RESEARCH AND PRACTICE

Deaths From Secondhand Smoke Exposure in the United
States: Economic Implications
Wendy Max, PhD, Hai-Yen Sung, PhD, and Yanling Shi, MS

Exposure to secondhand smoke (SHS) has been linked to several fatal illnesses among infants and adults.1 Worldwide, 603 000 deaths have been attributed to SHS exposure.2
In the United States, the Centers for Disease
Control and Prevention reported that 46 000 adults died from ischemic heart disease
(IHD) and 3400 adults died from lung cancer annually between 2000 and 2004 as a result of SHS exposure.1,3 In addition, 776 infants were reported to have died as a result of maternal exposure in utero each year.1,3 Premature death results in years of productive life lost as well as economic losses.
Active smoking has been shown to place a disproportionately high burden on communities of color,4 including Blacks and Hispanics.5,6 Blacks have also been shown to be more likely to be exposed to SHS.7---9 However, the economic impact of SHS exposure on different racial/ethnic groups has yet to be examined. Previous studies have estimated the impact of SHS exposure on mortality using selfreport exposure measures or assuming that those who live with smokers are exposed, but these measures yield much lower exposure estimates than biomarker-determined exposure. In 2003 to 2004, 14.8% of adults reported home or work exposure, but fully
42.4% had detectable serum cotinine.8
Several recent studies have examined the association between cotinine levels and cardiovascular disease and reported a greater risk of cardiovascular disease among SHS--exposed adults than among those not exposed.10,11 The purpose of this study was to estimate the number of SHS---attributable deaths, years of potential life lost (YPLL), and the value of lost productivity for different US racial/ ethnic groups in 2006. We estimated the number of SHS---attributable deaths for adults using cotinine-measured SHS exposure for the first time.

Objectives. We estimated the number of deaths attributable to secondhand smoke (SHS), years of potential life lost (YPLL), and value of lost productivity for different US racial/ethnic groups in 2006.
Methods. We determined the number of SHS–related deaths among nonsmokers from 2 adult and 4 infant conditions using an epidemiological approach. We estimated adult SHS exposure using detectable serum cotinine. For each death, we determined the YPLL and the value of lost productivity.
Results. SHS exposure resulted in more than 42 000 deaths: more than 41 000 adults and nearly 900 infants. Blacks accounted for 13% of all deaths but 24% to
36% of infant deaths. SHS–attributable deaths resulted in a loss of nearly 600 000
YPLL and $6.6 billion of lost productivity, or $158 000 per death. The value of lost productivity per death was highest among Blacks ($238 000) and Hispanics
($193 000).
Conclusions. The economic toll of SHS exposure is substantial, with communities of color having the greatest losses. Interventions need to be designed to reduce the health and economic burden of smoking on smokers and nonsmokers alike and on particularly vulnerable groups. (Am J Public Health. 2012;
102:2173–2180. doi:10.2105/AJPH.2012.300805)

METHODS

Data Sources

We estimated 3 SHS---attributable mortality outcome measures: deaths, YPLL, and productivity losses. Because separating the health impacts of active and passive smoking is difficult, we focused on nonsmokers, as have most previous studies of the health effects of SHS exposure.2 We calculated mortality measures for 2 conditions (lung cancer and IHD) found in adults (aged 20 years and older) and 4 conditions (sudden infant death syndrome, low birth weight, respiratory distress syndrome, and other respiratory conditions of newborns) found in infants younger than 1 year. We selected these conditions because strong statistical evidence has indicated a causal link between SHS