Burden of Disease Due to Secondhand Smoke among Korean Adults at Sub-National Level

BACKGROUND: Exposure to secondhand smoke (SHS) is one of the biggest health hazards. Quantifying the related burden of disease (BOD) is a powerful tool for making evidence-based policies. This study calculated the BOD due to SHS at sub-national level using the most recent statistics of Korea. METHODS: SHS related diseases were selected by the systematic review of previous studies. Population attributable fraction (PAF) was calculated by using the standard formula using prevalence of exposure derived from Community Health Survey (CHS) 2013. SHS burden was calculated by multiplying nonsmoker's disability adjusted life years (DALYs) with PAF of SHS. RESULTS: SHS burden at sub-national level ranged between 460 DALYs in Cheonan to 5 DALYs in Pyeongtaek, Songtan region. Median of DALY was highest in districts of metropolitan cities and lowest in small towns and rural areas. Twelve out of fifteen regions with highest DALY per 1,000 were small towns and rural areas. Gender and age standardized DALY was highest in Seogwipo (west) in Jeju-do (1.66/1,000) and lowest in Dong-gu, Ulsan (0.17/1,000). CONCLUSION: There were substantial variations between regions according to BOD. Regional governments should implement policies according to specific situation in each region and regular monitoring should be done by calculating BOD. Big cities need to focus more on control of active and SHS prevalence. Resources in small towns and rural areas need to be allocated more towards implementation of screening programs, early diagnosis and treatment of diseases especially in the elderly population.