Intended for healthcare professionals


Smoking remains leading cause of premature death in US

BMJ 2014; 348 doi: (Published 20 January 2014) Cite this as: BMJ 2014;348:g396
  1. Michael McCarthy
  1. 1Seattle

Fifty years after the US surgeon general’s 1964 landmark report that identified smoking as a leading cause of cancer and heart disease, smoking remains the leading cause of premature disease and death in the United States, says a new report issued by the current acting surgeon general, Boris D Lushniak. 1 2

Although the prevalence of cigarette smoking has fallen over the past five decades since the 1964 report from 42% to 18% in 2012, more than 42 million people in the US still smoke, the report said.

Should that prevalence continue, 5.6 million Americans younger than 18 years currently alive today will die prematurely from smoking related disease, the report said.

The report estimated that since the 1964 report’s publication more than 20 million Americans have died from smoking and that another 480 000 continue to die prematurely every year.

It said, “For the United States, the epidemic of smoking-caused disease in the twentieth century ranks among the greatest public health catastrophes of the century.”

All told, smoking costs the country more than $289bn (£175bn; €215bn) a year in direct medical care and other economic costs, the report said.

Smoking and exposure to secondhand smoke was responsible for 87% of lung cancer deaths, 61% of pulmonary disease deaths, and 32% of deaths from coronary heart disease, the report said.

In addition to lung and heart disease, the report found that smoking caused several other diseases, including age related macular degeneration, type 2 diabetes, colorectal and liver cancer, erectile dysfunction, birth defects, ectopic pregnancy, and immune dysfunction, including rheumatoid arthritis.

The report noted that for the first time women were now just as likely as men to die from many smoking related diseases: women who smoke now have the same risk of death from lung cancer as men, and the relative risk of dying of coronary heart disease among women aged 35 years or older is now higher than for men.

The report places the blame for the nation’s tobacco epidemic squarely on tobacco companies. “The tobacco epidemic was initiated and has been sustained by the aggressive strategies of the tobacco industry, which has deliberately misled the public on the risks of smoking cigarettes,” it said.

The report calls for determined effort to reduce the nation’s smoking rate to 10% in a decade as outlined in a strategic action plan published in 2010. Measures include sustained media campaigns to counteract tobacco industry marketing, higher cigarette taxes, expanded access to smoking cessation treatment, and use of the Food and Drug Administration’s regulatory authority to reduce tobacco product addictiveness and harmfulness.


Cite this as: BMJ 2014;348:g396


View Abstract