Assessing quality-adjusted years of life lost associated with exclusive cigarette smoking and smokeless tobacco use.

Abstract The main purpose of this analysis is to quantify quality adjusted life years (QALYs) lost associated with lifetime exclusive cigarette or smokeless tobacco use among U.S. adults. Multiple waves of National Health Interview Survey (NHIS) data linked to death certificate records were used to define current exclusive cigarette and smokeless tobacco use and associated mortality risks. NHIS data were used to assess health-related quality of life (HRQOL). Regression and Cox proportional hazard modeling were used to adjust HRQOL and mortality risk associated with tobacco use for age, sex, race/ethnicity, body mass index, education, and household poverty level. QALYs were estimated based on adjusted HRQOL and mortality risks. All analyses were initiated in 2019 and completed in 2020. Male current exclusive cigarette smokers, aged 25 to 29 years would lose 8.1 QALYs (SE = 0.09), and male current exclusive smokeless tobacco users aged 25 to 34 would lose 4.1 QALYs (SE = 0.22), compared to never users of tobacco. Current exclusive cigarette or smokeless tobacco use is associated with QALY loss. QALYs lost can be lessened through preventing the initiation of tobacco product use or helping tobacco product users quit as early in life as possible.