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Smoking linked to most excess deaths in less-educated white adults

Smoking was linked to an estimated 63% of 3.2 million excess deaths among less-educated white adults, compared with expected deaths based on more-educated adults’ mortality declines.

Paper by Xuyang Tang, Eo Rin Cho, Patrick Brown, Kenneth E. Warner, Prabhat Jha · University of Oxford
Fig. 1. Two-year moving average of age-standardized all-cause mortality rates in white adults by age group and years of education, 1992–2024.
Open the figure at full size
Fig. 1. Two-year moving average of age-standardized all-cause mortality rates in white adults by age group and years of education, 1992–2024.Two-year moving average of age-standardized all-cause mortality rates in white adults by age group and years of education, 1992–2024.Tang et al.

Our read

Populations
Studied:
Study of US non-Hispanic white adults, 1992 to 2019, against the highest-education group
What changed:
Smoking accounted for 63% of excess deaths among lower-education white adults, compared with mortality declines in the highest-education group
The catch:
Misclassified causes of death could inflate or lower estimated smoking-attributable death rates
In the record:
The 598th paper on education with results in people; 1,362 on record in all.
Why it’s aging research:
A leading disease of aging, its risks or menopause.

Editor of record: Boris Djordjevic · AgingResearch.News

Paper
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US non-Hispanic white men and women aged 30–79 were studied in an observational analysis of national death and population records from 1992 to 2019. Researchers grouped adults by completed schooling: 11 years or fewer, 12 years, or at least 13 years. They estimated smoking-related deaths indirectly using lung cancer death rates.

They estimated 3.2 million excess deaths in the two lower-education groups. These were deaths above the number expected if those groups’ death rates had declined as quickly as rates in the highest-education group. Smoking accounted for an estimated 63% of these deaths. Smoking-related death rates rose in the lowest-education group but fell in the other two. The gap in the risk of dying between ages 30 and 79 doubled between the lowest- and highest-education groups among men and tripled among women.

Why it matters

Stagnating survival through middle and older age raises questions about unequal gains in longevity. Separating smoking-related diseases from other causes helps identify which health burdens contributed most to that divide.

Caveats

Smoking-related deaths were estimated indirectly, and excess deaths depended on a hypothetical comparison with mortality declines in the highest-education group. The analysis covered non-Hispanic white adults aged 30–79, not other racial or ethnic groups.

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