Smoking Death Risk Appears to Be Rising—Study Finds a Surprising Reason - Newsweek

Deaths related to smoking appear to be rising—and scientists believe they know the reason why.

While the rates of cigarette smoking are dropping across the United States, the risk of a smoker dying from a smoking-related disease appears to be rising.

Research shows that the overall risk of mortality associated with smoking increased by almost 50 percent between 1987 and 2013.

Now, a new study that analyzed data from the U.S. National Health Interview Survey (NHIS) believes it has discovered the reason for this apparent rise.

Researcher Ralph Lawton told Newsweek that they set out to answer the question: "Has smoking itself become more harmful, has the way people use cigarettes changed, or do people who smoke cigarettes increasingly look different from the rest of the population?"

The study, which controlled for age, confirmed that mortality associated with smoking increased by nearly 50 percent between 1987 and 2013. However, they believe that this is driven by the changes in the age distribution of smokers.

"Using methods similar to previous estimates, we first reproduce the earlier finding—the overall risk of mortality associated with smoking increased by nearly 50 percent between 1987 and 2013," Lawton said.

"At comparable ages, however, these changes largely disappear. At any given age, the mortality gap between smokers and nonsmokers has not changed in any meaningful way over the past several decades."

Cigarette smoking rates have fallen significantly in recent decades, from 42.6 percent in 1965, to just 11.6 percent in 2022, according to the American Lung Association.

Smoking rates have fallen even further among youths—from 36.4 percent in 1997, to 3.8 percent in 2021.

The Centers for Disease Control (CDC) also reports that adults aged between 45 and 64 years have the highest prevalence of cigarette smoking.

As such, the researchers believe that the rapidly falling smoking rates in younger people, combined with an aging population more likely to smoke and more likely to develop health issues, mean that there is a biased estimate of an increasing smoking risk.

In their research, they used the 1987-2013 NHIS survey linked with death records through to 2018. Researchers then estimated the age-specific risk of mortality associated with smoking over three separate time periods, to account for the more modern shifts in the ages of smokers.

They then estimated the sociodemographic and health characteristic changes in smokers, related to mortality, and examined whether these demographic shifts impacted smoking-mortality associations.

Overall, it found that the association between smoking and mortality at any given age has remained stable, and has increased only minimally, if at all.

"The explanation we propose is that the impacts of smoking on mortality are larger for older people, and that the population—especially the population of smokers—has been getting older over time," Lawton said.

"When researchers produce estimates for the full population, they pool across older and younger individuals. Given recent demographic trends, older people have been getting more weight in the estimate, making it look like the risk of smoking is increasing for everybody, even though the age-specific risks have not changed."

Essentially, the average smoker is simply older than in previous years, with fewer younger people picking up the habit, and mortality risks associated with smoking rise with age.

Lawton clarified that smoking "remains a leading modifiable cause of death," and the reduction in smoking rates "has had immense public health benefits," but warned that models for the harms of smoking "need to account very carefully for these underlying changes in age."

The good news, he said, is that "we show this is quite doable with thoughtful application of commonly-used tools. For smoking specifically, accounting thoroughly for aging gets you the almost all the way towards explaining changes in risk over time."

Lawton revealed that the researchers of this study are involved in ongoing work exploring "smoking as a key marker of broader inequalities in midlife mortality in the U.S."

"We have also been thinking a lot about how similar methods can be used to examine changes in the mortality risks associated with factors like obesity and education," he said.

Ralph Lawton, Jennifer Beam Dowd, Jonathan Skinner, Ellen Meara, Why the mortality penalty of smoking is rising over time, PNAS Nexus, Volume 5, Issue 9, September 2026, pgag280, https://doi.org/10.1093/pnasnexus/pgag280