Cancer deaths linked to smoking lead to substantial losses of life years, earnings
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Key takeaways:
- Cancer deaths attributed to smoking resulted in 2.2 million person-years of life lost in the United States in 2019.
- Those deaths also resulted in $20.9 billion in lost earnings.
- Results showed greater disparities at nonacademic centers.
Cigarette smoking-attributable cancer deaths appeared associated with nearly 2.2 million person-years of life lost and $20.9 billion in lost earnings across the United States in 2019, according to study results.
The findings, published in International Journal of Cancer, suggest broad and equitable implementation and enforcement of proven tobacco control interventions could significantly reduce cancer deaths and the associated economic burden, researchers noted.
Background and methods
“We know that lost earnings because of cancer deaths are substantial in the U.S., with an estimated $94.4 billion lost earnings in 2015 alone, and cigarette smoking is associated with about one-third of all cancer deaths in this country,” Farhad Islami, MD, PhD, senior scientific director of cancer disparity research at American Cancer Society, told Healio.
“The most recent national estimate of the economic burden of smoking-attributable cancer deaths is for between 2005 and 2009. Since then, however, information for estimating the economic burden, such as number of cancer deaths attributed to cigarette smoking, median income and life expectancy, has changed,” Islami continued. “More importantly, no previous study had reported state-specific estimates, although smoking-attributable cancer deaths vary considerably across states.”
Islami and colleagues sought to inform tobacco control interventions at federal and state levels by estimating person-years of life lost and lost earnings due to cigarette smoking-attributable cancer deaths among individuals aged 25 to 79 years in 2019, both nationally and for all 50 states and the District of Columbia.
Key findings
Researchers estimated losses in 2019 alone of approximately 2.2 million person-years of life and $20.9 billion in earnings as a result of cigarette smoking-attributable cancer deaths.
The estimated rate of smoking-attributable cancer deaths per 100,000 population in 2019 ranged from 16.5% (95% CI, 15.9-17.2) in Utah to 37.8% (95% CI, 36.9-38.6) in Kentucky. Moreover, estimated age-standardized rates of person-years of life lost per 100,000 population ranged from 352 (95% CI, 339-366) in Utah to 1,337 (95% CI, 1,310-1,367) in West Virginia. The estimated age-standardized lost earnings rate per 100,000 population ranged from $4.3 million (95% CI, $3.5 million to $5.2 million) in Idaho to $14.8 million (95% CI, $10.6 million to $20.7 million) in Missouri.
“We also found that states with generally weaker tobacco control policies in the South and Midwest had the highest smoking-attributable person-years of life lost and lost earning rates,” Islami told Healio.
If all states had the same age-specific rates as Utah, 58.2% of total person-years of life lost and 50.5% of total lost earnings that resulted from smoking-attributable cancer deaths would have been avoided, researchers found.
Implications
Adequate funding for state tobacco prevention and cessation programs and broad and equitable implementation and enforcement of proven tobacco control interventions across all states could substantially reduce cancer deaths and the associated economic burden, Islami said.
“Some of these interventions include increasing cigarette excise tax rates, implementing and enforcing comprehensive smoke-free laws across all states, and increasing equitable access to smoking cessation services, such as counseling or FDA-approved medications, including for individuals covered by Medicaid,” he added. “In addition, increasing uptake of lung cancer screening can substantially reduce person-years of life lost and lost earnings due to lung cancer, which remains the most common cause of smoking-related cancer death. Lost earnings estimated in this study are one component of economic burden associated with smoking-related cancers; further research is needed to understand other costs associated with smoking-related cancers, such as medical care and caregiver burden.”
For more information:
Farhad Islami, MD, PhD, can be reached at farhad.islami@cancer.org.
Perspective
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Taghrid Asfar, MD, MSPH
The study is significant as it provided a critical update on person-years of life lost and lost earnings estimates due to smoking-attributable cancer deaths, and it is the first to report state-specific estimates.
According to the study findings, states with generally weaker tobacco control policies (eg, excise taxes on cigarettes, smoke-free policies) and lower median household incomes in the South and Midwest had the highest smoking-attributable person-years of life lost and lost earnings rates.
Islami and colleagues noted that in the nine-state Northeast region, the state excise tax rate per pack of cigarettes was $1.78 or higher, including greater than $3 in five states. In contrast, the highest state tobacco excise tax rates per pack in the 13 “tobacco nation” states as of March 2021 were $2.03 in Oklahoma, $2 in Michigan and $1.60 in Ohio, whereas the rate was $1.20 or less in the other 10 states and as low as 17 cents in Missouri.
Increasing the price of cigarettes through excise taxes is the single most effective policy for reducing cigarette smoking prevalence. Therefore, to substantially reduce the burden of cancer attributable to cigarette smoking, the excise taxes should be considerably increased in most states.
In addition, individuals with lower socioeconomic status often have limited access to smoking cessation services, such as medication or counseling, because of the associated costs. Furthermore, individuals residing in communities of lower socioeconomic status have consistently been targeted by the tobacco industry and are more likely to initiate and continue smoking. Therefore, eliminating the existing gaps in Medicaid and private insurance coverage of cessation services is necessary to eliminate tobacco-related health disparities and substantially reduce the burden of smoking-related cancers across all states.
Broad and equitable implementation and enforcement of proven tobacco control interventions across all states could substantially reduce cancer deaths and the associated economic burden. Further research is needed to understand other costs associated with smoking-associated cancers, for example, medical care and caregiver burden.
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Islami F, et al. Int J Cancer. 2022;doi:10.1002/ijc.34217.
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