Cigarette Smoking Linked to 14 Million Major Illnesses

The disease burden of smoking remains immense despite widespread tobacco cessation efforts.

According to a new study published online in JAMA Internal Medicine, US adults had a combined 14 million major medical conditions attributable to cigarette smoking in 2009, indicating the disease burden of smoking remains immense despite widespread tobacco cessation efforts.

For the study, researchers from the FDA’s Center for Tobacco Products and the US Centers for Disease Control and Prevention’s Office on Smoking and Health relied on smoking and disease prevalence estimates from National Health Interview Survey data that was self-reported by adults surveyed from 2006 through 2012, as well as spirometry data from the National Health and Nutrition Examination Survey that was collected to adjust for underreporting of chronic obstructive pulmonary disease (COPD).

Using the self-reported data, the investigators estimated that 6.9 million US adults aged 35 years and older had a combined 10.9 million self-reported smoking-attributable medical conditions in 2009. From the COPD data, the researchers concluded that US adults had a combined 14 million smoking-attributable conditions in 2009.

Similar to previous research, the authors of the current study found the largest cause of smoking-attributable conditions was COPD, with an estimated 7.5 million cases linked to smoking. However, that number is 70% higher than estimates based on self-reports, suggesting that COPD is substantially underreported in health survey data.

“Our study confirms that cigarette smoking remains a major cause of preventable disease in the United States,” the researchers concluded. “The number of major smoking-attributable medical conditions in the United States is larger than has been previously reported, demonstrating the need for vigorous smoking prevention efforts.”

In a related commentary, Steven A. Schroeder, MD, of the University of California, San Francisco, said the new study data “should serve to keep tobacco control and its 2-fold aims of preventing initiation and helping smokers quit as the most important clinical and public health priorities for the foreseeable future.”

"Tobacco control has been called one of the most important health triumphs of the past 50 years. Yet, although we have come a long way, there is still much more to be done,” Dr. Schroeder wrote. “The article…is a stark reminder of that unfinished work.”