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How much of the future mortality toll of smoking can be avoided?
  1. Kenneth E Warner,
  2. David Mendez
  1. Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
  1. Correspondence to Professor Kenneth E Warner, Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; kwarner{at}


Objective To determine how much future smoking-related mortality in the USA can be prevented, recognising that some of that future mortality results from past smoking.

Methods Employing a dynamic population simulation model, we estimate smoking’s expected mortality burden in the USA, measured as life-years lost (LYL), in a status-quo scenario run from 2018 through 2100. We then estimate LYL attributable to past smoking assuming that all smoking ceases at the end of 2017. We calculate the potential avoidable LYL, which we call the maximum potential reduction in premature mortality (MPRPM), as the difference between the two. We use data from the US Census Bureau, National Vital Statistics Reports, the National Health Interview Survey and Cancer Prevention Study II.

Results Under status-quo assumptions, smoking will claim 305 million LYL in the US from 2018 to 2100. If all smoking ceased at the end of 2017, past smoking would be responsible for 191.8 million LYL. Thus, avoidable LYL by 2100—the MPRPM—would be 113.2 million, 37% of the expected toll of smoking. A sensitivity analysis finds that were the annual smoking initiation rate 3% instead of 7.8%, the MPRPM would be 13-14% lower. Were the annual permanent smoking cessation rate twice our status-quo estimate of 4.35%, the MPRPM would be 38-39% lower.

Conclusions Public health can address only the future toll of future smoking. Smoking’s MPRPM is the reduction in the mortality burden of smoking that tobacco control can strive to achieve.

  • cessation
  • harm reduction
  • prevention
  • smoking caused disease

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  • Contributors KEW developed the original concept for the paper, wrote the first draft and participated in revisions. DM developed the simulation model and adapted it for this study, performed the simulations and participated in revising the manuscript.

  • Funding Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health and Food and Drug Administration Centre for Tobacco Products (Award Number U54CA229974).

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Food and Drug Administration.

  • Competing interests None declared.

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