Introduction:

Tobacco exposure is a well-established modifiable risk factor for neurodegeneration, yet its long-term contribution to Alzheimer’s disease and other dementias (ADOD) remains incompletely characterised. This study aimed to evaluate global, regional, and socio-demographic trends in tobacco-attributable ADOD burden from 1990-2023.

Methods:

Data were abstracted from the Global Burden of Disease 2023 study. Age-standardised death rates (ASDR) and disability-adjusted life years (DALYs) attributable to tobacco were analysed using Joinpoint software to calculate annual percent change (APC) and average annual percent change (AAPC) with respective 95% confidence intervals.

Results:

Globally, ASDR declined significantly (AAPC -0.23%). By SDI, ASDR decreased in high SDI (AAPC -0.17%) and high-middle SDI regions (AAPC -0.34%). Trends in low SDI and middle SDI regions were not statistically significant overall. By World Bank income, ASDR declined significantly in high-income, lower-middle-income, and low-income countries, while no significant change was observed in upper-middle-income countries. Regionally, only North America demonstrated a small but significant increase. For DALYs, global rates also declined significantly, with consistent reductions across most SDI strata. Declines were most pronounced in low-middle SDI regions. By income, DALYs decreased significantly in high-income, lower-middle-income, and low-income countries, with no significant change in upper-middle-income countries. Regionally, DALYs declined across all World Bank regions, except East Asia and the Pacific which showed a non-significant trend.

Conclusions:

The global burden of tobacco-attributable ADOD has declined over the past three decades, reflecting progress in tobacco control. However, heterogeneity was seen across regions and income groups, with slower or non-significant improvements in certain settings. Continued strengthening of tobacco control policies remains essential to further reduce the ADOD burden attributable to smoking worldwide.