-years (DALYs) in 2019\\u003csup\\u003e(8)\\u003c/sup\\u003e. In 2021, smoking was responsible for more than one in ten global deaths and nearly 142 million years of life lost (YLLs)\\u003csup\\u003e(7)\\u003c/sup\\u003e. Furthermore, the GBD 2021 Tobacco Forecasting Collaborators indicated that there would be 1040 million male smokers and 201 million female smokers by 2050, with projections of 1040 million \\u0026nbsp;and 816 million YLLs in 2050, respectively\\u003csup\\u003e(9)\\u003c/sup\\u003e.\\u0026nbsp;However, as a major health-related consequence by smoking, few studies have assessed the burden of mortality and DALYs about\\u0026nbsp;smoking-related cancers.\\u003c/p\\u003e\\n\\u003cp\\u003eThis study provided a standardized assessment of the burden of smoking-related cancers across different regions and time periods and projected the burden trends from 2022 to 2036. The findings will present quantitative evidence to guide tobacco control policies, contributing to substantial health benefits to citizens.\\u003c/p\\u003e\"},{\"header\":\"2. Method\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003e2.1 Data sources\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;GBD 2021 database includes information about 371 diseases and injuries, and 88 risk factors across 204 countries and regions\\u003csup\\u003e(7, 10)\\u003c/sup\\u003e. In the study, mortality and DALYs data of smoking-related cancers were extracted from the GBD study tools, covering 204 countries and regions between 1990 and 2021. The data is available at https://vizhub.healthdata.org/gbd-results.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e2.2 Overview and definitions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eCancer was a multifactorial disease with numerous potential risk factors. This study specifically investigated smoking-related cancers, excluding those caused by chewing tobacco and second-hand smoke\\u003csup\\u003e(11)\\u003c/sup\\u003e.\\u0026nbsp;The socio-demographic index (SDI) was a composite indicator of a country\\u0026apos;s development status, ranging from 0 to 1, where 0 represented the lowest level of development and 1 represented the highest level\\u003csup\\u003e(12)\\u003c/sup\\u003e. The age-standardized rate was the rate per 100,000 population following standardization to the global age structure, with differences across regions and over time independent of population size and age structure. DALYs represented the sum of years lost due to premature death and years living with disability due to the disease. The study obtained the mortality and DALYs from 16 types of smoking-related cancers.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e2.3 Statistical analysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe Joinpoint regression model was a collection of linear statistical models, and was used to assess trends in cancer burden over time. The software tracked the trend of data over time and fited the simplest model to the data by connecting several different segments on a logarithmic scale. The average annual percentage change (AAPC) was calculated, and the statistical significance of the fluctuation trends in different parts is investigated by comparing the AAPC to 0\\u003csup\\u003e(13, 14)\\u003c/sup\\u003e.\\u003c/p\\u003e\\n\\u003cp\\u003eDecomposition analysis was used to visually display the contributions of three factors (i.e., aging, population, and epidemiological changes) to the variation of cancer burden between 1990 and 2021. Epidemiological changes referred to age and population-adjusted mortality and morbidity rates\\u003csup\\u003e(14, 15)\\u003c/sup\\u003e.\\u003c/p\\u003e\\n\\u003cp\\u003eAutoregressive integrated moving average (ARIMA) model was composed of the autoregressive model and the moving average model. The basic assumption was that the data sequence was a transient random variable whose autocorrelation can be represented by the ARIMA model, and future values can be predicted based on past values. In this study, the ARIMA model was used to predict the cancer burden for the next 15 years\\u003csup\\u003e(16)\\u003c/sup\\u003e.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eUncertainty interval (UI) was calculated from the distribution of 500 draws through the multistage computational pipeline, with the 95% UI based on the 2.5th and 97.5th percentiles\\u003csup\\u003e(9)\\u003c/sup\\u003e. All statistical analyses and graphics were performed using R version 4.21 or GraphPad Prism 9, with p\\u0026lt;0.05 considered statistically significant.\\u003c/p\\u003e\"},{\"header\":\"3. Result\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003e3.1 Smoking was the leading level 4 risk factor contributing to cancer deaths\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e The risk factors contributing to cancer deaths were numerous. In 1990, the leading level 4 risk factor contributing to cancer deaths was smoking, accounting for 22.77% (95%UI: 19.74%, 25.68%). Smoking remained the leading level 4 risk factor, with a percent of 20.00% (95%UI: 17.02%, 22.69%) in 2021(Figure 1A). Smoking contributed to deaths from 16 types of cancers. In 2021, 66.23% (95%UI: 60.63%, 70.91%) of larynx cancer deaths and 58.89% (95%UI: 54.52%, 62.69%) of tracheal, bronchus, and lung cancer deaths were attributed to smoking (Figure 1B).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e3.2 The burden of smoking-related cancers in the global\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe global death number of smoking-related cancers increased from 1328875 (95%UI: 1154027, 1511048)\\u0026nbsp;to 2012845 (95%UI: 1682778, 2369033) during 1990-2021. During the same period, the DALYs of smoking-related cancers increased from 35581636 (95%UI: 30900964, 40450855) to 47976550 (95%UI: 40135805, 56484931).\\u0026nbsp;The\\u0026nbsp;age-standardized mortality rate (ASMR) of smoking-related cancer decreased from 33.76 (95%UI: 29.23, 38.45) to 23.31 (95%UI: 19.49, 27.43), with an AAPC of -1.22 (P \\u0026lt; 0.001) (Table 1; Figure 2A). The\\u0026nbsp;age-standardized disability-adjusted life year rate (ASDR)\\u0026nbsp;also decreased from 863.94 (95%UI: 749.97, 982.52) to 546.86 (95%UI: 456.92, 643.93) (Table 1; Figure S1). In 2021, the top four smoking-related cancer death number were tracheal, bronchus, and lung cancer; esophageal cancer; stomach cancer; and larynx cancer (Table 1). Stomach cancer had the steepest decline of ASMR, with an AAPC of -2.60 (p\\u0026lt;0.001) (Figure S2).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eFrom 1990 to 2021, the death number from smoking-related cancers among males increased from 1119129 (95%UI: 977622, 1265839) to 1686857 (95%UI: 1403744, 1987301). For females, it rose from 209746 (95%UI: 171307, 248222) to 325987 (95%UI: 264154, 392322) (Table 2). However, the ASMR declined in both males and females (Table 2), with an AAPC of -1.28 (P\\u0026lt;0.001) and -1.14 (P\\u0026lt;0.001) for males and females, respectively (Figure 2A). Esophageal cancer was the second-highest ASMR in males, while cervical cancer was the second-highest ASMR in females (Figure 3B). Stomach cancer had the steepest decline of ASMR, with an AAPC of -2.55 (P\\u0026lt;0.001) and -3.57 (P\\u0026lt;0.001) for males and females, respectively (Figure S3-S4). The\\u0026nbsp;ASDR\\u0026nbsp;for\\u0026nbsp;both males and females\\u0026nbsp;also showed a downward trend from 1990 to 2021 (Figure S1).\\u003c/p\\u003e\\n\\u003cp\\u003eThe age group with the highest death number of smoking-related cancer shifted from 65-69 years old to 70-74 years old during 1990-2021 (Figure 4A-B). Similarly, the age group with the highest DALYs of smoking-related cancers moved from 60-64 years old in 1990 to 65-69 years old in 2021 (Figure 4C-D). Age-specific death rates showed an increasing trend with advancing age (Figure 4A-B).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e3.3 The burden of smoking-related cancers in regions and countries\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAccording to the data of WHO global report on trends in prevalence of tobacco use 2000-2030\\u003csup\\u003e(6)\\u003c/sup\\u003e, Nauru has the highest smoking age-standardized\\u0026nbsp;prevalence (ASP) at 45.2%, while Ghana has the lowest smoking ASP at 2.4% worldwide (Figure 5A). The death number of smoking-related cancer increased from 1990 to 2021 in all 21 GBD sub-regions except for Western Europe, Eastern Europe, and Central Asia, however, the ASMR of all 21 GBD sub-regions declined (Table 2). The top 3 sub-regions with highest ASMR of smoking-related cancers was East Asia [40.05 (95%UI: 31.26, 50.64)], Central Europe, and High-income North America among the 21 GBD sub-regions in 2021. The lowest ASMR were found in Western Sub-Saharan Africa [2.87 (95%UI: 2.04, 3.73)], Eastern Sub-Saharan Africa, and Central Sub-Saharan Africa (Table 2; Figure 5B-C).