Smoking takes a major toll on health—and wallet, study shows

By John Murphy, MDLinx
Published April 18, 2018

Key Takeaways

Smoking is the leading cause of preventable death and a major cause of cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease (including emphysema and chronic bronchitis), according to the Centers for Disease Control and Prevention’s (CDC) Office on Smoking and Health.

Cigarette smoking costs 1,300 lives every day in the United States—totaling more than 480,000 deaths per year—including more than 41,000 deaths resulting from exposure to secondhand smoke.

While the cost to human lives and health is astounding, the economic, societal, and personal costs of smoking are also steep. According to the CDC, the total cost of smoking is more than $300 billion a year in the United States, which includes costs for direct medical care and lost productivity.

On a per person basis, smoking costs an individual more than $1 million in a lifetime—but that figure tops $2 million in six states (New York, Rhode Island, Massachusetts, Connecticut, Hawaii, Alaska), according to a recent study conducted by

The costliest state for smoking is New York, where the average smoker coughs up a total of $2,330,381 in a lifetime of smoking, WalletHub found. (Keep in mind that that the average smoker’s life is foreshortened by 10 years, according to CDC.)

Lifetime out-of-pocket costs alone total $194,341 (or $3,811 each year) per smoker in the Empire State, where a single pack of cigarettes (including tax) is around $10 (and more than $13 in New York City).

The silver lining: The high cost of smoking may have positive results. “Increasing tobacco product taxes is one of the most effective ways of reducing tobacco consumption,” Joanna E. Cohen, PhD, director of the Institute for Global Tobacco Control at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, told WalletHub.

The percentage of smokers in New York City, for example, declined from 21.5% in 2002 to 14.3% in 2015 as the cost of cigarettes went up. Recent legislation in New York City, which raised cigarette prices even higher and curbed sales of tobacco, is expected to reduce the number of smokers in the Big Apple by an additional 160,000 during the next three years.

Said Dr. Cohen, “There is a role for governments (federal, state, local), employers, health insurance companies and others, including health care professionals, in encouraging people to quit smoking.”

How can health care professionals help their patients quit?

“The approach resulting in the best long-term tobacco abstinence rates is combined behavioral and pharmacologic therapy,” J. Taylor Hays, MD, medical director of the Mayo Clinic Nicotine Dependence Center, Rochester, MN, told WalletHub.

“I would also add that the success rates with any treatment will vary depending on several factors, mostly related to the individual trying to quit,” Dr Hays noted.

That is, the smoker must have a sincere resolve to quit.

Notable results of the WalletHub study:

States with the highest total lifetime cost per smoker

  1. New York - $2,330,381
  2. Massachusetts - $2,209,285
  3. Connecticut - $2,188,930
  4. Rhode Island - $2,167,445
  5. Hawaii - $2,067,655
  6. Alaska - $2,059,662
  7. Minnesota - $1,919,776
  8. District of Columbia - $1,916,539
  9. Vermont - $1,902,453
  10. California - $1,879,072

States with the lowest total lifetime cost per smoker

  1. Kentucky - $1,145,128
  2. Georgia - $1,156,444
  3. North Carolina - $1,162,243
  4. Mississippi - $1,184,526
  5. North Dakota - $1,191,219
  6. Tennessee - $1,197,782
  7. Alabama - $1,198,089
  8. South Carolina - $1,202,648
  9. Missouri - $1,208,621
  10. Idaho - $1,248,479

States with the highest lifetime health care cost per smoker

  1. Massachusetts - $285,966
  2. Connecticut - $277,760
  3. Rhode Island - $269,173
  4. District of Columbia - $249,214
  5. New York - $241,200
  6. Maryland - $218,736
  7. New Jersey - $214,489
  8. Alaska - $214,057
  9. Delaware - $209,839
  10. California - $208,805

States with the lowest lifetime health care cost per smoker

  1. Arkansas - $116,115
  2. Kentucky - $118,056
  3. Georgia - $119,262
  4. Alabama - $119,748
  5. Louisiana - $119,834
  6. Tennessee - $122,073
  7. Mississippi - $123,138
  8. South Carolina - $129,717
  9. West Virginia - $141,375
  10. Indiana - $141,425
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