Quantifying lifetime productivity loss attributable to cigarette smoking in Taiwan

OBJECTIVES: Evaluating long-term health and economic burden of smoking is critical for assessing the effectiveness of tobacco control policies. This study aimed to estimate lifetime productivity loss attributable to smoking among adults in Taiwan. STUDY DESIGN: Longitudinal cohort study. METHODS: We analyzed data from the MJ cohort, linking medical and demographic information with National Health Insurance Research Database and Taiwan Death Registry database to estimate participants' monthly earnings and confirm vital status. Lifetime productivity loss was assessed using survival and earnings functions of comparative groups estimated through a rolling extrapolation algorithm, incorporating inverse probability of treatment weighting to address confounders. RESULTS: Among 215, 852 participants aged 30-64 years, those who had smoked had lower baseline employment rates and median monthly incomes. Smoking was associated with reduced life expectancy by 2. 0 years (95 % CI: 1. 54-2. 35) for men and 1. 37 years (95 % CI: -0. 47 - 2. 12) for women, and reduced employment time by 0. 70 years (95 % CI: 0. 26-1. 30) for men and 1. 82 years (95 % CI: 0. 97-2. 44) for women. The estimated average lifetime productivity loss attributable to smoking was US 45, 572 for men and US 61, 552 for women. Aggregating across Taiwan's population, this translates to a total lifetime productivity loss of US 80, 589 million (95 % CI: 56, 691 million to 103, 743 million). The loss per annum was US 4563 million (95 % CI: 3602-5574 million), accounting for 0. 6 % of Taiwan's GDP in 2022 (0. 49 % from males, 0. 11 % from females). CONCLUSIONS: This study provides a data-driven analytical framework and demonstrates substantial lifetime and annual productivity losses attributable to smoking in Taiwan. These findings underscore the economic imperative for strengthening tobacco control measures to mitigate the long-term health and financial burden of smoking.