Smoking into your grave: 7.36 million deaths caused by tobacco in 2023, Global Burden of Disease Study shows

 

Smoking into your grave: 7.36 million deaths caused by tobacco in 2023, Global Burden of Disease Study shows

By Hope Mafaranga

New research presented at the World Conference on Tobacco Control, hosted by the International Union Against Tuberculosis and Lung Disease (the Union) with support from Bloomberg Philanthropies and the World Health Organization (WHO), reveals that despite decades of progress, tobacco remains a leading risk factor for death globally – reinforcing the urgency of sustained, evidence-based tobacco control as a cornerstone of global health and development.

Researchers from the Institute for Health Metrics and Evaluation at the University of Washington shared new data from the Global Burden of Disease Study, revealing the staggering and persistent toll of tobacco exposure on global health. Researchers found that tobacco use was responsible for 7.36 million deaths and over 200 million disability-adjusted life-years (DALYs) worldwide in 2023.

The study also highlighted stark disparities globally: while countries like the United Kingdom saw a 45% decline in tobacco-attributable deaths since 1990, others, such as Egypt, experienced a dramatic rise, showing that decades of control efforts, tobacco remains the leading risk factor for death among men globally and ranks seventh among women.

“Tobacco exposure is one of the most significant risk factors identified in the Global Burden of Disease Study 2023, contributing to approximately 1 in 8 deaths worldwide,” said Brooks Morgan, researcher at the Institute for Health Metrics and Evaluation.

“While some countries are seeing encouraging declines in tobacco-related deaths, others are heading in the opposite direction. These trends highlight the urgent need for accelerated implementation and stronger enforcement of strategies proven to reduce tobacco use, such as the MPOWER measures recommended by the WHO.”

The findings underscore the urgent need for intensified global action and policy implementation to curb tobacco’s deadly impact and align with the WHO Framework Convention on Tobacco Control.

Additionally, researchers from China presented promising results from an AI-driven personalised mobile health (mHealth) intervention, designed to support smoking cessation. Developed using machine learning, the system delivers tailored messages and interactive tools – such as games and peer insights – based on each user’s quitting stage and preferences.

In a randomised controlled trial involving 272 smokers, the intervention group achieved a quit rate more than double that of the control group (17.6% vs. 7.4%). Participants also reported a significant drop in daily cigarette consumption and high satisfaction with the programme.

 

“In China, over 50 million smokers want to quit, yet most lack access to effective cessation services. Our study shows the significant potential of personalized ‘mHealth’ interventions to transform smoking cessation efforts.

By combining machine learning with behavior change theory, we created an intervention that can deliver cessation messages adapted to each user’s stage of quitting, preferences and needs in real time.

The system also has some interactive features, like decision-balancing games, which help boost motivation and engagement,” said Prof. Pinpin Zheng, professor and director of the Department of Preventive Medicine and Health Education in the School of Public Health, Fudan University.

“More than 80% of participants reported being satisfied with the system. These findings highlight how theory-based, technology-driven solutions can bridge the gap in cessation services and provide cost-effective, wide-reaching strategies to empower smokers to quit.”

The AI-driven, user-centric approach was shown to offer a scalable, evidence-based model for expanding cessation support in China and globally, addressing a critical gap in access to support for smokers in China who want to quit – of which there are over 50 million.

Researchers from the German Cancer Research Center presented new evidence on the cross-border marketing of Heated Tobacco Products (HTPs) on social media, revealing stark contrasts shaped by national regulatory frameworks.

Using media monitoring tools, the study analysed public posts across five platforms in the UK, Ireland, and Germany. While no promotional content was found in Ireland - where HTPs are regulated as tobacco products - nearly half of the posts in the UK and Germany promoted HTPs, primarily through commercial accounts.

The findings showed that Germany had a notably higher proportion of youth- and female-targeted content, and that marketing strategies varied by country, from price promotions in the UK to product design features in Germany.

The research highlights the urgent need for harmonised regulation, suggesting that classifying HTPs as conventional tobacco products, as is done in Ireland, could significantly reduce their online promotion and appeal.

“Our study reveals notable differences in the social media promotion of heated tobacco products (HTPs) - differences shaped by both regulatory frameworks and market presence. In Ireland, no promotional content was identified on social media, but commercial promotion of HTPs on social media was widespread in the UK and Germany - including content that may appeal to youth and women,” said Zauraiz Lone, Doctoral Researcher at the German Cancer Research Centre (DKFZ) and Heidelberg University.

“Promotional activity focusing on heating devices without explicitly showing tobacco sticks reveals exploitation of policy fragmentation and regulatory ambiguities. These findings highlight the importance of addressing enforcement gaps and revisiting how product categories are defined and regulated. Strengthening digital marketing regulation and closing definitional loopholes are essential for reducing exposure, limiting uptake among younger populations, and supporting public health goals.”

Academics from the Institute of Clinical and Health Effectiveness (IECS) in Argentina also unveiled new modelling data quantifying the devastating toll of tobacco use in five low- and middle-income countries: Bolivia, Honduras, Nigeria, Paraguay, and Uruguay.

They found that in 2023 alone, tobacco was responsible for 41,000 deaths, 360,000 disease events, and over 1.3 million years of healthy life lost, costing these countries a combined US$4.3 billion in medical expenses, lost productivity, and informal caregiving.

Using a microsimulation model, the study projected that full implementation of four key tobacco control strategies - tax increases, plain packaging, advertising bans, and smoke-free environments - could avert up to 234,000 deaths and save as much as US$2 billion over the next decade.

“Our research, led by IECS in Argentina, is the result of a strong collaborative effort with partners from Bolivia, Honduras, Nigeria, Paraguay, and Uruguay—countries that are deeply committed to tackling the tobacco epidemic.” Said Natalia Espinola, Coordinator of Health Economics at IECS.

“In 2023 alone, smoking caused over 41,000 deaths and generated nearly 4.3 billion dollars in direct and indirect costs—equivalent to around 1% of the countries' combined GDP. The message is clear: countries must fully implement proven tobacco control policies. Our findings confirm that raising tobacco taxes, enforcing smoke-free spaces, banning advertising, and mandating plain packaging are not only effective—they save lives and bring major economic benefits.”

The findings demonstrate the urgent need for data-driven policy action to reduce the health and economic burden of tobacco in LMICs and accelerate progress toward global development goals.

Cassandra Kelly-Cirino, Executive Director of the Union, said: “The research showcased today at the World Conference on Tobacco Control is a powerful reminder that tobacco remains one of the most devastating public health threats of our time – there is no such thing as a healthy tobacco product, and reduced risk all too often just means increased profit for industry. We must take a zero-tolerance approach.

“The evidence presented at this conference demonstrates that when we invest in data-driven, locally tailored interventions, we save lives. The Union is very proud to support and amplify this work which strengthens the global case for urgent, sustained tobacco control.”