Our world-leading smoking strategies have reduced harm, but new research from ANU shows that around one in six Australian deaths (24,000 a year and 66 per day) are attributable to smoking. This could mean smoking is deadlier than previously believed. Tobacco control efforts have to accelerate.
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Based on Relationship of tobacco smoking to cause-specific mortality: contemporary estimates from Australia by Joshy G, Soga K, Thurber KA, Egger S, Weber MF, Sarich P, Welsh J, Korda RJ, Yazidjoglou A, Nguyen MTH, Paige E, Gourley M, Canfell K, Banks E, published February 2025.
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ANU experts matched health questionnaire results with death records to assess Australians’ risk of death from 28 causes.
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Over the following decade, risk of death from 23 causes was much higher in those who smoked. For chronic lung disease and lung cancer, by 36- and 18-fold. Their risk of heart attack and stroke was more than doubled.
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Smoking still inflicts real and severe bodily harm and death. Tobacco control will have to accelerate, including in priority populations.
Researchers from the Australian National University (ANU) followed 180,000 people over time. They then analysed the relation of smoking to 13,000 real deaths which occurred during follow up.
Using the data, they found that smoking had significantly increased our risk of dying from 23 different causes.
The Australia-first study, 23 years in the making, provided real-world death data on the harms of smoking.
Experts used a questionnaire on health and ageing from the mid-2000s. Its participants’ cause of death was tracked over approximately another decade with administrative data, including death registries.
Among the 45- to 75-year-olds in the sample, around a quarter of the deaths were from smoking-related illnesses.
Experts then investigated what those numbers mean for everyone.
They found that despite strong tobacco control, 24,000 deaths every year (66 per day) can be attributed to smoking-related illnesses.
Chronic lung disease, lung cancer, heart disease and stroke were the most common causes of death.
Combined, they caused more than half the early deaths in people 45 and older.
Smoking also substantially increased the risk of a wide range of other cancers, circulatory diseases, and other conditions.
For the four leading causes of death, the likelihood of death increased with number of cigarettes smoked.
Even those ‘light smoking’ (<14 cigarettes per day) had much higher risk of death from these causes.
This group had a 21-fold increased risk of death by chronic lung disease. Their risk was 13-fold of death from lung cancer and double for death from coronary heart disease.
Having smoked in the past at all was also associated with risk.
But quitting at any age was shown to lower it. And people who had quit before the age of 45 had an even lower risk of death.
The findings reveal that Australia, a world-leader in controlling tobacco, could fall behind.
This evidence demands a stronger response. To protect public health, existing strategies, including mass-media campaigns, support for quitting and the Tackling Indigenous Smoking Program, have to expand.
Warnings on individual cigarettes is an important new measure.
And even as smoking rates fall, maximising health in ex-smokers with lung cancer screening and heart attack/stroke prevention measures is critical.
The evidence shows that new policies are needed. Especially ones that support quitting and stop young people taking up smoking.
Finally, new plans have to be built on the most up-to-date estimates of mortality risk.
“Chronic lung disease, lung cancer, heart disease and stroke were the most common causes of death ... Smoking also substantially increased the risk of a wide range of other cancers, circulatory and other conditions.”
