Despite a recent decline in the population that smokes, smoking is considered the leading cause of preventable death in this country. According to the Centers for Disease Control and Prevention (CDC), over 2 million deaths in the 5-year period from 1995 through 1999 were attributable to cigarette smoking. CDC, part of the Department of Health and Human Services (HHS), is a primary source of information on the health consequences of smoking tobacco. CDC reported its most recent estimates of selected health consequences of cigarette smoking in an April 2002 issue of its publication Morbidity and Mortality Weekly Report. CDC reported that, on average, over 440,000 deaths, 5.6 million years of potential life lost, $82 billion in mortality-related productivity losses, and $76 billion in medical expenditures were attributable to cigarette smoking each year from 1995 through 1999. CDC and others tasked with making such estimates face challenges. They build estimates on a set of assumptions and make choices about the data sources and methods used, each of which may have limitations that must be weighed against its advantages. Policymakers at both the state and federal levels have relied on estimates like these in considering bans on smoking in public places, taxes on cigarettes, litigation to recoup medical expenditures, and other matters concerning tobacco. Thus it is essential that the estimates CDC provides are sound and that their limitations are clear. In recognition of this, Congress asked us to review CDC's April 2002 report and determine whether its estimates of selected health consequences of cigarette smoking were reasonable. Specifically, we examined CDC's estimates of (1) deaths and years of potential life lost and (2) mortality-related productivity losses and medical expenditures attributable to cigarette smoking.
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