Tobacco Burden in Pakistan (1990–2021): Join point and Forecast Analysis

Abstract

Introduction:

Tobacco use remains a major global health concern and a leading cause of preventable morbidity and mortality. Despite national control measures, Pakistan continues to experience substantial health losses attributable to smoking, chewing tobacco, and secondhand smoke exposure.

Objective:

This study aimed to assess the burden of age-standardized mortality rates (ASMR) and disability-adjusted life years (dalys) associated with tobacco use in Pakistan from 1990 to 2021 using Global Burden of Disease (GBD) data, and to forecast future trends through 2031 using the Autoregressive Integrated Moving Average (ARIMA) model.

Methods:

Data on tobacco-related ASMR and dalys were extracted from the GBD 2021 dataset for the period 1990–2021. Joinpoint regression analysis was employed to identify significant changes in temporal trends, with statistical significance set at p < 0.05. Forecasting of mortality trends up to 2031 was performed using the ARIMA (1,1,2) model, selected based on optimal fit determined by the Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC).

Results:

Between 2004 and 2014, both ASMR and dalys showed significant declines, with reductions of −2.59% and −2.56%, respectively (p < 0.05), corresponding to the implementation of comprehensive tobacco control policies. Forecasts indicate continued downward trends through 2031, with projected reductions in ASMR of 96.17 (71.61–131.83) for overall tobacco use, 73.13 (61.96–85.22) for smoking, and 17.19 (6.84–17.46) for secondhand smoke exposure. Regional analysis demonstrated the greatest improvements in Sindh and Balochistan provinces.

Conclusion:

This study reveals a substantial decline in ASMR and dalys attributable to tobacco use in Pakistan over the past three decades, particularly following stricter tobacco control measures. Projections suggest continued progress through 2031, though regional disparities persist. Limited improvement in chewing tobacco-related mortality highlights the need for targeted interventions. Sustained, region-specific tobacco control strategies remain crucial to further reducing the national disease burden.