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eGreenland had the highest ASMR of smoking-related cancers among 204 countries and regions, with a decrease from 119.13 (95%UI: 101.88, 137.84) to 62.96 (95%UI: 49.85, 77.96)\\u0026nbsp;during 1990-2021, while Nigeria had the lowest ASMR, decreasing from 1.63 (95%UI: 1.07, 2.28) to 1.19 (95%UI: 0.76, 1.71)\\u0026nbsp;(Table S1; Figure 5B-C). The global distribution of the burden of\\u0026nbsp;ASDR\\u0026nbsp;was shown in Figure 5D-E.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e3.4 Burden of smoking-related cancers and SDI\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNotably, while the absolute death number of smoking-related cancer increased across all five SDI regions from 1990 to 2021, ASMRs declined during this period (Table 2). The ASMR of smoking-related cancer in high-middle SDI [33.3 (95%UI: 27.54, 39.95)] and high SDI [25.14 (95%UI: 21.23, 29.01)] regions were higher than in low-middle SDI [11.35 (95%UI: 9.31, 13.39)] and low SDI [6.18 (95%UI: 4.7, 7.74)] regions in 2021 (Table 2). The ASMR declined most rapidly in high SDI region (AAPC: -1.80, P\\u0026lt;0.001), and most slowly in low-middle SDI region (AAPC: -0.57, P \\u0026lt; 0.001) (Figure 2B-F).\\u0026nbsp;Esophageal cancer was the second-highest ASMR in high SDI, high-middle SDI, and middle SDI regions, while larynx cancer was the second-highest ASMR in low-middle SDI and low SDI regions in 2021 (Figure 3A). The ASDRs of the five SDI regions also decreased from 1990 to 2021 (Figure S1).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eIn addition, the positive correlation was observed between ASMR of smoking-related cancers and SDI in both 1990 (R = 0.77, P \\u0026lt; 0.001) and 2021 (R = 0.60, P \\u0026lt; 0.001) (Figure 6A-B).\\u0026nbsp;Similar positive correlations also existed between ASDR of smoking-related cancers and SDI (Figure 6C-D).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e3.5 Contributions and predictions of the burden of smoking-related cancers\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e The death number and DALYs of smoking-related cancers increased from 1990 to 2021. Decomposition analysis revealed that the increasing death number and DALYs were primarily attributed to aging and population growth, while epidemiological changes was the factor that reduced the burden (Figure 7A).\\u0026nbsp;It was noteworthy that the DALYs declined in high SDI region, mainly due to a reduction of epidemiological changes, which outweighed the combined effects of aging and population growth (Table 2;\\u0026nbsp;Figure 7B).\\u003c/p\\u003e\\n\\u003cp\\u003eStarting from 2022, it is predicted that the ASMRs of smoking-related cancers in both genders and across SDI regions will continue to decline over the next 15 years (Figure 3A-B), and the ASDRs showed similar declining trends (Figure S5A-B).\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"4. Discussion\",\"content\":\"\\u003cp\\u003eSmoking was the leading level 4 risk factor of deaths from smoking-related cancers. The death number and DALYs of smoking-related cancers increased from 1990 to 2021. Tracheal, bronchus, and lung cancer; esophageal cancer; stomach cancer; and larynx cancer were the top four types of smoking-related cancers in terms of death number in 2021. However, the ASMR of smoking-related cancers decreased in 2021, especially in high SDI region and males, with stomach cancer showing the most significant decline. In addition, the positive correlation existed between ASMR and SDI. The age group with the highest death number of smoking-related cancers shifted to older ages from 1990 to 2021.\\u003c/p\\u003e\\n\\u003cp\\u003eRecently, Wu et al. reported that 4.06 million cancer-related deaths were attributable to various risk factors in 2021.\\u0026nbsp;Tobacco emerged as the leading level 2 risk factor for cancer DALYs in males, and the second primary level 2 risk factor in females\\u003csup\\u003e(17)\\u003c/sup\\u003e. Similarly, our study found that smoking was the leading level 4 risk factor of cancer-related deaths in both males and females. In addition, smoking-related cancer death number increased from 1328875 to 2012845 during 1990-2021. Tracheal, bronchus, and lung cancer exhibited the highest death number among the 16 types of smoking-related cancers, which was consistent with some previous studies\\u003csup\\u003e(18-22)\\u003c/sup\\u003e. Nevertheless,\\u0026nbsp;the cancers with the second-highest ASMR exhibited gender-specific variations. Notably, esophageal cancer ranked second in males, whereas cervical cancer occupied this position in females.\\u0026nbsp;Stomach\\u0026nbsp;cancer has the most significant decline in ASMR, which was influenced by the interaction between smoking and helicobacter pylori.\\u0026nbsp;This decline may be attributed to a decrease in the prevalence of helicobacter pylori infections\\u003csup\\u003e(23, 24)\\u003c/sup\\u003e.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eThe death\\u0026nbsp;number\\u0026nbsp;and DALYs in males remained substantially higher than in females, possibly due to historical factors such as higher smoking rates and long-term exposure to tobacco risks among males\\u003csup\\u003e(25)\\u003c/sup\\u003e. Currently, the ASMR of\\u0026nbsp;smoking-related cancers\\u0026nbsp;was declining annually for\\u0026nbsp;both males and females, with males showing a faster trend. A possible explanation was that, despite the current lower smoking rates in femles compared to males, making rates of females were expected to rise in many low- and middle-income countries as society developed and women\\u0026apos;s status improved\\u003csup\\u003e(26)\\u003c/sup\\u003e.\\u0026nbsp;The age-specific mortality rate\\u0026nbsp;of smoking-related cancers\\u0026nbsp;continued to rise with increasing age. In addition,\\u0026nbsp;the age group with the highest death number of smoking-related cancers shifted from 65-69 years old to 70-74 years old during 1990-2021. This was mainly due to the cumulative effects of long-term smoking and the decline in immunity associated with aging\\u003csup\\u003e(27, 28)\\u003c/sup\\u003e.\\u003c/p\\u003e\\n\\u003cp\\u003eThe decline in ASMR of smoking-related cancers varied across different regions, with the most rapid decline in high SDI region and the slowest decline in low-middle SDI region. This was mainly attributed to the strict tobacco control policies, health education, and robust medical support systems in developed regions\\u003csup\\u003e(29)\\u003c/sup\\u003e. Additionally, population growth and aging were the main contributing factors to the DALYs of smoking-related cancers. However, epidemiological changes significantly alleviated the DALYs of cancer, especially in high-SDI region. This further emphasized the effectiveness of tobacco control policies in high-SDI region\\u003csup\\u003e(30)\\u003c/sup\\u003e. These indicated that to reduce the global burden of smoking-related cancers, it was essential to enhance tobacco control policies, elevate public health awareness, and boost the accessibility of medical services.\\u003c/p\\u003e\\n\\u003cp\\u003eOur study also had several limitations. Fisrtly, based on the GBD database, we were unable to present the incidence of smoking-related cancers. Secondly, the causes of smoking-related cancer death were certainly multifactorial, and analyzing smoking as the sole factor contributing to cancer mortality may introduce bias. Finally, the COVID-19 pandemic introduced significant uncertainty into mortality estimates for all diseases, particularly in regions most severely affected by the pandemic.\\u003c/p\\u003e\"},{\"header\":\"5. Conclusions\",\"content\":\"\\u003cp\\u003eThis study highlighted the increasing global death number of smoking-related cancers in 2021 compared to 1990. Tracheal, bronchus, and lung cancer had the leading ASMR, while the cancer with second-highest ASMR varied by different regions and gender. Fortunately, the global ASMR of smoking-related cancers declined, however, the rate of decline in ASMR varied across different regions and genders. These findings underscore the need for special tobacco control measures to address the specific needs of different regions and genders.