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Peer-reviewedCC BY 4.0Nature Health

Smoking, education level and excess premature deaths in the USA

  • Xuyang Tang1,2
  • Eo Rin Cho1
  • Patrick Brown1,3
  • Kenneth E. Warner4
  • Prabhat Jha1,2
4 affiliations
  1. 1Centre for Global Health Research, Dalla Lana School of Public Health, Toronto, Ontario Canada
  2. 2Oxford Population Health, Nuffield Department of Population Health, University of Oxford, Oxford, UK
  3. 3Department of Statistical Sciences, University of Toronto, Toronto, Ontario Canada
  4. 4School of Public Health, University of Michigan, Ann Arbor, MI USA
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Abstract

Adult survival among non-Hispanic white (‘white’) people in the USA has stagnated in recent decades, driven by rising mortality among adults with low educational attainment. We examined national mortality and population data to quantify the contributions of smoking-attributable diseases and selected other causes—notably opioids—to survival between ages 30 and 79 years from 1992 to 2019, stratified by three education levels: ≤11 years (low), 12 years (middle) and ≥13 years (high). We found that the absolute gap in the 50-year risk of death between low- and high-education white adults doubled among men and tripled among women. Smoking-attributable mortality increased markedly among low-education white adults but decreased in the two higher-education groups. Among 3.2 million excess premature deaths in low- and middle-education adults, smoking accounted for 63%. At ages 30–64 years, opioids accounted for 3% of excess deaths, rising to 8% during 2010–2019. Smoking-attributable mortality is the leading contributor to stagnating survival among white adults in the USA.

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Cite

BibTeXRIS
BibTeX
@article{tang2026smoking,
  title = {{Smoking, education level and excess premature deaths in the USA}},
  author = {Xuyang Tang and Eo Rin Cho and Patrick Brown and Kenneth E. Warner and Prabhat Jha},
  journal = {Nature Health},
  year = {2026},
  month = jul,
  doi = {10.1038/s44360-026-00153-7},
  url = {https://doi.org/10.1038/s44360-026-00153-7},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Smoking, education level and excess premature deaths in the USA
AU  - Xuyang Tang
AU  - Eo Rin Cho
AU  - Patrick Brown
AU  - Kenneth E. Warner
AU  - Prabhat Jha
PY  - 2026
DA  - 2026/07/10
JO  - Nature Health
DO  - 10.1038/s44360-026-00153-7
UR  - https://doi.org/10.1038/s44360-026-00153-7
AB  - Adult survival among non-Hispanic white (‘white’) people in the USA has stagnated in recent decades, driven by rising mortality among adults with low educational attainment. We examined national mortality and population data to quantify the contributions of smoking-attributable diseases and selected other causes—notably opioids—to survival between ages 30 and 79 years from 1992 to 2019, stratified by three education levels: ≤11 years (low), 12 years (middle) and ≥13 years (high). We found that the absolute gap in the 50-year risk of death between low- and high-education white adults doubled among men and tripled among women. Smoking-attributable mortality increased markedly among low-education white adults but decreased in the two higher-education groups. Among 3.2 million excess premature deaths in low- and middle-education adults, smoking accounted for 63%. At ages 30–64 years, opioids accounted for 3% of excess deaths, rising to 8% during 2010–2019. Smoking-attributable mortality is the leading contributor to stagnating survival among white adults in the USA.
SN  - 3005-0693
ER  -