The Impact of Smoking-Related Mortality on Changes in Life Expectancy in Brazil

Julia Calazans , (London School of Hygiene & Tropical Medicine
José Manuel Aburto, London School of Hygiene & Tropical Medicine
Felipe Sanchez, London School of Hygiene and Tropical Medicine

Smoking remains a major global public health challenge and a key risk factor for non-communicable diseases. Since the 1980s, Brazil has implemented comprehensive tobacco control policies under the National Tobacco Control Program, leading to a marked decline in smoking prevalence and establishing the country as an international reference in tobacco control. However, the extent to which these changes have shaped recent mortality patterns and life expectancy across regions remains underexplored. This study examines the contribution of age-specific smoking-attributable mortality to changes in life expectancy at age 35 across Brazilian states between 2000 and 2023. Smoking-related mortality was estimated using the Peto–Lopez and Preston method, and its impact on life expectancy was evaluated through Horiuchi decomposition. Results indicate that smoking-related deaths decreased substantially among men but rose slightly among women. From 2000 to 2023, age-standardized smoking-related mortality rates fell from 23.5 to 11.9 per 10,000 men, while increasing from 3.7 to 4.3 among women. These shifts contributed to a 1.0-year gain in male life expectancy at age 35, but a slight decline (–0.06 years) among women. Marked regional differences persist states in the South and Southeast recorded the greatest improvements, whereas those in the North and Northeast showed smaller gains. Overall, the findings suggest that Brazil’s long-standing tobacco control policies have been highly effective in reducing male mortality but face emerging challenges linked to evolving smoking behaviors among women, particularly those born before 1960.

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 Presented in Session 98. Causes of Death and Multi-Morbidity at Death