Smoking deaths increase in Minnesota despite tobacco usage decline

Declines in tobacco usage haven't reduced deaths in Minnesota over the past decade, because middle- and older-age adults continue to smoke even if young adults don't.

Tobacco-related deaths increased from 6,311 in 2014 to 6,530 in 2021, according to a report released Wednesday by Blue Cross and Blue Shield of Minnesota. The mortality trend was flat when excluding 269 deaths caused by a combination of smoking and COVID-19 in 2021, but even without them the latest total was greater than the 5,135 deaths in 2007.

"We're going backward a little bit now that there is another disease [COVID] that puts smokers at higher risk of mortality," said Janelle Waldock, a Blue Cross executive who has led the insurance company's effort to reduce smoking and its consequences.

Minnesota has seen historic declines in youth tobacco usage, although somewhat because young adults have replaced cigarettes with e-cigarettes. The 18 to 24 age group had the state's second-highest smoking rate at 25% in 2011, but in 2022 it had the lowest rate among adults at 8%, according to federal survey data.

That progress has little impact on today's death toll, which is influenced by adults whose persistent smoking is complicated by the onset of diabetes, heart disease and other conditions. Smoking rates have remained steady at 15% to 17% among Minnesotans 35 to 64 over the past decade.

"It puts people in a really difficult situation, because it's so hard to quit," Waldock said. She encouraged smokers to seek free support from the state-funded Quit Partner program.

Smoking costs every Minnesotan $824 in annual health care costs to treat related illnesses, according to Blue Cross' study, which repeated economic analyses from 2007 and 2014 for comparison. Those costs were largely reflected in rising insurance premiums.

The Eagan-based insurer calculated a total economic cost of $9.4 billion from smoking-related activities in 2021 when including the loss of productivity from workers who died prematurely as a result of tobacco usage.

Researchers from Ohio State University conducted the analysis, which was released ahead of Minnesota's 2024 legislative session to bolster Blue Cross' calls for a state ban on menthol cigarettes.

While studies conflict on whether menthol cigarettes cause more deaths, their smoother taste has been attributed to increased smoking habits in demographic groups with higher rates of chronic disease.

Smoking rates rebounded to 44% among American Indian adults in Minnesota in 2022 and to 18.7% among African American adults. Smoking also is found among one third of Minnesota adults with annual household incomes of $15,000 or less.

Waldock said it is unclear whether young adults will continue to refrain from smoking when they become older adults. Some research suggests that e-cigarette users eventually convert to traditional tobacco products.