Why the Risk of Smoking Death May Be Rising—Even as Rates Fall

Smoking Trends in the U.S. Have Shifted Dramatically

Over the past several decades, cigarette smoking has been on a steep decline in America. In 1965, nearly half of all adults smoked cigarettes. By 2022, that number had dropped to just 11.6 percent, according to data from the American Lung Association.

Among young people, the trend is even more pronounced. Smoking prevalence among youth fell from 36.4 percent in 1997 to just 3.8 percent in 2021—a dramatic shift that reflects changing social norms and better public health messaging. Yet, despite these positive developments, a new study raises a concerning question: Are we actually seeing an increase in the risk of dying from smoking-related diseases?

At first glance, this seems counterintuitive. If fewer people smoke, shouldn't smoking-related deaths decline too? But that's not what the data suggest. In fact, when researchers analyzed mortality trends using data from the U.S. National Health Interview Survey (NHIS) spanning 1987 to 2013 and linked with death records through 2018, they found something surprising: smoking's overall risk of mortality increased by nearly 50 percent during that time.

"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." — Ralph Lawton

The Real Culprit: Demographics and Aging

So what's driving this apparent increase in risk? The answer lies in how we interpret the data—and more specifically, how we account for age.

Ralph Lawton, one of the lead researchers, explained that smoking-related mortality is higher among older adults. As the population ages, and younger people increasingly avoid smoking, the average age of smokers has risen significantly. This means that the overall risk estimates now include a greater proportion of older smokers—people who are more likely to die from any cause, including those related to smoking.

Lawton emphasized that this is not because smoking itself has become more dangerous. The actual risk associated with smoking at a given age remains stable. Rather, when we look at the entire population and compute overall mortality risk, we inadvertently overweight the impact of older smokers.

In essence, we are seeing an aging smoker population skewing the statistics in a way that makes it appear as though the inherent dangers of smoking have grown—when in fact, they have not.

A Deeper Look at the Numbers

Lawton and his colleagues looked closely at three distinct time periods between 1987 and 2013 to better understand how demographic shifts might affect risk estimates. Their analysis controlled for age and found that when you isolate smokers by age, the mortality risk did not rise significantly.

This is a critical distinction. While the overall population of smokers may be getting older, the hazard of smoking at a given age has remained remarkably consistent. What's changing, instead, is the composition of who is smoking—and that, in turn, influences our calculations of risk.

The researchers also examined sociodemographic and health characteristics among smokers to determine how those factors may have shifted over time. They found that changes in these demographics had a meaningful impact on how we estimate smoking-related mortality, particularly when pooling across all age groups.

Why It Matters for Public Health

This study highlights an important issue for public health analysts and policy-makers: the need to carefully consider how population composition influences health risk assessments. If not accounted for, demographic changes can create misleading impressions of increasing dangers from behaviors like smoking.

Lawton noted that while this study focused on smoking, similar patterns may be at play with other health risks such as obesity or educational disparities. The methods they developed could help researchers better understand and interpret how these broader inequalities affect mortality trends in midlife and beyond.

"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 added.

The Bigger Picture

Despite this troubling statistic, there's no doubt that smoking rates have declined dramatically, offering enormous public health benefits. But it's equally clear that we must continue refining our methods for interpreting risk so that policy decisions are based on accurate data—rather than on misleading aggregates.

This study also underscores the importance of understanding not just what people do, but who is doing it. As public health efforts focus more on younger generations and prevention, we must remain vigilant about how changes in demographics can distort our measurements of risk over time.

The takeaway for all stakeholders—from health professionals to researchers to journalists—is this: Context matters. When examining complex trends like smoking-related mortality, the age structure of the population is a crucial variable that must not be overlooked.

What's Next?

Lawton and his team are now working on expanding their research to explore how other factors—like socioeconomic status or education levels—affect mortality risk. These insights could help shape more nuanced public health strategies and ensure we're addressing root causes rather than just symptoms.

As the population continues to age and smoking habits evolve, staying attuned to such demographic shifts will be essential for accurate health reporting and policy-making. The goal is not to alarm, but to clarify: we must understand the full story behind the numbers to protect public health effectively.