\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20.434%;\\\"\\u003e\\n \\u003cp\\u003eGBD\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 79.566%;\\\"\\u003e\\n \\u003cp\\u003eGlobal Burden of Disease\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20.434%;\\\"\\u003e\\n \\u003cp\\u003eARIMA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 79.566%;\\\"\\u003e\\n \\u003cp\\u003eAutoregressive integrated moving average\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20.434%;\\\"\\u003e\\n \\u003cp\\u003eUI\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 79.566%;\\\"\\u003e\\n \\u003cp\\u003euncertainty interval\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20.434%;\\\"\\u003e\\n \\u003cp\\u003eASMR\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 79.566%;\\\"\\u003e\\n \\u003cp\\u003eage-standardized mortality rate\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20.434%;\\\"\\u003e\\n \\u003cp\\u003eSDI\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 79.566%;\\\"\\u003e\\n \\u003cp\\u003esocio-demographic index\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20.434%;\\\"\\u003e\\n \\u003cp\\u003eAAPC\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 79.566%;\\\"\\u003e\\n \\u003cp\\u003eaverage annual percentage change\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20.434%;\\\"\\u003e\\n \\u003cp\\u003eDALYs\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 79.566%;\\\"\\u003e\\n \\u003cp\\u003edisability-adjusted life-years\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20.434%;\\\"\\u003e\\n \\u003cp\\u003eYLLs\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 79.566%;\\\"\\u003e\\n \\u003cp\\u003eyears of life lost\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20.434%;\\\"\\u003e\\n \\u003cp\\u003eWHO\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 79.566%;\\\"\\u003e\\n \\u003cp\\u003eWorld Health Organization\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20.434%;\\\"\\u003e\\n \\u003cp\\u003eASDR\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 79.566%;\\\"\\u003e\\n \\u003cp\\u003eage-standardized disability-adjusted life year rate\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20.434%;\\\"\\u003e\\n \\u003cp\\u003eASP\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 79.566%;\\\"\\u003e\\n \\u003cp\\u003eage-standardized\\u0026nbsp;prevalence\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20.434%;\\\"\\u003e\\n \\u003cp\\u003eAPC\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 79.566%;\\\"\\u003e\\n \\u003cp\\u003eannual percent change\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe datasets of the current study are available in the Global Health Data Exchange query tool (https://vizhub.healthdata.org/gbd-results).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare that they have no competing interests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding:\\u0026nbsp;\\u003c/strong\\u003eThis study was supported by the National Natural Science Foundation of China (Grant No. 82172848) and Shanghai Municipal Health Commission Special Clinical Research Project for the Hygiene Industry (20234Y0248).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u0026apos; contributions:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAo Zeng, Zhilong Xu, Xiao Zhou, and Jie Dai\\u003csup\\u003e\\u0026nbsp;\\u003c/sup\\u003econtributed to conceptualisation. Ao Zeng, Zhilong Xu, Keyi Chen, and Mengtao Wang contributed to data curation, formal analysis, investigation, methodology, and resources. Ao Zeng, Zhilong Xu, Jiarui Wang, Abudumijiti Abuduwayiti, Yanze Yin contributed to software, supervision, validation,\\u0026nbsp;project administration, and visualisation. Ao Zeng, Zhilong Xu, Xiao Zhou, and Jie Dai contributed to\\u0026nbsp;writing \\u0026ndash; original draft, and writing \\u0026ndash; review \\u0026amp; editing. Jie Dai\\u003csup\\u003e\\u0026nbsp;\\u003c/sup\\u003econtributed to funding acquisition. All authors read and approved the final manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements:\\u003c/strong\\u003e Not applicable.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eGlobal Burden of Disease Cancer C, Kocarnik JM, Compton K, Dean FE, Fu W, Gaw BL, et al. Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life Years for 29 Cancer Groups From 2010 to 2019: A Systematic Analysis for the Global Burden of Disease Study 2019. JAMA Oncol. 2022;8(3):420-44.\\u003c/li\\u003e\\n\\u003cli\\u003eHow Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General. Publications and Reports of the Surgeon General. Atlanta (GA)2010.\\u003c/li\\u003e\\n\\u003cli\\u003eHumans IWGotEoCRt. Tobacco smoke and involuntary smoking. IARC Monogr Eval Carcinog Risks Hum. 2004;83:1-1438.\\u003c/li\\u003e\\n\\u003cli\\u003eIslami F, Marlow EC, Thomson B, McCullough ML, Rumgay H, Gapstur SM, et al. Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States, 2019. CA Cancer J Clin. 2024;74(5):405-32.\\u003c/li\\u003e\\n\\u003cli\\u003eWorld Health O. Global action plan for the prevention and control of noncommunicable diseases 2013-2020. Geneva: World Health Organization; 2013 2013.\\u003c/li\\u003e\\n\\u003cli\\u003eWorld Health O. WHO global report on trends in prevalence of tobacco use 2000-2030. Geneva: World Health Organization; 2024 2024.\\u003c/li\\u003e\\n\\u003cli\\u003eCollaborators GBDRF. Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024;403(10440):2162-203.\\u003c/li\\u003e\\n\\u003cli\\u003eCollaborators GBDT. Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019. Lancet. 2021;397(10292):2337-60.\\u003c/li\\u003e\\n\\u003cli\\u003eCollaborators GBDTF. Forecasting the effects of smoking prevalence scenarios on years of life lost and life expectancy from 2022 to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Public Health. 2024;9(10):e729-e44.\\u003c/li\\u003e\\n\\u003cli\\u003eDiseases GBD, Injuries C. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024;403(10440):2133-61.\\u003c/li\\u003e\\n\\u003cli\\u003eCollaborators GBDCT. Spatial, temporal, and demographic patterns in prevalence of chewing tobacco use in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019. Lancet Public Health. 2021;6(7):e482-e99.\\u003c/li\\u003e\\n\\u003cli\\u003eDiseases GBD, Injuries C. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204-22.\\u003c/li\\u003e\\n\\u003cli\\u003eZhang Y, Liu J, Han X, Jiang H, Zhang L, Hu J, et al. Long-term trends in the burden of inflammatory bowel disease in China over three decades: A joinpoint regression and age-period-cohort analysis based on GBD 2019. Front Public Health. 2022;10:994619.\\u003c/li\\u003e\\n\\u003cli\\u003ePan H, Zhao Z, Deng Y, Zheng Z, Huang Y, Huang S, et al. The global, regional, and national early-onset colorectal cancer burden and trends from 1990 to 2019: results from the Global Burden of Disease Study 2019. BMC Public Health. 2022;22(1):1896.\\u003c/li\\u003e\\n\\u003cli\\u003eXie Y, Bowe B, Mokdad AH, Xian H, Yan Y, Li T, et al. Analysis of the Global Burden of Disease study highlights the global, regional, and national trends of chronic kidney disease epidemiology from 1990 to 2016. Kidney Int. 2018;94(3):567-81.\\u003c/li\\u003e\\n\\u003cli\\u003eLi Y, Ning Y, Shen B, Shi Y, Song N, Fang Y, et al. Temporal trends in prevalence and mortality for chronic kidney disease in China from 1990 to 2019: an analysis of the Global Burden of Disease Study 2019. Clin Kidney J. 2023;16(2):312-21.\\u003c/li\\u003e\\n\\u003cli\\u003eWu Z, Xia F, Lin R. Global burden of cancer and associated risk factors in 204 countries and territories, 1980-2021: a systematic analysis for the GBD 2021. J Hematol Oncol. 2024;17(1):119.\\u003c/li\\u003e\\n\\u003cli\\u003eChen ZM, Peto R, Iona A, Guo Y, Chen YP, Bian Z, et al. Emerging tobacco-related cancer risks in China: A nationwide, prospective study of 0.5 million adults. Cancer. 2015;121 Suppl 17(Suppl 17):3097-106.\\u003c/li\\u003e\\n\\u003cli\\u003eHenley SJ, Thomas CC, Sharapova SR, Momin B, Massetti GM, Winn DM, et al. Vital Signs: Disparities in Tobacco-Related Cancer Incidence and Mortality - United States, 2004-2013. MMWR Morb Mortal Wkly Rep. 2016;65(44):1212-8.\\u003c/li\\u003e\\n\\u003cli\\u003eMaguire FB, Movsisyan AS, Morris CR, Parikh-Patel A, Keegan THM, Tong EK. Evaluation of Cancer Deaths Attributable to Tobacco in California, 2014-2019. JAMA Netw Open. 2022;5(12):e2246651.\\u003c/li\\u003e\\n\\u003cli\\u003eCollatuzzo G, Malvezzi M, Mangiaterra S, Di Maso M, Turati F, Parazzini F, et al. Cancers attributable to tobacco smoking in Italy in 2020. Cancer Epidemiol. 2024;92:102623.\\u003c/li\\u003e\\n\\u003cli\\u003ePark S, Jee SH, Shin HR, Park EH, Shin A, Jung KW, et al. Attributable fraction of tobacco smoking on cancer using population-based nationwide cancer incidence and mortality data in Korea. BMC Cancer. 2014;14:406.\\u003c/li\\u003e\\n\\u003cli\\u003eToh JWT, Wilson RB. Pathways of Gastric Carcinogenesis, Helicobacter pylori Virulence and Interactions with Antioxidant Systems, Vitamin C and Phytochemicals. Int J Mol Sci. 2020;21(17).\\u003c/li\\u003e\\n\\u003cli\\u003eLeja M, Grinberga-Derica I, Bilgilier C, Steininger C. Review: Epidemiology of Helicobacter pylori infection. Helicobacter. 2019;24 Suppl 1:e12635.\\u003c/li\\u003e\\n\\u003cli\\u003eDai X, Gakidou E, Lopez AD. Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action. Tob Control. 2022;31(2):129-37.\\u003c/li\\u003e\\n\\u003cli\\u003eHitchman SC, Fong GT. Gender empowerment and female-to-male smoking prevalence ratios. Bull World Health Organ. 2011;89(3):195-202.\\u003c/li\\u003e\\n\\u003cli\\u003eHecht SS, Hatsukami DK. Smokeless tobacco and cigarette smoking: chemical mechanisms and cancer prevention. Nat Rev Cancer. 