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Impact of tobacco use on health and work productivity in Malaysia
  1. Qian Ying Tan1,2,
  2. Ella Zomer2,
  3. Alice J Owen2,
  4. Ken Lee Chin2,
  5. Danny Liew2
  1. 1 School of Medicine, Monash University, Malaysia, Malaysia
  2. 2 Centre for Cardiovascular Research and Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Australia
  1. Correspondence to Professor Danny Liew, Centre for Cardiovascular Research and Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Australia; danny.liew{at}


Background The loss of productivity arising from tobacco use in low/middle-income countries has not been well described. We sought to examine the impact of cigarette smoking on population health and work productivity in Malaysia using a recently published measure, the productivity-adjusted life year (PALY).

Methods A life table model was constructed using published Malaysian demographic and mortality data. Our analysis was limited to male smokers due to the low smoking prevalence in females (1.1%). Male smokers aged 15–64 years were followed up until 65 years or until death. The population attributable risk, health-related quality of life decrements and relative reduction in productivity due to smoking were sourced from published data. The analysis was repeated assuming the cohorts were never smokers, and the differences in outcomes represented the health and productivity burden conferred by smoking. The cost of productivity loss was estimated based on the gross domestic product per equivalent full-time worker in Malaysia.

Results Tobacco use is highly prevalent among working-age males in Malaysia, with 4.2 million (37.5%) daily smokers among men aged between 15 and 64 years. Overall, our model estimated that smoking resulted in the loss of over 2.1 million life years (2.9%), 5.5 million (8.2%) quality-adjusted life years (QALYs) and 3.0 million (4.8%) PALYs. Smoking was estimated to incur RM275.3 billion (US$69.4 billion) in loss of productivity.

Conclusion Tobacco use imposes a significant public health and economic burden among working-age males in Malaysia. This study highlights the need of effective public health interventions to reduce tobacco use.

  • tobacco industry
  • low/middle income country
  • economics

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  • Contributors The authors’ contributions are as follows: DL initiated the project, formulated the research idea, cleaned and analysed data, and revised the paper. EZ cross-checked data inputs, cleaned and analysed data, and revised the paper. AJO and KLC analysed data and revised the paper. QYT performed the literature search, cleaned and analysed data, drafted and revised the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval An ethics approval was not required for this study as it utilised freely available data from online published reports

  • Provenance and peer review Not commissioned; externally peer reviewed.