Life Extension Magazine®

Cigarettes and filling that have caused excess deaths

Tobacco More Lethal Than What Government Claims

Cigarette smoking causes more illnesses than what the government tells us. Anti-tobacco campaigns are failing to sufficiently curb this deadly menace. New evidence points to a staggering number of excess tobacco-related deaths that are not part of official statistics. There are better ways to mitigate this epidemic that increases healthcare costs for all Americans.

Scientifically reviewed by Dr. Gary Gonzalez, MD, in May 2022. Written by: William Faloon.

William Faloon
William Faloon

I’ve always been skeptical of government’s claim that 480,000 Americans die each year as a result of cigarette smoking.1

My reason for questioning this government statistic is that tobacco use is associated with more illnesses than what are officially counted.2

Take kidney failure for instance. Smoking is associated with double the risk of death in kidney failure compared with nonsmokers.2 Yet kidney failure is not counted in the official number of tobacco-related deaths.3,4

My suspicions have been further aroused by a study published in the New England Journal of Medicine. This report analyzed almost one million adults. These findings suggest cigarette smoking is associated with about 556,000 American deaths each year—higher than government estimates.1,2

Deaths associated with cigarettes are not limited to those who smoke. The federal government admits that over 41,000 additional Americans die each year from secondhand smoke.3 I believe this number also underestimates the real number of second-hand smoke victims.

Overlooked are insidious diseases that kill former smokers long after they quit. This happens when genetic changes inflicted by tobacco use at younger ages manifest decades later as a lethal disease.

The United States faces a healthcare cost crisis. A significant percentage of medical outlays are caused by cigarette smoking. Tobacco taxes don’t cover the medical and lost productivity costs of current and former smokers, or victims of secondhand smoke.

Anti-tobacco campaigns are failing to sufficiently curb this deadly menace. This article describes the staggering number of excess tobacco-related deaths that are not officially counted.

Cigarette smoking remains the most dominant cause of preventable death and disability.

The percentage of Americans who smoke dropped by approximately half over a four decade period, from the mid-1950s to the mid-1990s.5

Interventions such as warning mandates, tax hikes, and smoke-free environments have helped reduce the carnage.

The problem is that today nearly one out of every six American adults still smoke, nearly one out of five Americans who smoke have a disability, and at least 16 million Americans live with a smoking-related illness. Tobacco products are probably killing closer to 556,000 Americans each year.1,2

Based on an article published in the New England Journal of Medicine titled, “Smoking and Mortality–Beyond Established Causes” and accompanying analysis, the authors believe that at least 60,000 additional deaths per year may be associated with smoking that are not reported in government estimates.2

Cigarette smokers also face sharply higher risks of nonlethal illnesses that further burden today’s inadequately staffed sick-care system.

A solution must be found to spare this nation’s finances, as well as the lives of its citizenry.

New Study Exposes More Tobacco-Induced Carnage


Death rates among current smokers are two to three times higher compared to people who never smoked. Most of this higher mortality is explained by 21 common diseases officially recognized as caused by cigarette smoking (like lung cancer).3

If cigarettes cause other diseases, however, then government claims of smoking-attributable mortality are being significantly underestimated.

A study of almost one million men and women over age 55 was begun in year 2000 with data collection extending to 2011. Confounding factors such as age and alcohol intake were factored into the mortality data.

The final results from this study were published by the New England Journal of Medicine in 2015. The data revealed that cigarette smoking kills far more Americans than official statistics indicate!2

How Government Accounts for Tobacco-Induced Mortality

The 2014 Surgeon General’s report estimated that cigarette smoking causes more than 480,000 deaths in the US every year, including deaths from secondhand smoke.1

This widely cited statistic, however, is an underestimate, as it only considers deaths from 21 diseases that have been formally recognized as caused by cigarette smoking. When looking at other diseases associated with cigarettes, an updated analysis suggests the number of excess deaths jumps by 60,000 to 120,000 each year.2

This analysis published in the New England Journal of Medicine includes a total of 52 cause-of-death categories.2 The chart on the next page lists some of the illnesses not officially recognized as being caused by cigarette smoking. It then reveals the staggering increased risk of dying from these diseases in current smokers.

Many of the illnesses listed on the next page are caused by immune suppression,6,7 atherosclerosis,8,9 platelet aggregation,10,11 inflammation,12,13 and gene alterations,14,15 which are all related to cigarette smoking.

Relative Risk of Death from Specific Unofficial Causes Related to Smoking Status

This chart shows increases in deaths from specific causes in current cigarette smokers compared to a nonsmoking control group. These diseases are not factored in when the government estimates tobacco-induced mortality data.2

Diseases Not Officially Attributed to Smoking
Increased Relative Risk for Smokers
Infections (all) 150% (females) • 120% (males)
Hypertensive Heart Disease 90% (females) • 190% (males)
Intestinal Ischemia 510% (females) • 460% (males)
Kidney Failure 90% (females) • 110% (males)
Prostate Cancer 40% (males)
Breast Cancer 30% (females)
Liver Cirrhosis 160% (females) • 260% (males)
(not included on Surgeon General’s list)
90% (females) • 100% (males)
Rare cancers 10% (females) • 60% (males)
Digestive Diseases
(not included on Surgeon General’s list)
110% (females) • 160% (males)

These increased estimates of associated deaths in smokers were not fully documented until these new findings were disclosed by the New England Journal of Medicine.

