Wanderlei Flores, BibianaRey Brandariz, JuliaCorrêa, Paulo César Rodrigues PintoGuerra Tort, CarlaGarcía, GuadalupeMartín Gisbert, LucíaCandal Pedreira, CristinaMontes Martínez, AgustínPérez Ríos, Mónica2025-12-292025-12-292025Wanderlei-Flores B, Rey-Brandariz J, Rodrigues Pinto Corrêa PC, Guerra-Tort C, García G, Martín-Gisbert L, et al. Attributable mortality to secondhand tobacco smoke exposure in the 27 Brazilian federal units in 2019. Tobacco Control. 2025;1468-3318https://hdl.handle.net/10347/44785This article has been accepted for publication in Tobacco Control (TC), 2025 following peer review, and the Version of Record can be accessed online at https://doi.org/10.1136/tc-2025-059444. For the avoidance of doubt, this manuscript version is protected by copyright, including for uses related to text and data mining, AI training, and similar technologies.Objectives To estimate the attributable mortality to secondhand tobacco smoke (SHS) exposure among the population aged 35 years and older in Brazil and its 27 federal units in 2019. Study design Attributable mortality analysis. Methods A prevalence-dependent method was applied. Attributable mortality to SHS exposure was estimated under two scenarios. In scenario 1, attributable mortality from three causes (ischaemic heart disease, lung cancer and stroke) was calculated using the relative risks (RRs) reported by the Surgeon General. In scenario 2, attributable mortality from eight causes (ischaemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, type 2 diabetes mellitus, asthma, lower respiratory tract infections and breast cancer) was calculated using RRs derived from a recent meta-analysis. Results Scenario 1: in 2019, SHS exposure caused 10 604 deaths in Brazil, 5451 of which were due to ischaemic heart disease, 830 to lung cancer and 4323 to stroke. The attributable mortality rate due to SHS exposure varied across federal units, ranging from 5.6 deaths per 100 000 inhabitants in Amazonas to 16.1 in Piauí. Scenario 2: exposure to SHS caused 20 292 deaths, 5258 of which were due to ischaemic heart disease. In scenario 2, mortality attributable to SHS exposure from lung cancer increased, while mortality from ischaemic heart disease and stroke decreased compared to Scenario 1. Conclusions In Brazil, exposure to SHS is estimated to cause between 30 and 60 deaths per day. The mortality rates varied across federal units. Differences in the risk sources and the selection of health outcomes significantly influence mortality estimates. These findings underscore the importance of strengthening the enforcement of tobacco control policies by health authorities in Brazil.eng© Authors (or their employer(s)) 2025. Reuse of this manuscript version (excluding any databases, tables, diagrams, photographs and other images or illustrative material included where another copyright owner is identified) is permitted strictly pursuant to the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC-BY-NC 4.0). Attribution-NonCommercial 4.0 Internationalhttp://creativecommons.org/licenses/by-nc/4.0/Secondhand smokeMortalityBrazil3202 Epidemologia3212 Salud públicajournal article10.1136/tc-2025-059444open access