2022;22(3):143-55.\\u003c/li\\u003e\\n\\u003cli\\u003eSaint-Andre V, Charbit B, Biton A, Rouilly V, Posseme C, Bertrand A, et al. Smoking changes adaptive immunity with persistent effects. Nature. 2024;626(8000):827-35.\\u003c/li\\u003e\\n\\u003cli\\u003eBertollini R, Ribeiro S, Mauer-Stender K, Galea G. Tobacco control in Europe: a policy review. Eur Respir Rev. 2016;25(140):151-7.\\u003c/li\\u003e\\n\\u003cli\\u003eHawkins B, Holden C. European Union implementation of Article 5.3 of the Framework Convention on Tobacco Control. Global Health. 2018;14(1):79.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"},{\"header\":\"Tables\",\"content\":\"\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"680\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"9\\\" style=\\\"width: 680px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTable 1 Global burden of smoking-related cancers from 1990 to 2021\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 107px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eType of cancers\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width: 158px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eDeaths\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e(95%UI)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width: 113px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eASMR/10^5\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e(95%UI)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width: 170px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eDALYs\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e(95%UI)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width: 132px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eASDR/10^5\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e(95%UI)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 80px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e1990\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e2021\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e1990\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e2021\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e1990\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e2021\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e1990\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e2021\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 107px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNeoplasms\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 80px;\\\"\\u003e\\n \\u003cp\\u003e1328875 (1154027,\\u003c/p\\u003e\\n \\u003cp\\u003e1511048)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e2012845 (1682778,\\u003c/p\\u003e\\n \\u003cp\\u003e2369033)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e33.76 (29.23,38.45)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e23.31 (19.49,27.43)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e35581636 (30900964,40450855)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e47976550 (40135805,56484931)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e863.94 (749.97,982.52)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e546.86 (456.92,643.93)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 107px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTracheal, bronchus, and lung cancer\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 80px;\\\"\\u003e\\n \\u003cp\\u003e737926 (686229,\\u003c/p\\u003e\\n \\u003cp\\u003e791982)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e1195796 (1054670\\u003c/p\\u003e\\n \\u003cp\\u003e,1359223)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e18.72 (17.37,20.12)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e13.85 (12.22,15.74)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e19356963 (18071733,20777680)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e27713689 (24404593,31596581)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e471.15 (438.8,\\u003c/p\\u003e\\n \\u003cp\\u003e505.43)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e315.67 (278.19,359.86)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 107px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eStomach cancer\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 80px;\\\"\\u003e\\n \\u003cp\\u003e109818 (89441,\\u003c/p\\u003e\\n \\u003cp\\u003e131513)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e107926 (84603,\\u003c/p\\u003e\\n \\u003cp\\u003e138448)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e2.81 (2.29,\\u003c/p\\u003e\\n \\u003cp\\u003e3.36)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e1.25 (0.98,\\u003c/p\\u003e\\n \\u003cp\\u003e1.61)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e2929437 (2380225,\\u003c/p\\u003e\\n \\u003cp\\u003e3509272)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e2537998 (1991161,\\u003c/p\\u003e\\n \\u003cp\\u003e3270229)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e71.17 (58.04,\\u003c/p\\u003e\\n \\u003cp\\u003e85.11)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e29.01 (22.75,\\u003c/p\\u003e\\n \\u003cp\\u003e37.32)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 107px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eProstate cancer\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 80px;\\\"\\u003e\\n \\u003cp\\u003e9937 (4652,\\u003c/p\\u003e\\n \\u003cp\\u003e15975)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e12992 (5893,\\u003c/p\\u003e\\n \\u003cp\\u003e21582)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.28 (0.13,\\u003c/p\\u003e\\n \\u003cp\\u003e0.45)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.15 (0.07,\\u003c/p\\u003e\\n \\u003cp\\u003e0.26)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e218511 (102373,\\u003c/p\\u003e\\n \\u003cp\\u003e342894)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e281979 (131119,\\u003c/p\\u003e\\n \\u003cp\\u003e458053)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e5.73 (2.68,\\u003c/p\\u003e\\n \\u003cp\\u003e9.06)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e3.26 (1.52,\\u003c/p\\u003e\\n \\u003cp\\u003e5.33)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 107px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePancreatic cancer\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 80px;\\\"\\u003e\\n \\u003cp\\u003e38431 (34758,\\u003c/p\\u003e\\n \\u003cp\\u003e42214)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e72170 (62853,\\u003c/p\\u003e\\n \\u003cp\\u003e82937)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.98 (0.89,\\u003c/p\\u003e\\n \\u003cp\\u003e1.08)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.83 (0.73,\\u003c/p\\u003e\\n \\u003cp\\u003e0.96)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e1030312 (935957,\\u003c/p\\u003e\\n \\u003cp\\u003e1124872)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e1789503 (1567221,\\u003c/p\\u003e\\n \\u003cp\\u003e2042057)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e24.98 (22.66,\\u003c/p\\u003e\\n \\u003cp\\u003e27.32)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e20.38 (17.84,\\u003c/p\\u003e\\n \\u003cp\\u003e23.25)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 107px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eOther pharynx cancer\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 80px;\\\"\\u003e\\n \\u003cp\\u003e20279 (16847,\\u003c/p\\u003e\\n \\u003cp\\u003e23682)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e36033 (28368,\\u003c/p\\u003e\\n \\u003cp\\u003e43169)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.49 (0.41,\\u003c/p\\u003e\\n \\u003cp\\u003e0.57)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.41 (0.32,\\u003c/p\\u003e\\n \\u003cp\\u003e0.49)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e625853 (520372,\\u003c/p\\u003e\\n \\u003cp\\u003e729929)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e1032570 (809600,\\u003c/p\\u003e\\n \\u003cp\\u003e1231276)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e14.79 (12.29,\\u003c/p\\u003e\\n \\u003cp\\u003e17.25)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e11.68 (9.16,\\u003c/p\\u003e\\n \\u003cp\\u003e13.93)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 107px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNasopharynx cancer\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 80px;\\\"\\u003e\\n \\u003cp\\u003e11942 (8939,\\u003c/p\\u003e\\n \\u003cp\\u003e15073)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e13410 (9832,\\u003c/p\\u003e\\n \\u003cp\\u003e17103)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.29 (0.22,\\u003c/p\\u003e\\n \\u003cp\\u003e0.36)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.15 (0.11,\\u003c/p\\u003e\\n \\u003cp\\u003e0.