Quality-adjusted life expectancy (QALE) loss due to smoking in the United States

Purpose: Estimate quality-adjusted life expectancy (QALE) loss due to smoking and examine trends and state differences in smoking-related QALE loss in the U.S. Methods: Population health-related quality of life (HRQOL) scores were estimated from the Behavioral Risk Factor Surveillance System. This study constructed life tables based on U.S. mortality files and the mortality linked National Health Interview Survey and calculated QALE for smokers, non-smokers, and the total population. Results: In 2009, an 18-year-old smoker was expected to have 43.5 (SE = 0.2) more years of QALE, and a non-smoker of the same age was expected to have 54.6 (SE = 0.2) more years of QALE. Therefore, smoking contributed 11.0 (SE = 0.2) years of QALE loss for smokers and 4.1 years (37%) of this loss resulted from reductions in HRQOL alone. At the population level, smoking was associated with 1.9 fewer years of QALE for U.S. adults throughout their lifetime, starting at age 18. Conclusions: This study demonstrates an application of a recently developed QALE estimation methodology. The analyses show good precision and relatively small bias in estimating QALE––especially at the individual level. Although smokers may live longer today than before, they still have a high disease burden due to morbidities associated with poor HRQOL