Study Estimates 14 Million Smoking-Attributable Major Medical Conditions in U.S.

Bottom Line: Adults in the United States suffered from approximately 14 million major medical conditions attributable to smoking.1

Author: Brian L. Rostron, Ph.D., M.P.H., of the Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Md., and colleagues.

Background:  Smoking is the leading cause of preventable disease in the United States. Cigarette smoking harms nearly every organ and organ system in the body. The authors estimated major medical conditions (morbidity) attributed to smoking in 2009.

How the Study Was Conducted: The authors used data from the U.S. Census Bureau in 2009, National Health Interview Survey data from 2006 through 2012 and data from the National Health and Nutrition Examination Survey.

Results: First, the authors used National Health Interview Survey data to estimate that 6.9 million U.S. adults had a combined 10.9 million self-reported smoking-attributable medical conditions. Then, the authors used chronic obstructive pulmonary disease (COPD) prevalence estimates from the National Health and Nutrition Examination Survey of self-reported and spirometry (a test of lung function) data to estimate that U.S. adults had had a combined 14 million smoking attributable-conditions in 2009. The largest cause of smoking-attributable illness in the United States was still COPD (emphysema) with an estimated 7.5 million cases attributable to smoking, but this number is 70 percent higher than the estimated cases based on self-reported prevalence data.

Discussion: “The disease burden of cigarette smoking in the United States remains immense and updated estimates indicate that COPD may be substantially underreported in health survey data.”

In a related commentary 2, Steven A. Schroeder, M.D., of the University of California, San Francisco, writes: “The data from Rostron et al 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, with the number of smokers worldwide now just short of 1 billion people. The article by Rostron et al is a stark reminder of that unfinished work,” the author concludes.


1. JAMA Intern Med. Published online October 13, 2014. doi:10.1001/jamainternmed.2014.5219.

2. JAMA Intern Med. Published online October 13, 2014. doi:10.1001/jamainternmed.2014.4297.

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