Gulf region smoking mortality trends and forecasts: A 30-year systematic evaluation of tobacco-attributable deaths

Tobacco use remains a major preventable cause of morbidity and mortality worldwide. Despite economic development and growing health system capacity, countries in the Gulf Cooperation Council (GCC) region face rising tobacco use and a shifting burden of smoking-attributed diseases. This study systematically analyzes age-specific and age-standardized smoking-related mortality trends across six Gulf countries Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates over a 30-year period.

We extracted and analyzed smoking-attributed mortality data from the Global Burden of Disease 2021 dataset (1990-2019), including death rates per 100000 population for age groups 15-49, 50-69, and ≥70 years, and the age-standardized percentage of deaths due to smoking. We conducted descriptive trend analysis, heatmap visualization, correlation assessment, and linear projections to 2030.

Bahrain and Kuwait exhibited the highest smoking-attributed mortality rates with 14.3% of all deaths in 2019, particularly among those aged ≥70 years, with death rates exceeding 1300 per 100000. In contrast, Saudi Arabia and Oman maintained relatively lower and stable rates. Strong correlations were observed between mid-life and elderly smoking mortality (r about 0.97), while slightly lower in the ≥70 years group (r about 0.85). Projections indicate a highest burden increase in Bahrain (about 13.5%) and slight increases in Qatar and UAE (about 9%, each) by 2030 without policy intensification.

Despite regional advances in tobacco control, the burden of smoking-related mortality remains high in parts of the Gulf, especially among older adults. Immediate, targeted interventions particularly for middle-aged smokers are necessary to prevent further escalation. These findings support prioritizing tobacco cessation and surveillance as part of GCC public health strategies.