Your Life Expectancy Is Three Years Lower If You Live In These 12 States

The Centers for Disease Control and Prevention reported that from 2020-2021, the U.S. saw the largest two-year decline in life expectancy since the 1918 flu pandemic. On average, life expectancy in the United States is 76, but yours is likely higher if you live in most states. According to a 2023 report from Truth Initiative, your life expectancy is actually 79 unless you live in the "Tobacco Nation" — 12 states that have a high prevalence of smoking.

The Tobacco Nation is made up of 12 states: Alabama, Arkansas, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Tennessee, and West Virginia. Not only do 50% more people smoke in these dozen states than the others, but they smoke more cigarettes overall — a whopping 500 more cigarettes a year on average than the smokers in other states. 

This had the effect of bringing down life expectancy there rather drastically since, according to the CDC, smoking leads to two of the most common causes of death in the United States: heart disease and stroke.

The report said that people who smoked in Tobacco Nation even have poorer health outcomes and behaviors compared to smokers in other states. For example, 26% of smokers in the 12 states are also heavy drinkers, whereas 17% of smokers in other states drink heavily. Tobacco Nation smokers are also less physically active and report more days of poor physical health. They also have a higher incidence of poor mental health, type 2 diabetes, and chronic pulmonary disease.

Although the United States spends the most on healthcare compared to the rest of the world, it still leads the world in the number of preventable deaths per capita, according to a 2023 report from the Commonwealth Fund. These are deaths that can be avoided through regular screenings, a healthy diet, and exercise. Smoking is also a cause of preventable death, accounting for one out of every five deaths, according to the CDC.

So why do people smoke so much in these areas? The 12 states in the Tobacco Nation have less restrictive tobacco policies, fewer smoke-free places, and lower taxes on tobacco. Cigarettes are 20% cheaper in these states because of the lower cigarette taxes and excise taxes on cigarettes. 

These states also spend less money on smoking cessation programs. A separate analysis from Truth Initiative said that increasing cigarette taxes and spending more funding on smoking cessation programs are two ways that can reduce the gap between these states and the rest of the U.S. The latter is something experts have known about for a long time: the U.S. Surgeon General released a report in 2000 emphasizing the benefits of smoking cessation programs in increasing life expectancy.

The good news is that fewer people overall in the United States are smoking cigarettes, particularly among high school students, according to the report. In 2000, 28% of high school students were smoking. Now just 2% of high school students smoke. However, the report doesn't include high school students who use e-cigarettes, and it's unclear how vaping might contribute to life expectancy.