Later in this article we show a chart from this same New England Journal of Medicine study of the deaths from diseases that are officially recognized as being caused by cigarette smoking.

It’s Not Just the Lethal Diseases

Smokers are much more likely to contract viral infections (flu/cold) that leave them unproductive for extended time periods. One reason for this is that tobacco smoke adversely affects the immune system.

It also increases risk of acute myeloid leukemia which is sometimes curable after spending months in a hospital isolation unit undergoing aggressive chemotherapy followed by bone marrow transplants.16,17

The New England Journal of Medicine article reported on a host of wretched disorders that are far more prevalent in smokers that include:2

  • Peptic ulcers
  • Bowel obstructions
  • Gallstones
  • Diverticulitis
  • Acute pancreatitis
  • Gastric hemorrhage

Although these are not common direct causes of death, they account for millions of hospitalizations each year that the current healthcare system can no longer afford.

Research suggests that those who suffer pancreatitis are at higher risk of pancreatic cancer.18-20 Government statistics include pancreatic cancer as a smoking-attributable disease.2,3

Talking to Teenagers

When it comes to fulfilling my duty to educate teenagers to not start smoking, I tell them to not worry about all the terrible diseases they will invariably get since that is so far into the future. I also tell them to not be concerned that the many economic costs associated with smoking as they could wind up squandering their money in other ways.

The one adverse guarantee I relate to teenagers is that once addicted, a smoker craves a new cigarette as often as every 30 minutes.23 In the old days, when smoking was permitted everywhere, this was not a problem.

Now that smoking is prohibited virtually everywhere, nicotine addicts spend most of their day suffering the miseries of unfulfilled cravings. A long plane flight represents a withdrawal nightmare, as does any form of indoor confinement for those who need to light up every 30 minutes or so.

The fact that a nicotine addict will be deprived most of the time they crave it has persuaded a number of younger individuals I know to never consider starting smoking.

I wish more schools emphasized this neglected reason (unfulfilled cravings) as a reason to never try a nicotine product.

Breast and Prostate Cancers

The Surgeon General has not yet concluded that cigarettes increase breast cancer risk. The New England Journal of Medicine report estimated the number of breast cancer deaths increased significantly based on smoking intensity and declined after cessation of smoking.2

The New England Journal of Medicine estimated the relative risk of death from prostate cancer to be about 40% higher among current smokers than among those who had never smoked.2

Interestingly, other studies show associations between smoking and progression of prostate cancer as well as prostate cancer–specific mortality among men with prostate cancer. These findings show the adverse impact of smoking on later stages of carcinogenesis, making it imperative that those with any malignancy stop smoking.21,22

Adding Up the Death Toll

Taking into account only 21 diseases known to be caused by smoking, the Surgeon General’s most recent report of smoking-attributable mortality appears to be a significant underestimate.

This is not meant to be a criticism of the Surgeon General. The table on the next page provides more than enough data on smoking-induced mortality to dissuade mature individuals from initiating this deadly habit.

The problem is that our society is failing to recognize the nearly 556,000 total annual deaths inflicted on Americans by all forms of tobacco. As a result, teenagers see stacks of attractively labeled tobacco packs sitting behind virtually every store checkout counter.

For a variety of illogical/illegal reasons, a startling number of teenagers gain access to these cigarettes on retail display while older smokers seeking to quit have 24 hour/day convenient access to their addictive drug.

How to Reduce Tobacco-Related Healthcare Costs

One reason smoking is so easily initiated, and why so many people are unable to quit, is that cigarettes are conveniently sold at retail outlets everywhere. It is a serious crime to sell a narcotic drug. Yet the most dangerous and highly addictive drug (nicotine laced cigarettes) is prominently displayed in pharmacies, grocery stores, gasoline stations, and convenience stores.

To legally buy cigarettes in most states, a person needs to be age 18. With such widespread retail distribution, however, underage smoking and its inherent addiction remains rampant.

Smokers trying to quit suffer withdrawal agonies for weeks, but can easily succumb to temptation at a retail outlet where a pack of cigarettes can be purchased in seconds. Some retail outlets are open 24 hours a day, so the temptation for those trying to quit does not abate even when most other businesses are closed.

We think a substantial reduction in tobacco consumption would occur if more stores like CVS Pharmacy discontinued retail sales of cigarettes (and other tobacco products).

