Abstract
OBJECTIVES: To quantify sex and sociodemographic-specific burdens of cardiometabolic and respiratory diseases attributable to secondhand smoke (SHS) using GBD 2021 data. STUDY DESIGN: Global Burden of Disease (GBD)-based secondary data analysis. METHODS: We used sex-disaggregated GBD 2021 estimates (1990-2021) to calculate population attributable fractions (PAFs), cause-specific death rates, and cause-specific DALY rates, and to examine exposure-burden relationships across Socio-demographic Index (SDI) strata. RESULTS: PAFs and exposure declined overall, but heterogeneity persisted by sex and SDI. Females had higher PAFs for COPD and diabetes. Diabetes PAF in females rose slightly from 3.9 % (95 % UI: 1.4-6.4) to 4.0 % (95 % UI: 1.4-6.6). Absolute burdens support these patterns: in 2021 female COPD cause-specific DALY rate was 874.96 (95 % UI: 697.60-1092.43) versus male 606.07 (95 % UI: 490.75-755.31); male IHD death rate was 235.12 (95 % UI: 187.74-296.26) versus female 153.61 (95 % UI: 125.33-192.42). Low- and middle-SDI regions retained the largest burden per unit exposure. CONCLUSIONS: Sex differences in SHS-attributable burden persist and vary by SDI; policy responses should be sex- and context-specific.