Smoking prevalence and its impacts on lung cancer mortality in Sub-Saharan Africa: an epidemiological study.

Abstract

Reliable mortality data are sparse for developing countries. Furthermore, risk factor prevalence information is hardly available and thus not taken into consideration when estimating mortality. The authors used a validated, statistical model combined with representative smoking prevalence from WHO STEPS surveys to estimate lung cancer mortality for six Sub-Saharan African countries (Benin, Malawi, Mozambique, Niger, Sierra Leone, Swaziland). Results were compared to a reference database (GLOBOCAN). Using different smoking prevalence scenarios, future lung cancer deaths were estimated. The prevalence of current moderate smoking among males ranged from 8.7% to 34.6%. Prevalence was much lower among females. For all countries considered, our mortality estimates were higher than GLOBOCAN estimates that do not consider prevalence: Overall, we estimated 2405 lung cancer deaths for 2008 compared to 531 deaths estimated by GLOBOCAN. Up to 2030, lung cancer deaths are expected to increase in general and by over 100% in Benin and Niger. Even under the assumption of decrease in smoking prevalence, lung cancer mortality will rise. On the bases of detailed smoking prevalence information, our findings implicate a higher lung cancer burden in low income countries. The epidemiologic transition in African low-income countries alludes to the need for targeted health prevention efforts.