U.S. vs. Europe: Who Dies More from Smoking?

It's well-known that Europeans like to smoke. A recent European Commission survey (PDF) showed that 28% of Europeans light up, while this week's MMWR from the CDC indicates that 19% of Americans smoke. Therefore, one would predict that more Europeans die from smoking than Americans. But, you would be wrong.

In the EU, about 695,000 people die annually from what the EC report calls "tobacco-related causes." (The report also examined tobacco products other than cigarettes.) Roughly 503 million people live in the EU, meaning that the mortality rate due to tobacco is 138 deaths per 100,000 people.

In the U.S., about 443,000 people die from what the CDC report calls "smoking-related illnesses." (The report focused exclusively on cigarettes.) But, the population of the U.S. is much lower than the EU, about 315 million people. That means the mortality rate due to smoking is 141 deaths per 100,000 people. That's 3 more deaths per 100,000 people than Europe -- despite the fact that more Europeans smoke! What is going on?

Since these were two different reports, it is possible that differences in methodology account for the disparity. But, by digging deeper into the numbers, one can spot a more likely explanation.

The chart below shows the percentage of American smokers by the number of cigarettes smoked per day:

As shown, in the U.S., approximately:

22% of smokers smoked 1-9 cigarettes per day (CPD)

37% smoked 10-19 CPD

31% smoked 20-29 CPD

9% smoked 30 or more CPD

(Percents don't add up to 100% due to approximate readings from the chart.)

Compare that to European smokers. (The outer ring represents data for 2012.)

In Europe:

43% smoked 1-10 CPD

46% smoked 11-20 CPD

9% smoked 21 or more CPD

(Percents don't add up to 100% because about 2% of smokers smoked less than 1 CPD.)

Combining all that data, we see that far more American smokers (40%) than European smokers (9%) smoked 20 or more cigarettes per day. Overall, in the U.S., the average number of cigarettes smoked per day is 15.1, but in the EU it is 14.2.

The data seems to show that even though more Europeans smoke than Americans, American smokers are much heavier smokers. Could this be why more Americans die from smoking-related diseases?

Source: Centers for Disease Control and Prevention. "Current Cigarette Smoking Among Adults -- United States, 2011." MMWR 61 (44): 889-894.

Source: European Commission. "Attitudes of Europeans Towards Tobacco." Special Eurobarometer 385 (May 2012).