End tobacco smoking quickly for longer lives, fewer early deaths, study shows

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Faster progress towards ending tobacco smoking over the next three decades could extend lives and avoid millions of years of life lost worldwide, making it one of the single most critical health interventions, a new study shows.  

The study represents the first model to comprehensively forecast the potential global health impacts of smoking on life expectancy. It also measures years of life lost (or YLLs, the difference in years between life expectancy and premature death). 

Researchers developed three scenarios to predict the future burden of smoking for all countries and all smoking-related health conditions. Those include cancer, ischemic heart disease, and chronic obstructive pulmonary disease (COPD). 

Their analysis, published in The Lancet Public Health this month [October 2024], shows that:

“Together, these scenarios underscore the magnitude of health benefits, benefits that will continue to grow beyond 2050, which could be achieved if countries take action to end the global tobacco epidemic,” the researchers say.

The study comes at a time when the Lancet Commission on Investing in Health reports that tobacco control is “by far the most important” policy that governments can adopt to help achieve a 50% reduction in the probability of premature death in their populations. 

Researchers note the role played by the tobacco industry as a commercial determinant of health (CDoH), saying, “renewed efforts are required to overcome the tobacco industry’s attempts to maintain a market.” 

“We must not lose momentum in efforts to reduce, and ultimately eliminate, smoking around the world,” said senior author Dr. Stein Emil Vollset, head of the forecasting team at the Institute for Health Metrics and Evaluation (IHME). “Our findings highlight that millions of premature deaths could be avoided by bringing an end to smoking.”

Smoking is the leading risk factor for preventable death, disability, and disease, accounting for more than 175 million deaths worldwide over three decades. Rates of smoking have fallen substantially since the WHO’s Framework Convention on Tobacco Control was enacted in 2005, the researchers say. But the pace of decline has slowed in many parts of the world.

To fund other tax cuts, New Zealand repealed legislation prohibiting tobacco sales to anyone born on or after Jan 1, 2009. Malaysia, meanwhile, dropped a “generational endgame” provision from its tobacco control bill.

In the new study, researchers produced estimates using the IHME Future Health Scenarios platform, with data from the Global Burden of Disease (GBD) study. While noting wide regional variations in potential impacts, they say smoking elimination—even by 2050—would result in gains in life expectancy at a rate not possible by many other interventions.  

“Importantly, these gains represent an average across the entire population, including people who have never smoked, and are therefore underestimates of the gains expected among smokers,” they say.

Among other limitations, the forecast assumes that current tobacco smoking trends remain stable in the future. It also estimates only the direct effects of reduced tobacco smoking on health, not the health effects of second-hand smoke exposure, smokeless tobacco or e-cigarettes. It also does not account for future healthcare improvements in areas such as lung cancer detection or treatment.

Researchers say the majority of health gains would not be seen for several decades, given the age of the first smoke-free generation. It would also take time for all residual risks among people who quit smoking to dissipate. 

That could be as late as 2080 if the last smokers quit in 2050. But the time to start with new measures to stop the tobacco epidemic is now, the researchers say.

“Our analysis shows that smoking intervention would result in longer lives lived by current and former smokers,” they say. “Rather than dying prematurely from ischaemic heart disease or lung cancer, individuals would gain years of life.” 

References:

GBD 2021 Tobacco Forecasting Collaborators. Forecasting the effects of smoking prevalence scenarios on years of life lost and life expectancy from 2022 to 2050: a systematic analysis for the Global Burden of Disease Study 2021. The Lancet Public Health. 2024 Oct;9(10):e729-e744. doi: 10.1016/S2468-2667(24)00166-X.

Jamison, Dean T, et al. “Global health 2050: The path to halving premature death by mid-century.” The Lancet, Oct. 2024, https://doi.org/10.1016/s0140-6736(24)01439-9.