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e375819 (282167,\\u003c/p\\u003e\\n \\u003cp\\u003e472216)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e389614 (286016,\\u003c/p\\u003e\\n \\u003cp\\u003e495582)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e8.79 (6.59,\\u003c/p\\u003e\\n \\u003cp\\u003e11.04)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e4.43 (3.25,\\u003c/p\\u003e\\n \\u003cp\\u003e5.64)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 107px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eLiver cancer\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 80px;\\\"\\u003e\\n \\u003cp\\u003e31744 (11068,\\u003c/p\\u003e\\n \\u003cp\\u003e51200)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e53054 (18268,\\u003c/p\\u003e\\n \\u003cp\\u003e88111)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.77 (0.27,\\u003c/p\\u003e\\n \\u003cp\\u003e1.24)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.61 (0.21,\\u003c/p\\u003e\\n \\u003cp\\u003e1.01)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e991836 (348072,\\u003c/p\\u003e\\n \\u003cp\\u003e1595195)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e1482896 (505000,\\u003c/p\\u003e\\n \\u003cp\\u003e2478906)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e23.19 (8.13,\\u003c/p\\u003e\\n \\u003cp\\u003e37.31)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e16.9 (5.76,\\u003c/p\\u003e\\n \\u003cp\\u003e28.26)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 107px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eLip and oral cavity cancer\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 80px;\\\"\\u003e\\n \\u003cp\\u003e30582 (21972,\\u003c/p\\u003e\\n \\u003cp\\u003e38805)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e48773 (33622,\\u003c/p\\u003e\\n \\u003cp\\u003e63367)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.77 (0.55,\\u003c/p\\u003e\\n \\u003cp\\u003e0.98)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.56 (0.39,\\u003c/p\\u003e\\n \\u003cp\\u003e0.73)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e887464 (641443,\\u003c/p\\u003e\\n \\u003cp\\u003e1120445)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e1312511 (910638,\\u003c/p\\u003e\\n \\u003cp\\u003e1697046)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e21.29 (15.35,\\u003c/p\\u003e\\n \\u003cp\\u003e26.91)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e14.91 (10.34,\\u003c/p\\u003e\\n \\u003cp\\u003e19.27)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 107px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eLeukemia\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 80px;\\\"\\u003e\\n \\u003cp\\u003e23738 (9151,\\u003c/p\\u003e\\n \\u003cp\\u003e38473)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e34151 (12152,\\u003c/p\\u003e\\n \\u003cp\\u003e57975)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.64 (0.24,\\u003c/p\\u003e\\n \\u003cp\\u003e1.06)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.4 (0.14,\\u003c/p\\u003e\\n \\u003cp\\u003e0.69)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e565148 (225129,\\u003c/p\\u003e\\n \\u003cp\\u003e905446)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e719825 (263395,\\u003c/p\\u003e\\n \\u003cp\\u003e1207483)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e14.24 (5.61,\\u003c/p\\u003e\\n \\u003cp\\u003e22.93)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e8.34 (3.04,\\u003c/p\\u003e\\n \\u003cp\\u003e14)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 107px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eLarynx cancer\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 80px;\\\"\\u003e\\n \\u003cp\\u003e64528 (58868,\\u003c/p\\u003e\\n \\u003cp\\u003e69741)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e77951 (69554,\\u003c/p\\u003e\\n \\u003cp\\u003e86284)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e1.61 (1.47,\\u003c/p\\u003e\\n \\u003cp\\u003e1.74)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.89 (0.8,\\u003c/p\\u003e\\n \\u003cp\\u003e0.99)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e1848004 (1688370,\\u003c/p\\u003e\\n \\u003cp\\u003e1995684)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e2061113 (1838588,\\u003c/p\\u003e\\n \\u003cp\\u003e2281339)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e44.42 (40.58,\\u003c/p\\u003e\\n \\u003cp\\u003e47.99)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e23.38 (20.84,\\u003c/p\\u003e\\n \\u003cp\\u003e25.89)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 107px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eKidney cancer\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 80px;\\\"\\u003e\\n \\u003cp\\u003e9673 (6072,\\u003c/p\\u003e\\n \\u003cp\\u003e13617)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e16216 (9663,\\u003c/p\\u003e\\n \\u003cp\\u003e23217)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.25 (0.16,\\u003c/p\\u003e\\n \\u003cp\\u003e0.35)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.19 (0.11,\\u003c/p\\u003e\\n \\u003cp\\u003e0.27)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e251336 (159401,\\u003c/p\\u003e\\n \\u003cp\\u003e348868)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e382927 (233635,\\u003c/p\\u003e\\n \\u003cp\\u003e536755)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e6.17 (3.9,\\u003c/p\\u003e\\n \\u003cp\\u003e8.61)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e4.37 (2.66,\\u003c/p\\u003e\\n \\u003cp\\u003e6.14)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 107px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eEsophageal cancer\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 80px;\\\"\\u003e\\n \\u003cp\\u003e136450 (109956,\\u003c/p\\u003e\\n \\u003cp\\u003e163495)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e205463 (156544,\\u003c/p\\u003e\\n \\u003cp\\u003e257209)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e3.46 (2.79,\\u003c/p\\u003e\\n \\u003cp\\u003e4.13)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e2.38 (1.81,\\u003c/p\\u003e\\n \\u003cp\\u003e2.98)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e3640952 (2931006,\\u003c/p\\u003e\\n \\u003cp\\u003e4386515)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e4765032 (3626148,\\u003c/p\\u003e\\n \\u003cp\\u003e5973195)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e88.47 (71.26,\\u003c/p\\u003e\\n \\u003cp\\u003e106.51)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e54.26 (41.29,\\u003c/p\\u003e\\n \\u003cp\\u003e68.02)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 107px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eColon and rectum cancer\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 80px;\\\"\\u003e\\n \\u003cp\\u003e31090 (19792,\\u003c/p\\u003e\\n \\u003cp\\u003e42082)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e47613 (29670,\\u003c/p\\u003e\\n \\u003cp\\u003e66040)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.8 (0.51,\\u003c/p\\u003e\\n \\u003cp\\u003e1.09)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.55 (0.34,\\u003c/p\\u003e\\n \\u003cp\\u003e0.77)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e850250 (541714,\\u003c/p\\u003e\\n \\u003cp\\u003e1141631)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e1235667 (773606,\\u003c/p\\u003e\\n \\u003cp\\u003e1708237)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e20.64 (13.14,\\u003c/p\\u003e\\n \\u003cp\\u003e27.74)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e14.12 (8.84,\\u003c/p\\u003e\\n \\u003cp\\u003e19.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 107px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCervical cancer\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 80px;\\\"\\u003e\\n \\u003cp\\u003e22655 (13935,\\u003c/p\\u003e\\n \\u003cp\\u003e31928)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e22614 (13558,\\u003c/p\\u003e\\n \\u003cp\\u003e33567)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.55 (0.34,\\u003c/p\\u003e\\n \\u003cp\\u003e0.78)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.26 (0.16,\\u003c/p\\u003e\\n \\u003cp\\u003e0.39)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e766894 (477363,\\u003c/p\\u003e\\n \\u003cp\\u003e1073011)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e723320 (437008,\\u003c/p\\u003e\\n \\u003cp\\u003e1059888)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e17.71 (10.99,\\u003c/p\\u003e\\n \\u003cp\\u003e24.84)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e8.29\\u003c/p\\u003e\\n \\u003cp\\u003e(5,\\u003c/p\\u003e\\n \\u003cp\\u003e12.13)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 107px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eBreast cancer\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 80px;\\\"\\u003e\\n \\u003cp\\u003e8967 (6931,\\u003c/p\\u003e\\n \\u003cp\\u003e11032)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e9916 (7481,\\u003c/p\\u003e\\n \\u003cp\\u003e12405)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.22 (0.17,\\u003c/p\\u003e\\n \\u003cp\\u003e0.28)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.11 (0.09,\\u003c/p\\u003e\\n \\u003cp\\u003e0.14)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e297373 (229374,\\u003c/p\\u003e\\n \\u003cp\\u003e364980)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e309601 (236543,\\u003c/p\\u003e\\n \\u003cp\\u003e388913)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e7\\u003c/p\\u003e\\n \\u003cp\\u003e(5.4,\\u003c/p\\u003e\\n \\u003cp\\u003e8.59)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e3.54 (2.7,\\u003c/p\\u003e\\n \\u003cp\\u003e4.45)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 107px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eBladder cancer\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 80px;\\\"\\u003e\\n \\u003cp\\u003e41114 (35100,\\u003c/p\\u003e\\n \\u003cp\\u003e46965)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e58767 (49381,\\u003c/p\\u003e\\n \\u003cp\\u003e70892)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e1.13 (0.96,\\u003c/p\\u003e\\n \\u003cp\\u003e1.29)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e0.7 (0.59,\\u003c/p\\u003e\\n \\u003cp\\u003e0.84)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e945486 (805856,\\u003c/p\\u003e\\n \\u003cp\\u003e1076451)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e1238303 (1044303,\\u003c/p\\u003e\\n \\u003cp\\u003e1478221)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e24.2 (20.63,\\u003c/p\\u003e\\n \\u003cp\\u003e27.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e14.33 (12.09,\\u003c/p\\u003e\\n \\u003cp\\u003e17.14)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"9\\\" valign=\\\"top\\\" style=\\\"width: 680px;\\\"\\u003e\\n \\u003cp\\u003eASMR, age-standardized mortality rate; UI, uncertainty interval; DALYs, disability-adjusted life years; ASDR, age-standardized disability-adjusted life year rate\\u003c/p\\u003e\\n \\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"699\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"9\\\" style=\\\"width: 699px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTable 2 Burden of smoking-related cancers by 21 sub-regions and genders from 1990 to 2021\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eRegions\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width: 160px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eDeaths\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e(95%UI)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width: 123px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eASMR/10^5\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e(95%UI)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width: 170px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eDALYs\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e(95%UI)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width: 151px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eASDR/10^5\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e(95%UI)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e1990\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e2021\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 59px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e1990\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e2021\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e1990\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e2021\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e1990\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e2021\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMale\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e1119129 (977622,1265839)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e1686857 (1403744,\\u003c/p\\u003e\\n \\u003cp\\u003e1987301)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 59px;\\\"\\u003e\\n \\u003cp\\u003e63 (54.85,71.36)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e42.68 (35.53,\\u003c/p\\u003e\\n \\u003cp\\u003e50.34)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e30194060 (26320867,34138230)\\u003c/p\\u003e\\n 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valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e23.17 (18.72,\\u003c/p\\u003e\\n \\u003cp\\u003e28.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e8498331 (7047437,\\u003c/p\\u003e\\n \\u003cp\\u003e10082826)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e15049536 (12122220,18482496)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e764.47 (637.51,\\u003c/p\\u003e\\n \\u003cp\\u003e904.15)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e539.33 (435.78,\\u003c/p\\u003e\\n \\u003cp\\u003e661.11)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 95px;\\\"\\u003e\\n 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style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e4311086 (3525445,\\u003c/p\\u003e\\n \\u003cp\\u003e5087370)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e353.94 (286.72,\\u003c/p\\u003e\\n \\u003cp\\u003e421.24)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e284.93 (233.55,\\u003c/p\\u003e\\n \\u003cp\\u003e335.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eLow SDI\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e18101 (13844,\\u003c/p\\u003e\\n \\u003cp\\u003e22635)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e30129 (22816,\\u003c/p\\u003e\\n \\u003cp\\u003e37880)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 59px;\\\"\\u003e\\n \\u003cp\\u003e8.14 (6.21,\\u003c/p\\u003e\\n \\u003cp\\u003e10.16)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e6.18 (4.7,\\u003c/p\\u003e\\n \\u003cp\\u003e7.74)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e522508 (398700,\\u003c/p\\u003e\\n \\u003cp\\u003e655807)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e840567 (631090,\\u003c/p\\u003e\\n \\u003cp\\u003e1064186)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e211.99 (162.09,\\u003c/p\\u003e\\n \\u003cp\\u003e265.34)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e154.29 (116.57,\\u003c/p\\u003e\\n \\u003cp\\u003e194.78)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eWestern Sub-Saharan Africa\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e2781 (1927,\\u003c/p\\u003e\\n \\u003cp\\u003e3752)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e5515 (3836,\\u003c/p\\u003e\\n \\u003cp\\u003e7193)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 59px;\\\"\\u003e\\n \\u003cp\\u003e3.21 (2.23,\\u003c/p\\u003e\\n \\u003cp\\u003e4.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n 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Africa\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e6025 (4829,\\u003c/p\\u003e\\n \\u003cp\\u003e7135)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e9902 (8041,\\u003c/p\\u003e\\n \\u003cp\\u003e11968)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 59px;\\\"\\u003e\\n \\u003cp\\u003e22.4 (17.89,26.64)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e16.93 (13.63,\\u003c/p\\u003e\\n \\u003cp\\u003e20.71)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e175821 (142190,\\u003c/p\\u003e\\n \\u003cp\\u003e208148)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e285133 (231486,\\u003c/p\\u003e\\n \\u003cp\\u003e343325)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e601.47 (484.73,\\u003c/p\\u003e\\n \\u003cp\\u003e711.58)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e452.03 (367.15,\\u003c/p\\u003e\\n \\u003cp\\u003e546.75)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eEastern Sub-Saharan Africa\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e5606 (4138,\\u003c/p\\u003e\\n \\u003cp\\u003e6989)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e8988 (6544,\\u003c/p\\u003e\\n 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76px;\\\"\\u003e\\n \\u003cp\\u003e139.22 (101.28,\\u003c/p\\u003e\\n \\u003cp\\u003e181.34)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCentral Sub-Saharan Africa\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e1697 (1227,\\u003c/p\\u003e\\n \\u003cp\\u003e2316)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e3288 (2370,\\u003c/p\\u003e\\n \\u003cp\\u003e4528)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 59px;\\\"\\u003e\\n \\u003cp\\u003e7.4 (5.38,\\u003c/p\\u003e\\n \\u003cp\\u003e10.07)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e5.85 (4.25,\\u003c/p\\u003e\\n 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valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e71369 (57454,\\u003c/p\\u003e\\n \\u003cp\\u003e84676)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e135798 (107683,\\u003c/p\\u003e\\n \\u003cp\\u003e164447)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 59px;\\\"\\u003e\\n \\u003cp\\u003e12.59 (10.06,14.93)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e9.31 (7.37,\\u003c/p\\u003e\\n \\u003cp\\u003e11.31)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e2064157 (1652574,\\u003c/p\\u003e\\n \\u003cp\\u003e2451802)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e3646256 (2882362,\\u003c/p\\u003e\\n 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style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e722179 (608807,\\u003c/p\\u003e\\n \\u003cp\\u003e835189)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e1037982 (860872,\\u003c/p\\u003e\\n \\u003cp\\u003e1236175)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e739.18 (624.22,\\u003c/p\\u003e\\n \\u003cp\\u003e856.28)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e394.51 (327.06,\\u003c/p\\u003e\\n \\u003cp\\u003e470.13)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCentral Latin America\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e12108 (10094,\\u003c/p\\u003e\\n \\u003cp\\u003e14175)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e16043 (12561,\\u003c/p\\u003e\\n \\u003cp\\u003e19507)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 59px;\\\"\\u003e\\n \\u003cp\\u003e15.33 (12.77,17.96)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e6.49 (5.09,\\u003c/p\\u003e\\n \\u003cp\\u003e7.89)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e315584 (262071,\\u003c/p\\u003e\\n \\u003cp\\u003e371252)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e392437 (304452,\\u003c/p\\u003e\\n \\u003cp\\u003e482334)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e366.17 (304.95,\\u003c/p\\u003e\\n \\u003cp\\u003e429.46)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e153.89 (119.59,\\u003c/p\\u003e\\n \\u003cp\\u003e188.77)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAndean Latin America\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e1788 (1410,\\u003c/p\\u003e\\n \\u003cp\\u003e2176)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e3397 (2544,\\u003c/p\\u003e\\n \\u003cp\\u003e4494)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 59px;\\\"\\u003e\\n \\u003cp\\u003e9.12 (7.21,\\u003c/p\\u003e\\n 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valign=\\\"top\\\" style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCaribbean\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e6101 (5188,\\u003c/p\\u003e\\n \\u003cp\\u003e7039)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e9923 (8094,\\u003c/p\\u003e\\n \\u003cp\\u003e11921)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 59px;\\\"\\u003e\\n \\u003cp\\u003e23.88 (20.26,27.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e18.32 (14.95,\\u003c/p\\u003e\\n \\u003cp\\u003e22.02)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e153518 (131234,\\u003c/p\\u003e\\n \\u003cp\\u003e177323)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e241235 (197613,\\u003c/p\\u003e\\n \\u003cp\\u003e288506)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e584.24 (499.5,\\u003c/p\\u003e\\n \\u003cp\\u003e674.44)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e445.42 (364.92,\\u003c/p\\u003e\\n \\u003cp\\u003e532.63)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHigh-income North America\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e169887 (149101,\\u003c/p\\u003e\\n \\u003cp\\u003e190775)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e172503 (143741,\\u003c/p\\u003e\\n \\u003cp\\u003e201022)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 59px;\\\"\\u003e\\n \\u003cp\\u003e48.95 (43.04,54.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e25.63 (21.4,\\u003c/p\\u003e\\n \\u003cp\\u003e29.79)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e4237690 (3723063,\\u003c/p\\u003e\\n \\u003cp\\u003e4725098)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e3841710 (3240095,\\u003c/p\\u003e\\n \\u003cp\\u003e4440966)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e1278.57 (1124.29,1422.18)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e600.21 (507.72,\\u003c/p\\u003e\\n \\u003cp\\u003e693.41)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSouthern Latin America\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e15351 (13096,\\u003c/p\\u003e\\n \\u003cp\\u003e17485)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e16147 (13358,\\u003c/p\\u003e\\n \\u003cp\\u003e18839)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 59px;\\\"\\u003e\\n \\u003cp\\u003e32.74 (27.9,\\u003c/p\\u003e\\n \\u003cp\\u003e37.31)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e18.63 (15.42,\\u003c/p\\u003e\\n \\u003cp\\u003e21.71)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e432044 (370234,\\u003c/p\\u003e\\n \\u003cp\\u003e488828)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e413660 (345940,\\u003c/p\\u003e\\n \\u003cp\\u003e481002)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e917.68 (785.23,\\u003c/p\\u003e\\n \\u003cp\\u003e1038.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e489.99 (409.73,\\u003c/p\\u003e\\n \\u003cp\\u003e570.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eWestern Europe\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e251376 (220631,\\u003c/p\\u003e\\n \\u003cp\\u003e280529)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e232664 (193454,\\u003c/p\\u003e\\n \\u003cp\\u003e270795)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 59px;\\\"\\u003e\\n \\u003cp\\u003e43.71 (38.44,48.67)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e25.27 (21.38,\\u003c/p\\u003e\\n \\u003cp\\u003e29.11)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e6080164 (5383550,\\u003c/p\\u003e\\n \\u003cp\\u003e6785402)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e5063564 (4314320,\\u003c/p\\u003e\\n \\u003cp\\u003e5822117)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e1114.55 (987.42,\\u003c/p\\u003e\\n \\u003cp\\u003e1242.71)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e609.21 (519.97,\\u003c/p\\u003e\\n \\u003cp\\u003e697.13)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAustralasia\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e7761 (6694,\\u003c/p\\u003e\\n \\u003cp\\u003e8869)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e8275 (6746,\\u003c/p\\u003e\\n \\u003cp\\u003e9992)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 59px;\\\"\\u003e\\n \\u003cp\\u003e32.54 (28.05,37.19)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e15.36 (12.62,\\u003c/p\\u003e\\n \\u003cp\\u003e18.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e192378 (166411,\\u003c/p\\u003e\\n \\u003cp\\u003e217959)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e184927 (152891,\\u003c/p\\u003e\\n \\u003cp\\u003e221849)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e824.46 (712.97,\\u003c/p\\u003e\\n \\u003cp\\u003e933.47)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e369.28 (306.07,\\u003c/p\\u003e\\n \\u003cp\\u003e441.42)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHigh-income Asia Pacific\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e71776 (60911,\\u003c/p\\u003e\\n \\u003cp\\u003e82287)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e103244 (85262,\\u003c/p\\u003e\\n \\u003cp\\u003e121386)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 59px;\\\"\\u003e\\n \\u003cp\\u003e35.76 (30.38,40.97)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e20.49 (16.99,\\u003c/p\\u003e\\n \\u003cp\\u003e23.97)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e1762761 (1477226,\\u003c/p\\u003e\\n \\u003cp\\u003e2039266)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e1896336 (1571770,\\u003c/p\\u003e\\n \\u003cp\\u003e2214874)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e853 (715.59,\\u003c/p\\u003e\\n \\u003cp\\u003e986.32)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e437 (366.09,\\u003c/p\\u003e\\n \\u003cp\\u003e509.06)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eEastern Europe\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e111403 (101596,\\u003c/p\\u003e\\n \\u003cp\\u003e120655)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e85651 (72859,\\u003c/p\\u003e\\n \\u003cp\\u003e98166)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 59px;\\\"\\u003e\\n \\u003cp\\u003e38.53 (35.05,41.82)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e24.25 (20.63,\\u003c/p\\u003e\\n \\u003cp\\u003e27.