One reason I established the Life Extension Pharmacy® in 2008 is that I was infuriated that every major pharmacy chain had a wall of tobacco products behind the checkout counter of their stores. For a variety of bureaucratic reasons, our pharmacy did not generate enough sales to cover its overhead and we sold it to a quality compounding group (Posthaste Pharmacy) that does not sell cigarettes.

What You Need to Know

The High Cost of Tobacco Addiction

  • While the government puts the number of American deaths from cigarette smoking at 480,000, a recent New England Journal of Medicine report suggests that the real number is closer to 556,000.
  • At least 41,000 Americans die yearly from secondhand smoke.
  • Cigarette smoking is the most prominent cause of preventable death and disability.
  • At least 16 million Americans struggle with a smoking-related illness, placing a further burden on Medicare and our inadequately staffed sick-care system.
  • Aggressive efforts to reduce tobacco consumption would improve the health of countless people and reduce healthcare outlays almost immediately.

We Can’t Afford Tobacco-Induced Sick-Care Costs

The economic impact of widespread nicotine addiction is staggering. No matter how many taxes the government collects on cigarette sales, or how many people are employed in the tobacco industry, the healthcare costs borne by government and the private sector in treating sick smokers is always greater.

Medicare and other insurance programs face trillions of unfunded future liabilities that no one knows where the money will come from to pay. Cigarette smoking adds a significant burden to society’s future healthcare costs.

For this nation to remain solvent, creative ways of slashing future healthcare costs must be implemented.

Relative Risk of Death from Official Causes Related to Smoking Status

This chart shows increases in deaths from specific causes in current cigarette smokers compared to a nonsmoking control group. These are the diseases the government counts when estimating tobacco-induced mortality.2

Diseases Attributed to Smoking
Increased Relative Risk in Smokers
Esophageal cancer 410% (females) • 290% (males)
Ischemic heart disease 200% (females) • 160% (males)
Diabetes 50% (females) • 60% (males)
Stroke (total) 110% (females) • 90% (males)
Pancreatic cancer 90% (females) • 60% (males)
Urinary bladder cancer 290% (females) • 290% (males)
Atherosclerosis 110% (females) • 400% (males)
Aortic aneurysm 910% (females) • 650% (males)
Pneumonia, influenza, TB 90% (females) • 100% (males)
COPD2 400% (females) • 2,680% (males)
Colorectal cancer 60% (females) • 40% (males)
Lip/oral cancer 460% (females) • 470% (males)
Liver cancer 80% (females) • 130% (males)
Lung cancer 2,190% (females) • 2,430% (males)

If a terrorist group inflicted this kind of annual massacre on American citizens, our government would likely respond in a “nuclear” manner.

Tobacco lobbyists continue to dominate government policies that could mitigate this critical public health issue.

Not a Trivial Matter

More aggressive means to reduce tobacco consumption will result in substantial reductions in healthcare outlays that would begin almost immediately.

By way of example, when indoor smoking bans were implemented in Ireland, sudden heart attacks requiring emergency room care dropped.24

Experts showed how walking through a room filled with tobacco smoke can induce acute angina or heart attack by constricting coronary arteries, causing blood to abnormally clot inside blood vessels and/or inducing rupture of unstable plaque inside coronary arteries.25,26

These startling data alone make it clear how injurious tobacco smoke is, and why huge healthcare savings will occur if smoking cessation programs were to succeed, something that is NOT happening enough today.

Relative to the nearly 556,000 annual deaths inflicted by tobacco in the United States, efforts to curb tobacco accessibility are woefully lacking.

Our mission at Life Extension® is to defeat aging and its degenerative processes. We are not in the antismoking advocacy business.

I only hope policymakers can find the fortitude to reject tobacco company payoffs and lobbying activities and intensify efforts to reduce the staggering carnage that tobacco addiction inflicts. It remains a major unresolved health issue.



Government figures underestimate the number of Americans who succumb to smoking-related death by 60,000 to 120,000 each year, according to an extensive analysis in the New England Journal of Medicine.

This study found that smokers, compared to nonsmokers, have a significantly higher risk of dying from a number of diseases that are not formally recognized as being related to tobacco use, in addition to the 21 diseases that are officially recognized as related.

Also worth noting are the numerous nonlethal but nonetheless serious diseases that are more prevalent in smokers, such as bowel obstructions, peptic ulcers, gastric hemorrhage, and acute pancreatitis.

While various strategies such as tax hikes, warning mandates, and smoke-free zones have helped reduce deaths, almost one out of six Americans is a smoker, and one out of five smokers has a disability.

It’s absurd that while there are strict laws against the illicit sale of narcotics, nicotine-laced cigarettes—the most dangerous and highly addictive of drugs—are prominently displayed in stores and easily available.

We applaud businesses such as CVS Pharmacy, which has removed cigarettes from its stores. Other avenues to reduce tobacco consumption are urgently needed. The savings in both human lives and healthcare costs would be enormous.

If you have any questions on the scientific content of this article, please call a Life Extension® Wellness Specialist at 1-866-864-3027.


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