In 2019, 123K of U.S. Cancer Deaths Were Attributable to Cigarette Smoking, Study Finds

Researchers find that cigarette smoking is a leading cause of cancer-related death, with a significant economic burden.

In 2019, cancer deaths attributable to cigarette smoking resulted in more than 2.1 million person-years of life lost (PYLL) and $20.9 billion in lost earnings, a new research article says.

About 600,000 Americans succumb to cancer annually, making the disease the second leading cause of death in the country and generating a significant economic burden. Cigarette smoking is the most preventable cause of cancer death.

The new research article, which was published by International Journal of Cancer, estimates the proportions and numbers of cigarette smoking-attributable cancer deaths and associated PYLL and lost earnings among Americans between the ages of 25 and 79. The study generated several key data points.

• In 2019, there were 418,563 cancer deaths among Americans aged 25 to 79 years. An estimated 122,951 of the deaths were linked to cigarette smoking, with 2,188,195 PYLL.
   
• In 2019, the total lost earnings linked to cigarette smoking-attributable cancer deaths were estimated at $20.9 billion.
   
• The estimated number of cancer deaths linked to cigarette smoking were higher among men than women (74,508 versus 48,425).
   
• Lost earnings linked to cigarette smoking-attributable cancer deaths were higher among men than women (15.2 billion versus $5.6 billion). The study's co-authors said this difference was caused by higher employment rates and wages among men.
   
• Lung cancer accounted for the most smoking-attributable lost earnings ($12.9 billion), followed by esophageal cancer ($1.5 billion), colorectal cancer ($1.2 billion), and liver cancer ($1.1 billion).
   
• Utah had the lowest estimated proportion of cancer deaths linked to cigarette smoking (16.5%), and Kentucky had the highest estimated proportion of cancer deaths linked to cigarette smoking (37.8%).
   
• Wyoming had the lowest estimated total lost earnings linked to cigarette smoking-attributable cancer deaths ($32.2 million), and California had the highest estimated total lost earnings linked to cigarette smoking-attributable cancer deaths ($1.6 billion).
   
• If the PYLL and lost earnings rate of Utah had been achieved nationwide in 2019, more than half of the estimated total PYLL and lost earnings nationally would have been avoided.

In a prepared statement, the lead author of the study said the research shows the terrible toll that smoking takes on the country. "Our study provides further evidence that smoking continues to be a leading cause of cancer-related death and to have a huge impact on the economy across the U.S. We must continue to help individuals to quit using tobacco, prevent anyone from starting, and work with elected officials at all levels of government for broad and equitable implementation of proven tobacco control interventions," said Farhad Islami, MD, PhD, senior scientific director for cancer disparity research at the American Cancer Society.

Interpreting the data

There are 13 states in the South and Midwest—the "Tobacco Nation" states—that have generally weaker tobacco control policies and higher cigarette smoking prevalence than the rest of the country. Those states are Alabama, Arkansas, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Oklahoma, South Carolina, Tennessee, and West Virginia.

Death rates were highest in the Tobacco Nation states. In addition, the annual PYLL rate for the Tobacco Nation states was 46.8% higher than in other states and the District of Columbia, and the lost earnings rate for these states was 44% higher than in other states and the District of Columbia.

Relatively low tobacco excise taxes in the Tobacco Nation states likely contribute to their worse outcomes, the study's co-authors wrote. "The highest state tobacco excise tax rate per pack of cigarettes in the 13 'Tobacco Nation' states as of March 2021 was in Oklahoma ($2.03), Michigan ($2.00), and Ohio ($1.60), while it was ≤$1.20 in the other 10 states, as low as $0.17 in Missouri. In contrast, the state excise tax rate per pack of cigarettes in the Northeast region was ≥$1.78 in all 9 states, and >$3.00 in 5 states. Increasing the price of cigarettes through excise taxes is the single most effective policy for reducing cigarette smoking prevalence."

Smoking restriction laws also play a role in smoking prevalence at the state level, the study's co-authors wrote. "States with the highest smoking-attributable PYLL and lost earnings rates also generally lack statewide comprehensive smoke-free policies that completely prohibit smoking in workplaces, restaurants, and bars."

Lung cancer screening is critical to address smoking-attributable mortality and lost earnings, the study's co-authors wrote. "In addition to reinforcing tobacco control policies and expanding access to care, strategies and efforts to increase uptake of lung cancer screening can substantially reduce PYLL and lost earnings due to lung cancer, which accounts for about two-thirds of the total PYLL and lost earning due to smoking-attributable cancer deaths."

At the national level, stronger tobacco control policies are needed to reduce smoking-attributable mortality and lost earnings, the study's co-authors wrote. "PYLL and lost earnings due to cigarette attributable cancer deaths are substantial in all states, although they are largest in states with weaker tobacco control policies. Broad and equitable implementation and enforcement of proven tobacco control interventions across all states could substantially reduce cancer deaths and the associated economic burden."

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