Toll of Tobacco in the U.S.
Despite enormous progress in reducing smoking, tobacco use remains the leading cause of preventable disease and death in the United States – killing more than 490,000 people and costing the nation over $600 billion in health care expenses and lost productivity each year. This isn’t an accident. It’s the direct result of tobacco companies spending billions to market their deadly and addictive products.
Despite enormous progress in reducing smoking, tobacco use remains the leading cause of preventable disease and death in the United States – killing more than 490,000 people and costing the nation over $600 billion in health care expenses and lost productivity each year. This isn’t an accident. It’s the direct result of tobacco companies spending billions to market their deadly and addictive products.
Deaths and Disease in the U.S. from Tobacco Use
Smoking kills more people than alcohol, AIDS, car accidents, illegal drugs, murders, and suicides combined, with thousands more dying from spit tobacco use. Of all the kids who become new regular, daily smokers each year, almost a third will ultimately die from it. In addition, smokers lose a decade of life because of their smoking.
490,000+
16 MILLION+
Tobacco-Related Monetary Costs in the U.S.
Total annual public and private health care expenditures caused by smoking: Approximately $241.4 Billion
- Annual Federal and state government smoking-caused Medicaid payments: $72.7 billion
[Federal share: $42.0 billion per year. States’ share: $30.66 billion] - Federal government smoking-caused Medicare expenditures each year: $61.1 billion
- Other federal government tobacco-caused health care costs (e.g. through VA health care): $21.8 billion
Annual health care expenditures solely from secondhand smoke exposure: $6.5 billion
Additional smoking-caused health costs caused by tobacco use include annual expenditures for health and developmental problems of infants and children caused by mothers smoking or being exposed to second-hand smoke during pregnancy or by kids being exposed to parents smoking after birth. Also not included above are costs from smokeless or spit tobacco use, adult secondhand smoke exposure, or pipe/cigar smoking.
Productivity losses from smoking-caused premature death each year: $179.9 billion
Productivity losses from smoking-caused illness each year: $184.9 billion
[Productivity losses are from smoking-caused shortened work lives and illness that may impact the ability to work, including absenteeism, non-productivity at work, and inability to work due to disability.]
Other non-healthcare costs from tobacco use include residential and commercial property losses from smoking-caused fires, tobacco-related cleaning & maintenance, and expenditures through Social Security Survivors Insurance for kids who have lost at least one parent from a smoking-caused death.
- Taxpayers yearly fed/state tax burden from smoking-caused gov't spending: $1,207 per household
- Smoking-caused health costs and productivity losses per pack sold in U.S. (low estimate): $51.52 per pack
- Weighted average retail price per pack in the U.S. (including sales tax): $9.83
Tobacco Industry Advertising & Political Influence
- Annual tobacco industry spending on marketing its products nationwide: $8.6 billion ($23.5 million each day)
- Annual e-cigarette company spending on marketing its products nationwide: $859.4 million
Research studies have found that kids are three times as sensitive to tobacco advertising than adults and are more likely to be influenced to smoke by cigarette marketing than by peer pressure; and that a third of underage experimentation with smoking is attributable to tobacco company advertising and promotion.
- Tobacco company PAC and Soft Money contributions to federal candidates/parties/outside spending groups, 2024 election cycle: $33.9 million.
- Tobacco industry expenditures lobbying Congress in 2025: $37.0 million
See our fact sheet on Tobacco's Toll in the United States.
Last updated July 1, 2026