Category: Also in TR

How did the 1980–2020 fall in U.S. smoking incidence impact smoking-related deaths?

By George Gay

I have a question. What proportion of smokers die “belatedly,” a word I shall use to mean later than predicted or expected, the opposite of “prematurely”? What I am getting at is, if, as I am told, 50 percent of smokers die prematurely from smoking-related diseases and, as I assume, X percent of smokers die prematurely from nontobacco-related causes, unless X is equal to 50, there must be a proportion of smokers who either die on their allotted day or after their allotted day, either from a tobacco-related disease or other causes. But you rarely hear of these people outside of the odd sensational newspaper story that tells how Joan Naughtie has just celebrated her 105th birthday with a cigarette, a glass of whiskey and a bout of raunchy, unprotected sex.

There are probably a number of reasons why you rarely hear about these people, one of which is that they are an embarrassment, especially in the case of the Joan Naughties of this world who have clearly been having too much fun.

But firstly, it is necessary to be clear what we mean by a smoker dying prematurely, on time or belatedly. Although it is difficult to impossible to prove a negative, experience tells me that none of us comes into this world tattooed or otherwise marked with a use-by date, so the day on which we are “supposed” to die must be predicted in some way by people who dabble in necromancy, I assume on the basis of past years’ age-related death statistics. I don’t know how sophisticated longevity figures are, but what I see usually are nationwide figures, stated separately for men and women. I trust the breakdown is more intricate than this, however, because, in a country such as the U.K., for instance, where inequality is rife, longevity varies hugely by region, so judging whether a smoker died prematurely against a national average would lead to overestimations.

Given such concerns, I think that, in the cause of balance, the percentage of smokers who die belatedly should from now on always be stated whenever the percentage of smokers who die prematurely of smoking-related diseases is given.

I wrote above that the number of smokers who died on their allotted day or after was an embarrassment, and one reason is that they, especially those who die not of a smoking-related disease, give the lie to the general statement that “smoking kills.” Smoking might be the indirect cause eventually of the deaths of a proportion—even a high proportion—of smokers, but, if I am correct in my assumptions above, given that people smoke and live beyond their allotted lives, it cannot be stated, without caveat, that smoking kills.

One other embarrassment concerns whether, given that it is claimed that smokers who die before their allotted time die because of their smoking unless there is clear evidence to the contrary (they were hit by a bus, perhaps), it can be said that smokers who die after their allotted time live longer because of their smoking, unless there is clear evidence to the contrary (they were genetically modified, perhaps).

Cause and Effect

I started to think about such things after reading what struck me as a strange story in The Hill titled “Despite drop in popularity, cigarette smoking continues to be a leading cause of U.S. cancer deaths.” The story was based around some figures from the oddly named U.S. Centers for Disease Control and Prevention (CDC) and new research from the American Cancer Society. The CDC input was that the cigarette smoking rate in the U.S. dropped from 33 percent in 1980 to a little above 12 percent in 2020.

The story followed up these figures by saying, in part: “But new research from the American Cancer Society shows smoking is still taking a huge toll on American life expectancy and the economy. According to a new study published in the International Journal of Cancer, nearly 123,000 U.S. cancer deaths were caused by cigarette smoking in 2019, making up close to 30 percent of all cancer deaths for that year. Cancers associated with smoking included cancers of the oral cavity, pharynx, esophagus, stomach, lungs and bronchus, among others.”

This is interesting as far as it goes, but it was what was not revealed that I found frustrating and interesting. Nowhere in the story does it say whether the fall in the incidence in smoking between 1980 and 2020 was mirrored by a fall in smoking-related deaths. Clearly, this is the critical point because if the fall in the incidence of smoking-related deaths has mirrored or closely followed, at a certain time remove, the fall in the incidence of smoking, then many of the claims and assumptions that have been made surrounding smoking and its effects will have been confirmed. However, if there is a largish variation, then questions need to be asked. We certainly need to know if the fall in the incidence of smoking-related deaths in the U.S.—I take it there has been one, though you wouldn’t know from the story—has fallen behind or raced ahead of the fall in the incidence of smoking. And, in either case, we need to know why what has occurred has occurred. Could it be, perhaps, that smoking between 1980 and 2020 became more or less dangerous?

It might be an uncomfortable truth for politicians and those who refuse to cut back on car journeys, but if the fall in the incidence of “smoking-related” deaths has not kept up with the fall in the incidence of smoking, it would be fairly obvious where to start investigating—the incidence of pollution exposure. I am not a medical person, but some of the smoking-related cancers listed above could seemingly be caused wholly or partly by pollution.

None of this is meant to support tobacco smoking. On the contrary, it is meant to help us understand what the facts—rather than the myths—are surrounding “smoking-related” deaths and in this way lessen those deaths.