Global burden trends of Alzheimer's disease and other dementias attributable to smoking from 1990 to 2021

Abstract

Background

Smoking is a major modifiable risk factor for Alzheimer's disease and other dementias (ADODs), but comprehensive assessments of its global burden remain scarce.

Objective

This study examines spatiotemporal trends in smoking-attributable ADODs across 204 countries and territories from 1990 to 2021.

Methods

Using data from the Global Burden of Disease (GBD) 2021 study, we estimated smoking-attributable mortality, disability-adjusted life years (DALYs), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR). Temporal trends were quantified via estimated annual percentage change (EAPC), and future trajectories were projected using autoregressive integrated moving average (ARIMA) models.

Results

Between 1990 and 2021, global smoking-attributable ADOD deaths and DALYs increased by 108.85% (67,176 deaths) and 92.88% (1.53 million DALYs), respectively. However, age-standardized rates declined significantly: ASMR decreased by 22.22% (EAPC = −0.95, 95% CI: −0.99, −0.91) and ASDR by 21.30% (EAPC = −0.88, 95% CI: −0.92, −0.83). Men exhibited higher baseline rates, but women experienced steeper declines (ASMR EAPC: −1.60vs−0.79). Elderly populations disproportionately bore the highest burden, especially those ≥65 years. The middle-SDI region bore the heaviest burden (47,038,000 DALYs), while East Asia accounted for 38% of deaths. Projections suggest that the burden of smoking-related ADOD may continue to rise by 2036.

Conclusions

The burden of smoking-related ADODs remains high, with marked disparities across age, gender and socioeconomic strata. Targeted interventions, such as tobacco taxation, smoking bans, and integrated cognitive screening programs.