The Health and Economic Burden of Tobacco Use
Smoking-Attributable Societal Costs
In 2021, an estimated 342,532 deaths in the US were attributed to smoking. The largest numbers of these smoking-attributable deaths were due to cancer (154,585) and cardiovascular diseases (94,561). The burden of diseases and deaths from smoking varies widely across states. For example, the smoking-attributable death rate ranged from 34 per 100,000 population in Utah to 5.6 times higher rate of 194 per 100,000 population in West Virginia.1
Most of the tangible economic costs of smoking stems from health expenditures to treat tobacco-induced illnesses and loss of productivity from these illnesses and associated premature mortality. Treating diseases attributable to cigarette smoking comprise 11.7% of US annual healthcare spending during 2010-2014 (over $225 billion a year in 2014 dollars), more than 60% of which was funded by taxpayers’ money from Medicare, Medicaid, or other federal health insurance programs.2 Productivity loss is incurred through workplace absenteeism and presenteeism, loss in home productivity and inability to work (Figure 3.2.2). It also results from premature mortality of individuals who would otherwise be active in the labor force earning their livelihood or be working at home. Globally, the combined cost of smoking-attributable health expenditures and productivity losses is the highest in the United States (Figure 3.2.3).
At the aggregate level, there are downstream effects of smoking-related illnesses on employment probability, expected earnings, size of workforce, and accumulation of physical and human capital that in turn affect aggregate economic output. By this measure, cigarette smoking cost the US economy an estimated $436.7 billion (equivalent to 2.1% of US GDP) in 2020, including $362.4 billion in personal income loss and $74.1 billion in household productivity loss (Map 3.2.1). The lower income trajectory caused by smoking from 2010 to 2020 resulted in a cumulative economic loss of $891.8 billion in 2020.
Estimating smoking-attributable expenditures on a state-by-state basis translates the adverse health effects into dollar terms, the universal language of decision makers.3
Most of the tangible economic costs of smoking stems from health expenditures to treat tobacco-induced illnesses and loss of productivity from these illnesses and associated premature mortality. Treating diseases attributable to cigarette smoking comprise 11.7% of US annual healthcare spending during 2010-2014 (over $225 billion a year in 2014 dollars), more than 60% of which was funded by taxpayers’ money from Medicare, Medicaid, or other federal health insurance programs.2 Productivity loss is incurred through workplace absenteeism and presenteeism, loss in home productivity and inability to work (Figure 3.2.2). It also results from premature mortality of individuals who would otherwise be active in the labor force earning their livelihood or be working at home. Globally, the combined cost of smoking-attributable health expenditures and productivity losses is the highest in the United States (Figure 3.2.3).
At the aggregate level, there are downstream effects of smoking-related illnesses on employment probability, expected earnings, size of workforce, and accumulation of physical and human capital that in turn affect aggregate economic output. By this measure, cigarette smoking cost the US economy an estimated $436.7 billion (equivalent to 2.1% of US GDP) in 2020, including $362.4 billion in personal income loss and $74.1 billion in household productivity loss (Map 3.2.1). The lower income trajectory caused by smoking from 2010 to 2020 resulted in a cumulative economic loss of $891.8 billion in 2020.
Estimating smoking-attributable expenditures on a state-by-state basis translates the adverse health effects into dollar terms, the universal language of decision makers.3
Sources
- Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2021 (GBD 2021) Results. Seattle, United States: Institute for Health Metrics and Evaluation (IHME), 2024. Available from https://vizhub.healthdata.org/gbd-results/.
- Xu X, Shrestha SS, Trivers KF, Neff L, Armour BS, King BA. U.S. healthcare spending attributable to cigarette smoking in 2014. Preventive Medicine 2021 Sept; 150: 106529.
- Miller LS, Zhang X, Rice DP, Max W. State estimates of total medical expenditures attributable to cigarette smoking, 1993. Public Health Reports 1998 Sep-Oct; 113(5): 447–58.