Terrible toll: 14 million U.S. adults suffer from serious smoking-related illness

The number of smokers in the U.S. has been steadily, if slowly, declining, but a grim new estimate finds that the burden of disease associated with cigarettes is greater than ever.

More than 14 million U.S. adults had at least one serious medical condition tied to smoking in 2009 -- a figure far higher than the 8.6 million calculated by the Centers for Disease Control a decade earlier.

That’s according to detailed analysis by researchers at the U.S. Food and Drug Administration’s Center for Tobacco Products, which found that chronic obstructive pulmonary disease, or COPD, is still the most common problem.

“Cigarette smoking remains a leading cause of preventable disease in the United States, underscoring the need for continuing and vigorous smoking-prevention efforts,” wrote Brian L. Rostron, the FDA’s lead author on the paper published Monday in the journal JAMA Internal Medicine.

The message is echoed by Dr. Jonathan Bricker, a smoking prevention and cessation expert at the Fred Hutchinson Cancer Research Center.

“Despite policies like smoking bans in public places and cigarette taxes, this study is a sober reminder that tobacco continues to afflict our society at a magnitude much greater than previously believed,” he said.

More than 42 million adults in the U.S., or about 18 percent of the population, smoke, according to CDC figures. It’s a figure that has been declining steadily since 1965, when 43 percent of U.S. adults regularly lit up.

But nearly 500,000 people still die each year from smoking or smoking-related illnesses, Bricker noted. The new study means about 14 million more have to live with the consequences every day.

“Basically, compared to death by smoking, people are 28 times more likely to have to live with a chronic medical condition caused by smoking,” he added. “People have to live with conditions like emphysema every day.”

The study found 7.5 million Americans with COPD, 1.8 million with diabetes, nearly 2.3 million with heart attacks, 1.2 million with cancer and 1.1 million with stroke, all related to smoking.

The new research expands on previous calculations of smoking-related illness. Rostron and his colleagues analyzed data from the National Health Interview Survey, or NHIS, which uses self-reported surveys to collect information on smoking and illness, among other topics.

That analysis showed that 6.9 million Americans had nearly 11 million smoking-related illnesses from 2006 through 2012. But then the researchers also looked at COPD data based on actual tests conducted by the National Health and Nutrition Examination Survey, or NHANES, from 2007 through 2010.

That data included diagnoses of COPD based on spirometry exams that assess how well patients’ lungs work by measuring the volume of air inhaled and exhaled. Based on those results, it became clear that COPD – and the impact of cigarette smoking on lung function – was severely underreported, the authors found.

“This study is a reminder that better science yields a higher impact on public health,” Bricker said. “Stronger methods to detect emphysema and chronic bronchitis showed that prior research had grossly underestimated the number of Americans with chronic diseases caused by smoking.”

The news that smoking is even riskier than previously assumed is important, noted Dr. Steven A. Schroeder of the University of California, San Francisco, in an accompanying commentary. The number of smokers is declining, but at an “excruciatingly slow” pace. There’s no advocacy group targeting tobacco disease -- and even doctors who encounter smokers with the worst disease are inconsistent in addressing the problem, he added.

“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,” he wrote.

Interventions like WebQuit, an online quit-smoking program and five-year research study conducted by Fred Hutch and Group Health Research Institute, might be one way to stop or reverse the rise in smoking-related illness, Bricker said.

“This study underscores the urgent need to help smokers quit now, to prevent them from suffering horrible medical conditions,” he said. 

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