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e3294362 (3011196,\\u003c/p\\u003e\\n \\u003cp\\u003e3562144)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e2327903 (1973209,\\u003c/p\\u003e\\n \\u003cp\\u003e2663793)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e1143.64 (1043.57,1238.38)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e681 (577.03,\\u003c/p\\u003e\\n \\u003cp\\u003e778.37)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCentral Europe\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e69711 (62259,\\u003c/p\\u003e\\n \\u003cp\\u003e77106)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e79581 (67907,\\u003c/p\\u003e\\n \\u003cp\\u003e90591)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 59px;\\\"\\u003e\\n \\u003cp\\u003e45.62 (40.67,50.53)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e36.49 (31.18,\\u003c/p\\u003e\\n \\u003cp\\u003e41.47)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e1992923 (1784200,\\u003c/p\\u003e\\n \\u003cp\\u003e2197243)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e1988345 (1703852,\\u003c/p\\u003e\\n \\u003cp\\u003e2251840)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e1305.39 (1167.31,1441.04)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e965.5 (827.14,\\u003c/p\\u003e\\n \\u003cp\\u003e1094.03)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCentral Asia\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e14197 (12432,\\u003c/p\\u003e\\n \\u003cp\\u003e16067)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e12332 (10240,\\u003c/p\\u003e\\n \\u003cp\\u003e14580)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 59px;\\\"\\u003e\\n \\u003cp\\u003e29.06 (25.38,32.99)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e14.78 (12.34,\\u003c/p\\u003e\\n \\u003cp\\u003e17.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e426914 (374368,\\u003c/p\\u003e\\n \\u003cp\\u003e481826)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e346670 (286286,\\u003c/p\\u003e\\n \\u003cp\\u003e410207)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e844.29 (737.89,\\u003c/p\\u003e\\n \\u003cp\\u003e953.92)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e386.37 (319.77,\\u003c/p\\u003e\\n \\u003cp\\u003e457.17)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eOceania\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e431\\u003c/p\\u003e\\n \\u003cp\\u003e(311,\\u003c/p\\u003e\\n \\u003cp\\u003e588)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e920\\u003c/p\\u003e\\n \\u003cp\\u003e(674,\\u003c/p\\u003e\\n \\u003cp\\u003e1268)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 59px;\\\"\\u003e\\n \\u003cp\\u003e14.68 (10.74,19.93)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e12.19 (9.01,\\u003c/p\\u003e\\n \\u003cp\\u003e16.87)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e13053 (9119,\\u003c/p\\u003e\\n \\u003cp\\u003e17951)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e27860 (20238,\\u003c/p\\u003e\\n \\u003cp\\u003e38414)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e388.92 (280.03,\\u003c/p\\u003e\\n \\u003cp\\u003e530.89)\\u003c/p\\u003e\\n 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(14.83,\\u003c/p\\u003e\\n \\u003cp\\u003e21.36)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e1402126 (1155372,\\u003c/p\\u003e\\n \\u003cp\\u003e1673213)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e3026068 (2460232,\\u003c/p\\u003e\\n \\u003cp\\u003e3643820)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e519.22 (430.79,\\u003c/p\\u003e\\n \\u003cp\\u003e618.29)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e434.27 (354.27,\\u003c/p\\u003e\\n \\u003cp\\u003e520.58)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 95px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eEast Asia\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e396816 (320954,\\u003c/p\\u003e\\n \\u003cp\\u003e478786)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e877873 (682843,\\u003c/p\\u003e\\n \\u003cp\\u003e1109437)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 59px;\\\"\\u003e\\n \\u003cp\\u003e47.11 (38.55,56.48)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 64px;\\\"\\u003e\\n \\u003cp\\u003e40.05 (31.26,\\u003c/p\\u003e\\n \\u003cp\\u003e50.64)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e10976168 (8776756,\\u003c/p\\u003e\\n \\u003cp\\u003e13268730)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 85px;\\\"\\u003e\\n \\u003cp\\u003e20705743 (15931876,26397507)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e1181.07 (952.71,\\u003c/p\\u003e\\n \\u003cp\\u003e1423.83)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e915.7 (708.44,\\u003c/p\\u003e\\n \\u003cp\\u003e1165.28)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"9\\\" style=\\\"width: 699px;\\\"\\u003e\\n \\u003cp\\u003eASMR, age-standardized mortality rate; UI, uncertainty interval; DALYs, disability-adjusted life years;\\u0026nbsp;ASDR, age-standardized disability-adjusted life year rate; SDI,\\u0026nbsp;socio-demographic index\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-cancer\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bcan\",\"sideBox\":\"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bcan/default.aspx\",\"title\":\"BMC Cancer\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"smoking-related cancers, age-standardized mortality rate, socio-demographic index, average annual percent change, disability-adjusted life-years \",\"lastPublishedDoi\":\"10.21203/rs.3.rs-6861637/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-6861637/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBackground\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe global cancer mortality burden was exceptionally high, especially due to smoking-related cancers. This study aimed to analyze the global burden of smoking-related cancers from 1990 to 2021.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethod\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eEpidemiological data from the 2021 Global Burden of Disease (GBD) study was used to analyze the burden of smoking-related cancers across different ages, genders, and regions. The Joinpoint regression model was applied to evaluate trends in cancer burden during 1990-2021, while decomposition analysis visually represented the contributions of aging, population growth, and epidemiological changes to the variation of burden. Additionally, autoregressive integrated moving average (ARIMA) model was used to predict the burden over the next 15 years.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResult\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eSmoking was the leading level 4 risk factor contributing to cancer deaths. The global smoking-related cancer death number increased from 1328875 [95% uncertainty interval (UI): 1154027, 1511048)] to 2012845 (95%UI: 1682778, 2369033) during 1990-2021. The top four smoking-related cancer death number were tracheal, bronchus, and lung cancer; esophageal cancer; stomach cancer; and larynx cancer in 2021. The global age-standardized mortality rate (ASMR) of smoking-related cancers decreased from 33.76 (95%UI: 29.23, 38.45) in 1990 to 23.31 (95%UI: 19.49, 27.43) in 2021, which declined most rapidly in high socio-demographic index (SDI) region [average annual percentage change (AAPC): -1.80)] and males (AAPC: -1.28). Stomach cancer had the steepest decline of ASMR, with an AAPC of -2.60 (p\\u0026lt;0.001). There was a positive correlation between ASMR and SDI in 2021 (R=0.60). The age group with the highest death number of smoking-related cancer shifted from 65-69 years old to 70-74 years old during 1990-2021. In addition, ASMRs of smoking-related cancers is predicted to continue to decline in both genders and across all SDI regions over the next 15 years.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eSmoking-related cancers are a significant global public health issue. Despite the decline in ASMR of smoking-related cancers, the absolute death number of smoking-related cancers continued to rise. Therefore, making specific tobacco control policies is crucial to address the smoking-related health challenges.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Global burden of smoking-related cancers from 1990 to 2021: insights from the Global Burden of Disease study\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-07-07 09:58:45\",\"doi\":\"10.21203/rs.3.rs-6861637/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-07-21T14:26:21+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"118686302156434958292770799174923441678\",\"date\":\"2025-07-21T07:05:46+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2025-07-03T10:27:02+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2025-06-12T06:18:19+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2025-06-11T00:45:17+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2025-06-11T00:45:02+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Cancer\",\"date\":\"2025-06-10T09:42:10+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-cancer\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bcan\",\"sideBox\":\"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bcan/default.aspx\",\"title\":\"BMC Cancer\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"15f453c1-0af6-431c-ae39-0b62689fcdb8\",\"owner\":[],\"postedDate\":\"July 7th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"under-review\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-07-07T09:58:45+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-07-07 09:58:45\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-6861637\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-6861637\",\"identity\":\"rs-6861637\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}